Occupational Therapy's Role in Return to Occupations Post-Concussion in High School Athletes.

AIM: This study was designed to explore experiences of high school athletes in order to understand their occupational engagement after sustaining a sports-related concussion. The study explored the role occupational therapists (OTs) can play in post-concussion care while supporting adolescents in returning to meaningful occupations. METHODS: The study utilized a qualitative, phenomenological approach by conducting interviews with high school athletes to understand their participation in occupations during recovery. Six student-athletes from 14-18 years of age were interviewed. RESULTS: The five identified themes from the study included impacts on ADL performance, school performance, sleep, mental health, and driver safety. Student-athletes reported feelings of loneliness and loss of identity. Dressing, showering, grooming, and driving were disturbed due to balance deficits, headaches, and nausea. Participants reported decreased participation in social, sports, and leisure occupations due to heightened symptoms. CONCLUSIONS: Due to the considerable variability of disturbance in occupational participation post-concussion, occupational therapists can assist in creating and implementing individualized treatment plans to support high school athletes while recovering from a sports-related concussion.

Molecular Signatures of Glomerular Neovascularization in a Patient with Diabetic Kidney Disease.

The Kidney Precision Medicine Project (KPMP) aims to create a kidney tissue atlas, define disease subgroups, and identify critical cells, pathways, and targets for novel therapies through molecular investigation of human kidney biopsies obtained from participants with acute kidney injury (AKI) or chronic kidney disease (CKD). We present the case of a 66-year-old woman with diabetic kidney disease who underwent a protocol KPMP kidney biopsy. Her clinical history included diabetes mellitus complicated by neuropathy and eye disease, increased insulin resistance, hypertension, albuminuria, and relatively preserved glomerular filtration rate (early CKD stage 3a). The patient's histopathology was consistent with diabetic nephropathy and arterial and arteriolar sclerosis. Three-dimensional, immunofluorescence imaging of the kidney biopsy specimen revealed extensive peri-glomerular neovascularization that was underestimated by standard histopathologic approaches. Spatial transcriptomics was performed to obtain gene expression signatures at discrete areas of the kidney biopsy. Gene expression in the areas of glomerular neovascularization revealed increased expression of genes involved in angiogenic signaling, proliferation and survival of endothelial cells, as well as new vessel maturation and stability. This molecular correlation provides additional insights into the development of kidney disease in patients with diabetes and spotlights how novel molecular techniques employed by the KPMP can supplement and enrich the histopathologic diagnosis obtained from a kidney biopsy.

Intercultural-global competencies for the 21st century and beyond.

Increased diversity exists in Anglo-Saxon countries, such as Australia, the United Kingdom, and the United States. By 2050, no single ethnic group is expected to be in a majority in the United States. Health care reform points to an urgent need for health care professionals, such as nursing, medicine, allied health, nutrition, and other interdisciplinary health care team members, to serve a multi-ethnic population by developing intercultural-global and 21st-century competencies. Nurse educators must acknowledge the need to familiarize themselves and integrate these competencies into university and continuing education programs by evaluating and reporting outcomes. All nurses can be expected to have these competencies as global citizens through local, intercultural, and global interactions and exchanges.

Improving self-directed learning/intercultural competencies: breaking the silence.

Nurse educators need to develop innovative, technological curricula that foster intercultural competencies as essential components of a university education and break the silence with respect to lesbian, gay, bisexual, transgender, and queer (LGBTQ) health. Goals are to foster using these competencies to make LGBTQ content explicit in nursing curricula and in their professional organizations to promote equality and lessen disparities in this group.

The relationship between pressure ulcer prevalence, body mass index, and Braden scales and subscales: a further analysis.

The purpose of this study was to evaluate whether any of the Braden subscales were more strongly related to pressure ulcer occurrence than the Braden total score in obese and nonobese hospitalized patients. The authors investigated whether defining high risk for the total Braden score of 16 or less was associated with pressure ulcer occurrence.

Catching the spirit of cultural care: a midwifery exemplar.

Midwives provide an integral part of health care in underserved, rural areas of the United States. To meet the health care needs of people from diverse cultures, they need to learn culturally competent care. This article describes efforts by a university and its college of nursing to adapt to a changing cultural climate and prepare faculty and students to become culturally competent in practice encounters with diverse populations. Culturally competent care is infused in the midwifery curriculum through self-directed inquiry and discovery approaches. Outcomes of these approaches are evident in the nurse-midwifery program, which can serve as a model for integration of culturally competent care throughout the nursing curriculum.

Pilot testing the augmentech body position sensor on the morbidly obese patient.

The Augmentech Body Position Sensor (ABPS), a device for monitoring patient repositioning, was tested for use in morbidly obese patients. Specific aims were to: determine whether there was correspondence between data on patient turning and repositioning from the ABPS and data gathered through human observation; determine whether the ABPS is an acceptable instrument for measuring body movements in morbidly obese patients in terms of ease of use, comfort and ability to stay in place. A descriptive study was conducted. Data from the ABPS recording patients' body positions were compared with data from videotapes taken of the same patients during the same time period. The sleep center of a tertiary care facility in the southeastern United States was used. Ten participants with BMI ≥30 were selected from patients referred to the sleep center for polysomnography. Positioning the device on the patient's thigh, data were collected from midnight until discharge. Videotapes taken of the same patient during the same time period were examined for changes in body position over time. There was a strong correspondence between the videotaped data and the ABPS data. The device was comfortable and not irritating to the patient. The APBS can be a useful measure for determining changes in body position but further study should be undertaken to test other sites for placement.

Barriers to transition of obese patients from hospital to community.

OBJECTIVES: To identify barriers encountered by case managers in hospitals, home care agencies, and nursing homes in the transition of the obese patient from the hospital to the community. STUDY DESIGN: Exploratory descriptive design was used. Hospital case managers, nursing home administrators, and Medicare-certified home healthcare agency administrators were surveyed to identify barriers. METHODS: Hospital case managers in each licensed acute care hospital, directors of licensed nursing homes, and administrators of the Medicarecertified home healthcare agencies in 1 southern state were surveyed. The survey instrument was designed by the investigators based on variables identified in the literature or encountered within their practice. Instruments consisted of items related to the respondent's experience with barriers such as patient size, degree of patient independence, patient care requirements, staffing levels, and the need for assistive equipment, as well as items used to collect basic demographic information. RESULTS: Both hospital case managers and nursing home directors reported as major barriers the equipment, the size of the patient, patient independence, and finances. Home care agency directors reported that the presence or absence of a competent caregiver was the major factor in the decision to accept or not accept an obese patient. CONCLUSIONS: Transition of the obese patient presents major challenges. Further exploration is needed to identify the extent of problems and make policy recommendations toward a solution.

Pain experience of the elderly.

Too often, the elderly suffer silently and needlessly with chronic pain. To investigate the pain experience of the elderly living in the community, a descriptive research design was used. The aims of the study were to determine the prevalence of pain in an older population living in the community, to obtain a description of the older adult's pain experience, and to determine strategies used to manage their pain. The results of the study indicated that >90% of the elderly living in the community experienced pain within the past month, with 41% reporting discomforting, distressing, horrible, or excruciating pain. Musculoskeletal pain was found to be the most predominant pain, and inactivity was the most effective strategy used to lessen pain. Pain in the elderly continues to be a challenge which needs to be addressed more effectively by health care providers. Based on the high prevalence of pain experienced by the elderly and the expected demographic shifts in the next two decades, it is imperative to continue research in this area to assure the highest quality of life, as well as maximum functional ability, for the elderly. Health care providers need to understand the multidimensional pain experience that occurs in the daily life of the community-dwelling older adult and the most effective management strategies that can be used to provide pain relief.

The use of innovative pedagogies in nursing education: an international perspective.

The purpose of this global study was to explore the types of innovative pedagogies used in nursing education worldwide; transformative learning theory served as the theoretical basis for the study. A descriptive, mixed-method design with a researcher-developed instrument was used to conduct the electronic survey. Respondents were 946 nurse educator members of Sigma Theta Tau International; more than 93 percent were Caucasian women. Respondents indicated that the conventional teacher-centered approach remains the most prevalent pedagogical style (56 percent); fewer than 20 percent of respondents used feminist or postmodern approaches. Ninety percent of respondents reported using instruments to evaluate the effectiveness of their teaching. The majority viewed their faculty role as facilitator (88 percent) or information provider (65 percent). Greater efforts are needed to create an evidence base for nursing education through research that focuses on the effectiveness of innovative pedagogical strategies. This study, by describing the current patterns of teaching/learning strategies and approaches used by nurse educators, provides a beginning research base for improving nursing education.

Pharmacist-implemented pharmaceutical manufacturers' assistance programs: effects on health outcomes for seniors.

In the environment of rapidly mounting medication costs, pharmaceutical manufacturers' assistance programs (PMAPs) have become increasingly important in supplying medications to financially vulnerable patients. At Shenandoah Valley Compassionate Pharmacy, Winchester, Virginia, a nonprofit facility serving low-income seniors, a pharmacist and a patient advocate implement PMAPs by helping to enroll patients, dispensing medications, and providing patient counseling. To examine the effects of the program, we compared patients' clinical indicators before and after a 42-month intervention. Statistical analysis evaluated changes in clinical variables, such as systolic and diastolic blood pressure, glycosylated hemoglobin A1c, lipid panel (total cholesterol, low-density lipoprotein [LDL], highdensity lipoprotein [HDL], and triglycerides [TG]) for 84 seniors diagnosed with one or more chronic conditions. Results show statistically significant improvement in total cholesterol, LDL, and mean arterial pressure (calculated). TGs and A1c did not change significantly. In addition to dispensing free medications, the pharmacist provides counseling to enhance the efficacy of geriatric pharmacotherapy.

A review of narrative pedagogy strategies to transform traditional nursing education.

Traditional nursing pedagogies using teacher-centered learning approaches have produced efficient, knowledgeable nursing graduates for many years. However, 21st century learners will require and demand new educational approaches. The information age of computers has challenged all facets of education to keep pace. Nursing education must evolve with ever-changing forms of communication and technology and recognize generational differences in learning. The creation of partnerships in learning, rather than the traditional hierarchy of education, is projected to meet the needs of today's learners more effectively. The National League for Nursing, in its position statements, has challenged nurse educators to develop new research-based pedagogies responsive to the changing health care environment and reflective of new partnerships between and among students, teachers, and clinicians. This article will explore examples of one approach, narrative pedagogy, and its usefulness in nursing education as a way to expand the pedagogical literacy of nurse educators.

The ovarian cancer journey of families the first postdiagnostic year.

Ovarian cancer care has shifted from hospitals to families and has resulted in an unanticipated cancer journey as survivability for women so diagnosed has increased. This research investigated the impact of this responsibility on selected aspects of family functioning. Eighteen families participated in 5 family research visitations over the first postdiagnostic year. Quantitative data were obtained on socioemotional responses, behaviors, and coping strategies. Accounts of family experiences were recorded in field notes and narrative descriptions. Descriptive and narrative analyses were used. Subject families were strong and experienced a mosaic of variations in socioemotional and behavioral responses. Coping responses relied primarily on reframing and spiritual support. Families had hope and optimism and received socioemotional support from kin and friends. Response patterns consisted of providing support and care to sick members; making transformative changes in family structures, roles, and functions; reorganizing daily living experiences to integrate new situations; and minimizing gaps between professional and familial perspectives and realities. On this journey, families could have used timely knowledge and professional expertise to plan care, balance illness and family needs, restructure roles and responsibilities, maintain family unity, and give meaning and wholeness to experiences. Family-based oncology nursing is essential for family well-being and growth.

Leadership development in geriatric care through the Intergeneration Make a Difference Project.

The Intergeneration Make a Difference Project (MADP) is designed to develop leadership skills in geriatric nursing for seniors in a baccalaureate nursing program. This service-learning project with octogenarians and older individuals is based on theoretical constructs of caring. Stories and journaling are of great importance in the project. Expected outcomes are cognitive, affective, personal, and interpersonal. Students are expected to engage in critical/reflective thinking and develop leadership skills, heightened respect for the elderly, and interest in lifelong learning and a service orientation to society. Empowered to influence their clients, students receive the reciprocal benefits of an intergenerational relationship that, it is hoped, will affect how they care for the elderly in the future.

Combining olfaction and cognition measures to screen for mild cognitive impairment.

PURPOSE: This exploratory study examined the relationship between performance on the University of Pennsylvania Smell Identification Test (UPSIT) and the Addenbrooke's Cognitive Examination (ACE) to identify a possible association between olfaction and mild cognitive impairment(MCI). DESIGN AND METHODS: 54 community-dwelling older (ages 49-91) volunteers were given the UPSIT and ACE. RESULTS: The ACE identified 7 subjects (13%) who had probable MCI. UPSIT total scores were significantly related to ACE total scores (r = 0.37, p = 0.005). Four specific odorants (mint, lime, chocolate, and cheddar cheese) from the UPSIT identified 4 of the 7 (57.1%) probable MCI subjects. The prevalence rate of MCI in subjects over 65 was 19.4%. IMPLICATIONS: Selective odorants in UPSIT used with ACE show promise as a non-invasive method of detecting MCI in community dwelling elders. Detection of MCI could facilitate earlier interventions and treatment of dementia.

Impact of the Medicare modernization act on low-income persons.

BACKGROUND: Low-income Medicare beneficiaries without prescription benefits have high out-of-pocket medication expenses that can discourage adherence to treatment regimens. The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 created a temporary drug discount card program and a prescription benefit with low-income provisions to assist with medication expenditures for eligible seniors. OBJECTIVE: To determine the impact of the new drug discount card and prescription benefit on medication expenditures by low-income Medicare recipients who require pharmaceutical company assistance for obtaining medications. DESIGN: Retrospective, nonrandomized evaluation. SETTING: Family practice physicians' office in northern Virginia. PATIENTS: 137 Medicare recipients without prescription coverage who received assistance from pharmaceutical companies for medications. MEASUREMENTS: Patients were stratified into 3 categories according to income, household size, and the federal poverty line (FPL), as defined by the new Medicare act. Participants' long-term oral and inhaled medications, dosages, and instructions for use were obtained. The MMA criteria for low-income provisions were applied for the drug discount program and for the prescription benefit. Medication costs under the new Medicare benefits were compared with those incurred without assistance and with the use of pharmaceutical company programs for the cohort and FPL categories. RESULTS: In all income categories, medication costs were lower after enrollment in all programs than those of patients without assistance. Compared with pharmaceutical company assistance, Medicare drug discount cards resulted in less savings for all income groups. For the prescription benefit, persons with incomes less than 135% of FPL had the greatest benefit because of low-income subsidies. Persons ineligible for low-income subsidies receiving the standard benefit had a smaller reduction in out-of-pocket costs and variable monthly expenditures; they realized a superior savings with pharmaceutical company assistance programs. LIMITATIONS: The generalizability of these findings is limited because the authors used a discount pharmacy to determine drug costs for persons receiving no assistance, could not determine asset criteria for the MMA drug benefit low-income subsidy, and used a selected Medicare population. CONCLUSIONS: In a low-income Medicare population without prescription coverage, pharmaceutical company programs offered considerable savings and were superior to the Medicare drug discount cards. For the Medicare prescription plan, the greatest savings was among those eligible for low-income subsidies. Month-to-month medication costs may vary substantially for persons ineligible for such subsidies, and pharmaceutical company assistance may be a better alternative.

An ovarian cancer diagnosis-seeking process: unraveling the diagnostic delay problem.

PURPOSE/OBJECTIVES: To propose a conceptualization that identifies when diagnostic delays occur and suggests a delay-reduction strategy for the diagnosis of ovarian cancer. DATA SOURCES: Findings and extrapolations from published national and international research studies, research reviews, books, Internet sources, and a family-functioning research project. DATA SYNTHESIS: Three phases of diagnosis seeking were identified. Self-care was characterized by self-diagnosis, self-interpretation of symptoms, and self-management. Primary provider care was characterized by misdiagnosis and ineffective symptom management. Specialist care was characterized by specialized examinations, tests, and definitive diagnoses. Diagnostic delays were associated with extended periods of self-care and the misinterpretation of symptoms in primary care. CONCLUSIONS: Periods of opportunity for early diagnosis occurred in the early symptom stages, when self- and primary care were dominant. IMPLICATIONS FOR NURSING: Women must be taught to self-monitor for early ovarian cancer symptoms. Primary care providers should be urged to attend frequent state-of-the-science updates that regard early symptoms as manifestations of ovarian cancer.

Health seeking related to ovarian cancer.

Critical review of general health-seeking models showed a need for expansion to include the early and atypical symptom period associated with ovarian cancer and the role of self and primary care in the diagnostic process. Data from family functioning research showed that in the self-care phase, the initial gastrointestinal symptoms were unrecognized as serious, given common sense labels, and self-managed. When primary care provider care was sought, misdiagnoses occurred three fourth of the time. Diagnostic delays occurred in these 2 phases of care. An expansion of a model of health seeking links personal and family risks and adds early symptom data may be obtained through monthly self-monitoring by women using a symptom checklist. Organization of risks and symptom information assists in interpretation of disparate streams of data and gives a recommended outcome: high personal risk level + high family risk level + high early and persistent symptoms presence = high need for a prompt gynecological evaluation. The restructured health-seeking process requires women be taught how to monitor their ovarian health. Nurses and primary care providers need frequent continuing education updates and the health media need current and accurate information about this malignancy.

Narrative pedagogy: teaching geriatric content with stories and the "Make a Difference" project .

As the elderly population increases in number, the need to integrate innovative teaching strategies in geriatric education becomes more apparent. Teaching with stories promotes knowledge and values to students and is appealing and enjoyable. This article describes a geriatric nursing course in which stories in films and literature are used to teach content and values promoted by the Hartford Institute best practices curriculum. Stories are also used for the service-learning component of the course as students participate in a "Make a Difference" project with elderly people.

Ovarian cancer: early symptom patterns.

PURPOSE/OBJECTIVES: To examine early symptom and diagnostic-seeking experiences of women newly diagnosed with ovarian cancer. DESIGN: Longitudinal descriptive. SETTING: Homes of families. SAMPLE: Purposive; 19 families were obtained by referrals. METHODS: Interviews and questionnaires; descriptive analysis. MAIN RESEARCH VARIABLES: Early symptoms and delays in diagnosis. FINDINGS: Families were 88% Caucasian and 12% African American. Almost two-thirds had annual incomes of 25,000 dollars or more. The ages of the patients with cancer ranged from 28-73 years (mean = 56 years). Delay between initial symptoms and diagnosis was mean = 14 weeks. Early symptoms experienced by 95% of women were abdominal bloating, vague abdominal pain and "spots," indigestion problems, fatigue, and urinary problems. CONCLUSIONS: Women usually experience a cluster of symptoms, unrecognized and discounted, which delays diagnosis. IMPLICATIONS FOR NURSING: Pelvic assessments should be reformulated to conceptualize early symptoms, risk factors, and family cancer history as a dynamic, interconnected whole to guide and interpret ovarian health.