Operations of Lenders in the Small Loan Field from 1939 to the Present

TesisTrujilloEscuela de PosgradoAtención Integral Del Infante, Niño Y AdolescenteEsta investigación tuvo como objetivo principal determinar la relación entre el clima social familiar y las conductas antisociales y delictivas en adolescentes del distrito La Esperanza, Con una muestra de 248 participantes de ambos sexos entre los 12 – 18 años de edad. El tipo de investigación es no experimental, diseño correlacional – descriptivo. Los instrumentos son cuestionario de clima social familiar de Moos y cuestionario de conductas antisociales y delictivas de Seisdedos. Los resultados evidenciaron que no existe relación entre el clima social familiar con las conductas antisociales con un P = .739 (P> 0.05), así mismo se encontró un P = .573 (P> 0.05) indicando que no existe relación entre clima social familiar y las conductas delictivas. así también, se determinó que no existe relación entre las dimensiones relaciones, desarrollo y estabilidad del clima social familiar con las conductas antisociales y delictivas. por otro lado, un 58% de los adolescentes perciben su clima familiar como malo. También se encontraron niveles bajos en cuanto a las conductas antisociales en un 80.6 % y 68% respecto a las conductas delictivas

Discovering Ways That Influence the Older Nurse to Continue Bedside Practice

A descriptive qualitative approach was used to investigate older nurses practicing bedside nursing and to identify ways to influence older nurses to continue bedside practice. A purposive sample of 18 older nurses was recruited from a healthcare system located in the Southeastern United States. Interpretative analysis of interviews resulted in the identification of three constitutive patterns and eight themes. The first constitutive pattern identified was attributes of the older nurse. The themes comprising this pattern were (a) professional growth in confidence and skills through experience and (b) passion and love for nursing. The second constitutive pattern was enduring stress and frustration. The themes comprising this pattern were (a) physical and mental changes associated with aging, (b) increased patient acuity and patient load, (c) constant change, and (d) time constraints. The third constitutive pattern was enhancements needed for older nurses to continue bedside nursing. The themes comprising this pattern were (a) work environment enhancements and (b) organizational relationship enhancements. Findings may provide a better understanding of the older nurse's role in bedside nursing

The Effects of Guided Imagery on Patients Being Weaned from Mechanical Ventilation

The study purpose was to assess the effects of guided imagery on sedation levels, sedative and analgesic volume consumption, and physiological responses of patients being weaned from mechanical ventilation. Forty-two patients were selected from two community acute care hospitals. One hospital served as the comparison group and provided routine care (no intervention) while the other hospital provided the guided imagery intervention. The intervention included two sessions, each lasting 60 minutes, offered during morning weaning trials from mechanical ventilation. Measurements were recorded in groups at baseline and 30- and 60-minute intervals and included vital signs and Richmond Agitation-Sedation Scale (RASS) score. Sedative and analgesic medication volume consumption were recorded 24 hours prior to and after the intervention. The guided imagery group had significantly improved RASS scores and reduced sedative and analgesic volume consumption. During the second session, oxygen saturation levels significantly improved compared to the comparison group. Guided imagery group had 4.88 less days requiring mechanical ventilation and 1.4 reduction in hospital length of stay compared to the comparison group. Guided imagery may be complementary and alternative medicine (CAM) intervention to provide during mechanical ventilation weaning trials

Perceptions of Risk, Work, and Lifestyle Changes on Mental Health of Healthcare Workers Amidst the Covid-19 Pandemic

The COVID-19 outbreak is significantly affecting the mental health of healthcare workers worldwide. This study aims to investigate mental health outcomes of healthcare workers in a health system located in the Southeastern US during the first peak of the pandemic and examine the association of specific factors on the mental well-being of healthcare workers. A cross-sectional survey of 388 healthcare workers was conducted. Data were collected using a 79-item questionnaire, which included the Patient Health Questionnaire (PHQ-9) instrument, the 7-item Generalized Anxiety Disorder (GAD-7) instrument, and the 22-item Impact of Event Scale-Revised (IES-R), to assess symptoms of depression, anxiety, and general distress, respectively. Data were analyzed using descriptive, bivariate, and multivariate statistics. 30.1%, 28.7%, and 39.4% of respondents reported depression, anxiety, and distress symptoms, respectively. Younger workers and females reported higher mental symptomologies. We identified significant, nontraditional factors associated with depression and anxiety symptoms among healthcare workers: healthcare procedure change, concern of exposing family to COVID-19, number of missed shifts, and access to psychological resources/services. These findings emphasize the importance of providing the proper training to reduce concerns of exposing family members and psychological interventions to promote mental health well-being for healthcare workers during the stressful COVID-19 pandemic

Do NGOs Deliver? The Role of NGOs in Responding to the Syrian Refugee Crisis in Jordan

Eleven million Syrians have fled their homes or have been killed as a result of the Syrian Civil War that began in 2011 (Mercy Corps, 2016). The violence, destruction of homes, human rights violations, and lack of access to basic necessities such as food and medication are the motivations for many Syrians to leave their homes and seek refuge in both neighboring countries and Europe. Each year has seen an exponential increase in the number of Syrian refugees; in 2012 there were 100,000 refugees and today there are 4.3 million refugees. This large increase each year contributes to the already significant workload for NGOs responding to the crisis

UK experience of liver transplantation for erythropoietic protoporphyria

Erythropoietic protoporphyria (EPP) is characterised by excess production of free protoporphyrin from the bone marrow, most commonly due to deficiency of the enzyme ferrochelatase. Excess protoporphyrin gives rise to the cutaneous photosensitivity characteristic of the disease, and in a minority of patients leads to end-stage liver disease necessitating liver transplantation (LT). There is limited information regarding the timing, impact and long-term outcome of LT in such patients, thus we aimed to identify the indications and outcomes of all transplants performed for EPP in the UK using data from the UK Transplant Registry. Between 1987 and 2009, five patients underwent LT for EPP liver disease. Median follow-up was 60 months, and there were two deaths at 44 and 95 months from causes unrelated to liver disease. The remaining recipients are alive at 22.4 years, 61 months and 55 months after transplant. A high rate of postoperative biliary stricturing requiring multiple biliary interventions was observed. Recurrent EPP-liver disease occurred in 4/5 (80%) of patients but graft failure has not been observed. Given the role of biliary obstruction in inducing EPP-mediated liver damage, we suggest that consideration should be given for construction of a Roux loop at the time of transplant. Thus we demonstrate that although EPP liver transplant recipients have a good long-term survival, comparable to patients undergoing LT for other indications, biliary complications and disease recurrence are almost universal, and bone marrow transplantation should be considered where possible

Screening for atrial fibrillation – a cross-sectional survey of healthcare professionals in primary care

Introduction: Screening for atrial fibrillation (AF) in primary care has been recommended; however, the views of healthcare professionals (HCPs) are not known. This study aimed to determine the opinions of HCP about the feasibility of implementing screening within a primary care setting. Methods: A cross-sectional mixed methods census survey of 418 HCPs from 59 inner-city practices (Nottingham, UK) was conducted between October-December 2014. Postal and web-surveys ascertained data on existing methods, knowledge, skills, attitudes, barriers and facilitators to AF screening using Likert scale and open-ended questions. Responses, categorized according to HCP group, were summarized using proportions, adjusting for clustering by practice, with 95% C.Is and free-text responses using thematic analysis. Results: At least one General Practitioner (GP) responded from 48 (81%) practices. There were 212/418 (51%) respondents; 118/229 GPs, 67/129 nurses [50 practice nurses; 17 Nurse Practitioners (NPs)], 27/60 healthcare assistants (HCAs). 39/48 (81%) practices had an ECG machine and diagnosed AF in-house. Non-GP HCPs reported having less knowledge about ECG interpretation, diagnosing and treating AF than GPs. A greater proportion of non-GP HCPs reported they would benefit from ECG training specifically for AF diagnosis than GPs [proportion (95% CI) GPs: 11.9% (6.8–20.0); HCAs: 37.0% (21.7–55.5); nurses: 44.0% (30.0–59.0); NPs 41.2% (21.9–63.7)]. Barriers included time, workload and capacity to undertake screening activities, although training to diagnose and manage AF was a required facilitator. Conclusion: Inner-city general practices were found to have adequate access to resources for AF screening. There is enthusiasm by non-GP HCPs to up-skill in the diagnosis and management of AF and they may have a role in future AF screening. However, organisational barriers, such as lack of time, staff and capacity, should be overcome for AF screening to be feasibly implemented within primary care