Women’s decision-making about the use of hormonal and non-hormonal remedies for the menopausal transition

Objective:To describe women’s experiences when making decisions about the use of hormonal or nonprescription remedies during or after the menopausal transition. The specific aims were to identify the influences on women’s decisions, identify their counseling needs, and describe how women evaluated the care and counseling provided. Design:A qualitative descriptive approach was used. Semi-structured, tape recorded interviews were conducted with seven women who were currently making a decision about menopausal management and at two subsequent points after the initial interview. Transcripts were analyzed using content analysis with grounded theory techniques. Findings were validated with study participants at the end of the study to assure trustworthiness. Results:Women’s priorities were feeling well and returning to their former level of functioning. Their decision-making was a non-linear process that consisted of several stages in which women became aware and made sense of symptoms, sought information about management options, assured safety, weighed benefits and risks, tried various prescription and non-prescription remedies, judged the efficacy of their choice, and re-evaluated their decision. If symptoms were severe or quality of life was low women reconciled the risks of hormone therapy before trying this option. Women were unsure about the meaning of research findings about the safety of hormone therapy and felt anxiety about using hormone therapy. Decision-making was influenced by women’s needs, perception of risks and benefits, and beliefs about menopause and its management. Conclusions:Decision support can be provided through individual counseling, group support programs, internet sites, and articles in consumer literature, and should be tailored to each woman based on her individual preferences. Presented October 14, 2006, at North American Menopause Society Annual Scientific Sessions meeting, Nashville, TN

Effects of standardized patient encounter on graduate nurse practitioner student learning and performance of genital examinations

Previous methods for teaching genital examinations to nurse practitioner students enrolled in a laboratory portion of an advanced health assessment course have included videotapes, plastic models for both male and female genital examinations, and voluntary examinations of a classmate for the female exam. Standardardized patients are specially trained consumers who teach physical examination techniques during the student’s performance of the examination. Medical schools have successfully used these patients to teach physical assessment. The purpose of this study was to determine if standardized patients were the best method for graduate nurse practitioner students to learn genital examinations in comparison to previous teaching methods. Presented April 21, 2004, at National Organization of Nurse Practitioner Faculty National Meeting, San Diego, CA

Foster Parent Training Program Evaluation Report 1982-1983

The Center for Applied Urban Research at the University of Nebraska at Omaha is proud to have been the developers of the Nebraska Foster Parent Training Program materials. These materials have received national recognition and have been adopted for foster parent· training by other states as well. Evaluations of the previous CAUR Foster Parent Training Program (May, 1978 and December, 1981) indicated a high degree of acceptance and utilization of the training. With funding provided by Title XX and co-sponsored by the Nebraska Department of Public Welfare and the Center for Applied Urban Research, the Basic Course was continued throughout Nebraska from April, 1982 to April, 1983. Over 500 foster parents and caseworkers were trained during 1982-83. The following report presents a summary of the delivery plan, the year\u27s activities, and the results of the evaluation of the Basic Course

Antimicrobial Use in Patients with Dementia: Current Concerns and Future Recommendations

Infections are common in people with dementia, and antibiotic use is widespread, albeit highly variable, across healthcare settings and countries. The few studies conducted to date that consider the appropriateness of antibiotic prescribing specifically for people with dementia focus on people with advanced dementia and suggest that much of the prescribing of antibiotics for these patients may be potentially inappropriate. We suggest that clinicians must consider a number of factors to determine appropriateness of antimicrobial prescribing for people with dementia, including the risks and benefits of assessing and treating infections, the uncertainty regarding the effects of antibiotics on patient comfort, goals of care and treatment preferences, hydration status, dementia severity and patient prognosis. Future research should examine antibiotic prescribing and its appropriateness across the spectrum of common infections, dementia severities, care settings and countries, and should consider how antibiotic therapy should be considered in discussions regarding treatment preferences, goals of care and/or advance care planning between clinicians, patients and families

Treating Homeless Opioid Dependent Patients with Buprenorphine in an Office-Based Setting

CONTEXT Although office-based opioid treatment with buprenorphine (OBOT-B) has been successfully implemented in primary care settings in the US, its use has not been reported in homeless patients. OBJECTIVE To characterize the feasibility of OBOT-B in homeless relative to housed patients. DESIGN A retrospective record review examining treatment failure, drug use, utilization of substance abuse treatment services, and intensity of clinical support by a nurse care manager (NCM) among homeless and housed patients in an OBOT-B program between August 2003 and October 2004. Treatment failure was defined as elopement before completing medication induction, discharge after medication induction due to ongoing drug use with concurrent nonadherence with intensified treatment, or discharge due to disruptive behavior. RESULTS Of 44 homeless and 41 housed patients enrolled over 12 months, homeless patients were more likely to be older, nonwhite, unemployed, infected with HIV and hepatitis C, and report a psychiatric illness. Homeless patients had fewer social supports and more chronic substance abuse histories with a 3- to 6-fold greater number of years of drug use, number of detoxification attempts and percentage with a history of methadone maintenance treatment. The proportion of subjects with treatment failure for the homeless (21%) and housed (22%) did not differ (P=.94). At 12 months, both groups had similar proportions with illicit opioid use [Odds ratio (OR), 0.9 (95% CI, 0.5–1.7) P=.8], utilization of counseling (homeless, 46%; housed, 49%; P=.95), and participation in mutual-help groups (homeless, 25%; housed, 29%; P=.96). At 12 months, 36% of the homeless group was no longer homeless. During the first month of treatment, homeless patients required more clinical support from the NCM than housed patients. CONCLUSIONS Despite homeless opioid dependent patients' social instability, greater comorbidities, and more chronic drug use, office-based opioid treatment with buprenorphine was effectively implemented in this population comparable to outcomes in housed patients with respect to treatment failure, illicit opioid use, and utilization of substance abuse treatment

Beyond Severe Disabilities: National Approaches and Networking Guide

As we studied these programs, it became clear to us that most of these programs have some intrinsic values and that it would not be practical or advisable for us to evaluate the programs, Instead of rating programs, we selected programs that met at least one of our ten critical factors for program selection, and many of them met several. Our decisions were also based on a desire to present a variety of programs, especially those that seemed to be appropriate for program planners in Nebraska. We thought that it would be best to have program personnel describe their programs. Thus, a principal staff member wrote the description of each program, Some program personnel did not respond in time to meet our publication deadlines. Therefore, some programs which may be known to many rehabilitation professionals may be missing from our listing. Our listing is not intended to be exhaustive nor is it intended to include only those programs that are considered noteworthy

Influence of functional rider and horse asymmetries on saddle force distribution during stance and in sitting trot

Asymmetric forces exerted on the horse's back during riding are assumed to have a negative effect on rider–horse interaction, athletic performance, and health of the horse. Visualized on a saddle pressure mat, they are initially blamed on a nonfitting saddle. The contribution of horse and rider to an asymmetric loading pattern, however, is not well understood. The aim of this study was to investigate the effects of horse and rider asymmetries during stance and in sitting trot on the force distribution on the horse's back using a saddle pressure mat and motion capture analysis simultaneously. Data of 80 horse-rider pairs (HRP) were collected and analyzed using linear (mixed) models to determine the influence of rider and horse variables on asymmetric force distribution. Results showed high variation between HRP. Both rider and horse variables revealed significant relationships to asymmetric saddle force distribution (P < .001). During sitting trot, the collapse of the rider in one hip increased the force on the contralateral side, and the tilt of the rider's upper body to one side led to more force on the same side of the pressure mat. Analyzing different subsets of data revealed that rider posture as well as horse movements and conformation can cause an asymmetric force distribution. Because neither horse nor rider movement can be assessed independently during riding, the interpretation of an asymmetric force distribution on the saddle pressure mat remains challenging, and all contributing factors (horse, rider, saddle) need to be considered

Less Code, More Product: Leveraging Open Source Technologies To Develop Digital Library Collections

Over the last 10 years, the research library community has made significant investments in developing and utilizing open-source software products to build sustainable digital library infrastructure and services at scale. Community-driven open standards, data formats, protocols and governance are crucial to fulfilling the objective of scalable preservation and access infrastructure. Our collective investments in such development has the further benefit of helping reduce the amount of locally written code while delivering more “product” in the form of online archives, digital collections, exhibitions and services, offering flexible solutions to unique requirements. A good example of the benefits of leveraging open-source infrastructure can be seen in Columbia University’s Seymour B. Durst Old York Library project. In August 2011, Columbia received a substantial gift of New York-related materials from the Old York Foundation together with supporting funds to accession, process and produce a digital library based on the materials. The gift funded digitization of this large and unique collection and provided capacity-building funding that helped us to explore new project management models, establish new collaborative workflows and production processes, and expand development of our digital library infrastructure and feature set. The session will include an overview of Columbia’s strategy for leveraging community-based, open approaches to digital library infrastructure and also describe the specific set of open-source technologies used to implement this and other digital library projects. It will also describe how the Old York Library project helped to accelerate our development efforts, reduce the amount of locally written code, and build more sustainable approaches to meet the needs of unique and distinctive digital collections

Level rearrangement in exotic atoms and quantum dots

A presentation and a generalisation are given of the phenomenon of level rearrangement, which occurs when an attractive long-range potential is supplemented by a short-range attractive potential of increasing strength. This problem has been discovered in condensate-matter physics and has also been studied in the physics of exotic atoms. A similar phenomenon occurs in a situation inspired by quantum dots, where a short-range interaction is added to an harmonic confinement.Comment: 12 pages, 11 figures, RevTeX