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Have you ever watched as care providers, be they student nurses or staff nurses, display behaviors that seem to indicate that they are becoming overwhelmed by situations in the acute care setting? Have you also observed other providers who seem to thrive on the "challenges" presented by these same situations? The same situation stimulates responses that reflect opposite ends of a continuum, the continuum of tolerance of ambiguity. The nurse educator needs to develop a greater understanding of the elements in the clinical situation (the ambiguities) that have stimulated the behavioral responses, and how an individual's level of tolerance of ambiguity influences reactions to the ambiguous situations. These understandings provide the nurse educator with the foundation for developing teaching strategies to facilitate effective management of ambiguous situations in clinical settings.
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Recently published consensus statements and conference proceedings from the Cystic Fibrosis Foundation provide new direction with regard to the etiology, diagnosis, and treatment of the adult patient with cystic fibrosis (CF). Survival has improved through early diagnosis and improved treatment, and aggressive management of complications. The current state of knowledge, the most recent evidence-based treatment options, and essentials of nursing care for the adult patient with CF are outlined.
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Since the advent of medical treatments for HIV, the promotion of adherence to these difficult treatment regimens has proven critical to disease management. Three Connecticut state-funded HIV medication adherence programs were evaluated.1 The purpose of this process evaluation was to explore and compare the goals and modality of each adherence program, assess client and staff satisfaction, and provide recommendations for the improvement of these programs. Focus group interviews with clients and individual interviews with staff were conducted at each of the programs. Interviews were transcribed, coded and analyzed with a code and retrieve method of theme identification. Focus group themes included the importance of social support on medication adherence and the "lifesaving" effect the program has had. The staff expressed that although complete adherence should be the long-term objective, more intermediate objectives should be considered (e.g., behavioral changes to increase clients' ability, self-esteem, and self-efficacy to take medications).
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The periodized resistance-training model has not been well documented in the literature. Further research is needed to determine if periodized resistance training in conjunction with creatine supplementation can cause changes in strength, performance, total body weight, girth, and lean muscle mass. Therefore, the purpose of this investigation was to determine the effects of periodized resistance training in conjunction with low-dose (LD) and high-dose (HD) creatine supplementation on strength, body composition, and anaerobic muscular endurance. Subjects were divided into 3 groups: LD, HD, and placebo (P). Testing took place pre-, mid-, and postsupplementation for the following: weight, body composition (fat-free mass and fat mass), 1 repetition maximum squat, and anaerobic muscular endurance testing. Results revealed no significant differences in either creatine group when compared with the P group. However, significant differences were noted over time. These data suggest that 10 weeks of periodized resistance training was effective for causing changes in strength, body composition, and anaerobic muscular endurance.
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This study was designed to evaluate maximum length sequences-auditory brainstem responses (MLS-ABR) in children with auditory processing disorders and to compare these results with a normal control group matched for age, intelligence, and gender. Although each waveform was analyzed for the presence of waves I, III, and V, the primary focus was wave V. Although absolute latency measures for wave V were obtained from all subjects, waves I and III were not always identified. Although the results showed latency increases for all waveforms in both groups, the only significant difference noted was an increase in wave V latency for both the left and right ears in the clinical group. These results suggest that the MLS-ABR may be useful in the assessment of auditory processing disorders. Implications for the potential use of the MLS-ABR in management programs are discussed.
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While many studies have documented tamoxifen's benefits as an adjuvant therapy in the treatment and prevention of recurrent breast cancer in estrogen receptor positive (ER+) breast carcinoma, this beneficial effect may decrease with long-term tamoxifen use. This experimental study was designed to compare the cytotoxic responses of ER+ primary breast cancer solid tumors derived from the MCF7 cell line to experimental therapeutics, including genistein, tamoxifen, all-trans retinoic acid (ATRA) and parthenolide in the presence and absence of exogenous beta-estradiol. The results of this study suggest that the growth inhibitory effects of tamoxifen, were dependent on beta-estradiol levels. In contrast, the cytotoxic effects of the isoflavone soy derivative, genistein, were observed to be independent of exogenous estrogen. Moreover, combined therapy using tamoxifen and genistein produced enhanced cytotoxic effects also independent of beta-estradiol levels. Additional studies involving the use of the novel agents all trans retinoic acid (ATRA) and parthenolide produced notable tumor responses and combined effects that were also estrogen-independent. Overall, these preclinical research findings suggest possible clinical applications suggesting that genistein might be a useful clinical adjuvant, particularly in post-menopausal women in whom breast cancer occurs more frequently. Moreover, this research suggests that combined treatment approaches involving the use of tamoxifen in conjunction with agents that inhibit NFkappaB pathway signaling, such as parthenolide and genistein, warrant further study.
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