Description of the moderate brain injured patient and predictors of discharge to rehabilitation.

OBJECTIVE: To describe patients with moderate traumatic brain injury (TBI) treated and discharged at levels I and II trauma centers in the United States; and to describe the predictors of discharge to rehabilitation after acute care. DESIGN: Retrospective, cross-sectional, descriptive study. SETTING: Trauma centers. PARTICIPANTS: Patients with moderate TBI (N=2087; age range, 18-64 y) as reported in the 2010 National Sample Project. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Discharge destination (rehabilitation vs home with no services). RESULTS: Multivariate logistic regression models revealed that demographic, clinical, and financial characteristics influenced the likelihood of being discharged to rehabilitation. Increased age, increased severity, Medicare use, longer length of stay, and trauma center locations in the Midwest and Northeast all increased the likelihood of discharge to rehabilitation. CONCLUSIONS: The decision to discharge a person with moderate TBI from acute care to rehabilitation appears to be based on factors other than just clinical need. These findings should be considered in creating more equitable access to postacute rehabilitation services for patients with moderate TBI because they risk long-term physical and cognitive problems and have the potential for productive lives with treatment.

Pharmacotherapeutics for osteoporosis prevention and treatment.

Osteoporosis is a silent disease that affects 10 million Americans; 80% of those affected are women. Although the disease is more common in postmenopausal Caucasian women, all ages and races are at risk. Osteoporosis can be a debilitating disease that can cause pain, fractures, depression, and social withdrawal. Signs of osteoporosis include kyphosis, loss of height, and protrusion of the abdomen. Because symptoms generally do not occur until after the disease has progressed, clinicians should include osteoporosis screening and preventative education as part of the regular gynecologic care. Diagnosis is typically made by a dual energy x-ray absorptiometry (DEXA) scan. Treatment consists of dietary and lifestyle changes, along with pharmacologic intervention. Although hormone therapy has been shown to be effective in preventing osteoporosis, the risks of long-term treatment with HRT are discussed. The following effective treatment options for women who have been diagnosed with the disease are discussed: bisphosphonates, calcitonin, and selective estrogen receptor modulators (SERMs). Because midwives regularly care for women of all ages, they are ideal candidates to provide women with preventative education, screening, counseling, and treatment.

Outcomes of high-risk women cared for by certified nurse-midwives.

This study describes the incidence of specific high-risk factors of a population cared for by a group of certified nurse-midwives (CNMs) in a Mid-Atlantic, inner-city, nonprofit, hospital-based clinic. Outcomes were compared with all women who delivered in the United States in 1994. Univariate statistics, which consisted of descriptive statistics, frequencies, and percentage distribution, were used. This comparison suggests that CNMs can provide safe care to women with high-risk conditions. Outcomes for the midwifery sample were more favorable for vaginal births, vaginal deliveries after cesarean section, forceps- and vacuum-assisted deliveries, cesarean delivery, and 5-minute Apgar scores. The incidence of maternal fever and meconium stained amniotic fluid was higher. Implications and limitations of the study are discussed.

Establishing prevention, education and community awareness through a comprehensive diabetes, hypertension and hypercholesterolaemia screening programme: The Smith Island, Maryland, USA experience.

Glucose screening is essential in providing early detection for diabetes. Screening for hypertension and hypercholesterolaemia in diabetics can help identify clients at an increased risk for morbidity and mortality. Free health screening clinics, which included components based on the ABCs of Diabetes, were set up on Smith Island, Maryland, USA in January 2001. An extensive health history was performed on each clinic attendee and baseline assessment data were collected. To date, 273 residents have been screened at the clinics. Clinic education adopted from the National Diabetes Education Program was provided to all attendees. This programme provided members of the community with a baseline assessment and general information on diabetes prevention, detection and treatment. Positive lifestyle strategies were introduced within the community. Barriers to future disease prevention were identified during the programme.

A phenomenological evaluation: using storytelling as a primary teaching method.

This phenomenological study examines the experiences of students who had been enrolled in an undergraduate women's health issues course where storytelling served as one of the primary teaching and learning tools. Using hermeneutic phenomenology, the investigator explored the perceptions of participants at the conclusion of the course. A purposive sample of 10 students made up the focus group. Themes were explicated and analyzed from interviews until data saturation was reached. Content analysis from focus groups revealed three themes: personalizing learning, participatory learning, and group trust/safe environment. Storytelling provided students with an opportunity to become more actively involved, provided a forum to relate real life examples to concrete didactic data, served as a trigger for information recollection, and made material seem more realistic. The increased discussion and interaction within the classroom setting enabled students to probe alternative views and perspectives in the class room. The use of more diverse teaching tools can enhance the students' experiences in the classroom setting.

Physical activity and body composition analysis of female baccalaureate nursing students.

Although nursing students are educated about the importance of healthy diets and the benefits of exercise, many do not engage in health promotion behaviors. This study longitudinally examined specific indicators of obesity among a group of female nursing students who incorporated an exercise program into their normal weekly routine. Indicators for obesity were identified using anthropometric data that included weight, body mass index (BMI), and percentage of body fat. Blood pressure, pulse data, and a physical activity level assessment were performed at the beginning and at the conclusion of the study period. Results indicated improvement in overall body composition, including a reduction in percent body fat and BMI. Students also showed improved physical activity levels. Since nurses need to counsel clients on primary prevention issues such as physical activity and maintaining ideal body weight and lean mass, the importance of positive health behaviors for nursing students and nurses cannot be stressed enough.