Evaluation of a Medication Management Program for Older Adults

Background: As the prevalence of chronic disease increases among older adults in the United States, the need for medical interventions to adequately manage disease is also growing. Increased prescription drug use and care by multiple health providers among older adults are associated with potentially inappropriate prescribing, which may lead to adverse drug events. The HomeMeds Medication Assurance Program (HomeMeds program) is an in-home medication risk assessment for older adults to identify and prevent potentially inappropriate prescribing. Objective: To determine the effectiveness of the HomeMeds program by describing the attitudes about the program among the target population, identifying barriers and facilitators to the program, and evaluating the results of medication risk assessments. Methods: Qualitative data were collected through focus group sessions with members of the target population and key informant interviews with HomeMeds program staff and experts in geriatric clinical pharmacy. Quantitative data were collected using the HomeMeds program database. Results: Barriers to participation in the program were a lack of awareness about the susceptibility and severity of potentially inappropriate prescribing among older adults, trust in the health care system to accurately track medications, and fear of breach in confidentiality. Clients who took five or more medications were more likely to have an alert generated in the HomeMeds system than clients who took fewer medications. Despite this, less than 35% of alerts resulted in follow-up consultations between the partnering pharmacist and client. HomeMeds staff experienced challenges with recruiting individuals and providing clinically relevant recommendations about medications. Conclusion: The public health significance of this study is that community programs that implement medication risk assessments may not be effective in preventing potentially inappropriate prescribing in older adults. Improvements to the HomeMeds program should include pharmacist-led educational sessions to provide the information necessary to motivate participation in the program. Program champions at AgeWell residential sites should be leveraged to identify vulnerable older adults and facilitate participation. Finally, partnerships with local primary care practices should be formed to recruit clients to the program, provide comprehensive information about clients’ health history, and evaluate outcomes that result from participation

Dena'ina duch'deldih: "we are learning Dena'ina," language goals and ideologies among adult learners of Dena'ina Athabascan

Thesis (M.Ed.) University of Alaska Fairbanks, 2006The work contained herein consists of two research papers that emerged from a single qualitative study of goals and ideologies of adult learners of Dena'ina Athabascan in attendance at the 2005 Dena'ina Language Institute. The study draws upon 19 semi-structured, in-depth interviews that were collected and analyzed in order to increase community control over the program and to assist in the development of future programming offered by the University of Alaska Fairbanks. The first research paper suggests that goals of attendees clustered into four categories: fluency, literacy, cultural knowledge, and community building. More important than these four stated goals were the ways in which these goals connected to overarching themes of visibility, healing and resistance. It is argued that these themes are interconnected forms of, and tools for, empowerment. The second research paper suggests that the presence and work of university representatives is always ideological and always educational. It outlines the importance of ideological critique on the part of both community and institution when goals of empowerment are being sought after. The work contains both-site specific recommendations and broader implications for educational institutions involved in Native language programming

Playful Transformations: Directing Sarah Ruhls adaptation of Orlando by Virginia Woolf

This thesis documents my artistic process as a director for a production of Sarah Ruhls adaptation of Orlando by Virginial Woolf. The research and preparation for this process begins with Ruhls aesthetic and approach to adaptation, and the influence of Joyce Pivens work in Story Theatre. A sample of contemporary versionings of Orlando in film, visual art, theatre, and music reveal not only a resurgence in popularity of Woolfs novel, but also its role in the current cultural dialogue of gender and sexual politics. These research findings informed and shaped my conceptual approach to the play and the premise: Keeping reality at bay reveals poignant truths. With this in mind, the rehearsal process explored gender, essential selves, and the unity of selves which were brought to light through languages of intimacy, physicality and characterization. Focusing on transformation, playfulness, metaphor and emptiness for our design premise led to the interactive nature of costumes, set and props, as well as lights and sound that transformed technologically. The creative process is outlined in the journal section which details the application of the research and preparation, ideas and concepts, as well as the development of the fluidity and movement of the ensemble work. The final section reflects upon the outcomes of my artistic process from the initial concept, to the rehearsal process, and the production

Making nutrition decisions in high-cost environments

Take home messages • At average fertiliser costs, return on investment to nitrogen applications exceed 5:1, i.e. every dollar spent on nitrogen results in $5 of additional profit • When N prices double, growers are still receiving$2.10 in profit for every dollar spent on nitrogen, and at triple the cost nitrogen is still expected to return $0.85 in additional profit for every dollar spent • With higher N prices profitable N responses to winter cereals are only expected under favourable grain prices or seasonal conditions • Soil testing and precision/variable nutrient application become more valuable as nutrition costs rise

Feasibility of project ECHO telementoring to build capacity among non-specialist emergency care providers

The COVID-19 pandemic has led to global disruptions in emergency medicine (EM) teaching and training and highlighted the need to strengthen virtual learning platforms. This disruption coincides with essential efforts to scale up training of the emergency healthcare workforce, particularly in low-resource settings where the specialty is not well developed. Thus, there is growing interest in strengthening virtual platforms that can be used to support emergency medicine educational initiatives globally. These platforms must be robust, context specific and sustainable in low-resource environments. This report describes the implementation of Project ECHO (Extension for Community Healthcare Outcomes), a telementoring platform originally designed to extend specialist support to health care workers in rural and underserved areas in New Mexico. This platform has now been implemented successfully across the globe. We describe the challenges and benefits of the Project ECHO model to support a Point-of-Care Ultrasound (POCUS) training program for health care providers in Kenya who do not have specialty training in emergency medicine. Our experience using this platform suggests it is amenable to capacity building for non-specialist emergency care providers in low-resource settings, but key challenges to implementation exist. These include unreliable and costly internet access and lack of institutional buy-in