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BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians. (J Am Coll Cardiol 2021;78:2131-2143) (c) 2021 by the American College of Cardiology Foundation.

BACKGROUND Annually 2.5 million infants die in the first 28 days of life, with a significant regional distribution disparity. An estimated 80% of those could be saved if neonatal resuscitation were correctly and promptly initiated. A barrier to achieving the target is the knowledge and skills of healthcare workers. PURPOSE The objective of this cluster randomized trial was to assess the improvement and retention of resuscitation skills of nurses, midwives, and birth attendants in 2 birth centers serving 60 villages in rural India using high-frequency, low-dose training. RESULTS There was a significant difference (P < .05) between the groups in the rate of resuscitation, with 18% needing resuscitation in the control group and 6% in the intervention group. The posttest scores for knowledge retention at the final 8-month evaluation were significantly better in the intervention group than in the control group (intervention group mean rank 19.4 vs control group mean rank 10.3; P < .05). The success rate of resuscitation was not significantly different among the groups. IMPLICATIONS FOR PRACTICE Improved knowledge retention at 8 months and the lower need for resuscitation in the intervention group support the efficacy of the high-frequency, low-dose education model of teaching in this setting. IMPLICATIONS FOR RESEARCH Replication of these findings in other settings with a larger population cohort is needed to study the impact of such intervention on birth outcomes in low-resource settings.

Neonatal epilepsy occurs for many reasons. Infants may present shortly after birth with seizure activity or seizures may occur later in the neonatal period. Seizures that are refractory to treatment can be difficult to manage and because of different presentations, there may be a delay in diagnosing the exact etiology. Prompt intervention is necessary and developing a plan of care can be done while exploring the etiology. There are several genetic mutations, including the SCN2A sodium ion channelopathy, that can result in a wide array of epileptic conditions, ranging from mild to severe. This case review focuses on diagnosis and management of SCN2A refractory seizures.

BACKGROUND Globally, stillbirths account for 2.7 million infant deaths each year, with the vast majority occurring in sub-Saharan Africa and South Asia. Approximately 900,000 infants die due to birth asphyxia. The focus of the Helping Babies Breathe (HBB) program is to help the nonbreathing infant to breathe within the first minute of life, termed the "Golden Minute." PURPOSE To present a multinational interprofessional development program utilizing the train-the-trainer methodology for HBB to address neonatal morbidity and mortality. Involving nursing students in collaboration with established global partners provided an innovative method of professional development. Lessons learned and challenges will be shared to enhance success of future efforts. PROJECT IMPLEMENTATION HBB train-the-trainer workshops were held to provide professional development for nurses and nursing students in 5 locations in 4 countries including Ethiopia, India, Vietnam, and Zambia. Workshop participants and the trainers participated in discussions and informal conversation to assess impact on professional development. RESULTS HBB training and train-the-trainer workshops were implemented in 4 counties. Equipment and supplies were provided in these countries through several internal university grants. All 145 participants demonstrated increased knowledge and skills at the end of the workshops through the HBB check off. Collaborative teaching and cross-cultural professional skills were enhanced in student and faculty trainers. IMPLICATIONS FOR PRACTICE Nurses, midwives, and advance practice nurses can engage globally and contribute to closing this gap in knowledge and skills by providing train-the-trainer workshops. IMPLICATIONS FOR RESEARCH Developing systems to integrate the HBB program within each country's existing healthcare infrastructure promotes in-country ownership. Joining the global effort to save the lives of neonates can be a meaningful opportunity for innovative professional development projects. While HBB education has been shown to save lives, a 1-time training is insufficient. Determining how often HBB updates or refreshers are required to maintain skills is an important next step. Another direction for research is to implement this project within prelicensure nursing programs.

Background About 20% of patients taking apremilast alone obtain PASI 75 by week 8. This single-center, pilot study aimed to determine whether add-on topical therapy with calcipotriene/betamethasone dipropionate (C/BD) could improve responses of partial apremilast responders by week 12. Methods Adults (g18 years of age) with moderate to severe plaque psoriasis (baseline PGA g3, BSA affected g10%, PASI g12) took oral apremilast (30 mg twice daily) for 8 weeks. Patients who achieved between PASI 25n74 at week 8 used add-on, daily topical C/BD (.005%/.064%) foam up to week 12; those with lPASI 25 at week 8 were discontinued. Results Of 50 patients enrolled, 26 achieved PASI 25m74 and 8 PASI 75 at week 8. At week 12, 29 achieved PASI 75, and 24 at week 16. Of the week-8 partial responders, 21/26 achieved PASI 75 at week 12 on combination therapy and 15 maintained PASI 75 through week 16 on apremilast alone (4 did not maintain; 2 lost to follow up). In partial responders, mean PGA and BSA affected improved by 30% and 33% on apremilast, respectively, and by 67% and 86% at week 12 on the combination therapy, respectively. The most commonly reported adverse events (AEs; g5% occurrence) were headache (14%), diarrhea (10%), and nausea (8%); majority were mild. No related serious AEs occurred. Conclusion We show that most week-8 partial apremilast responders can achieve PASI 75 at week 12 with combination C/BD topical therapy, and maintain PASI 75 through week 16 with apremilast monotherapy. J Drugs Dermatol. 2020;19(12): doi:10.36849/JDD.2020.5435.

Cystic fibrosis (CF) is considered one of the most commonly occurring fatal genetic disorders. This disorder is associated with pancreatic insufficiency and pulmonary complications. However, at birth the initial complications are associated with bowel obstruction. Cystic fibrosis management warrants an interdisciplinary team because this disorder affects various organ systems. Effective management of the newborn with CF assists in improving the child’s overall prognosis. Family support is critical throughout the prenatal and postnatal periods. The case presented reviews a child born with suspected CF and the clinical course within the NICU.

Aim To provide a unique model for use in guiding global collaboration and policy to upscale nursing and midwifery partnerships. Background and introduction Nurses and midwives across nations need skills reaching beyond the bedside and unit level in today's complex, global, multifaceted healthcare milieu. Thoughtful consideration, research and concomitant development of models to guide appropriate upscaling of nurse and midwifery capacity within and between nations are needed. Discussion This article explores an integrated global approach to upscaling nurse and midwifery capacity using examples of partnerships between nursing and midwifery programmes across multiple continents. Conclusion and implications for nursing Global nurse and midwifery capacity is effectively being developed using a myriad of approaches. A new model is presented to illustrate supports, strategies and activities to achieve intermediate and long-term goals for capacity building through strong and sustainable global partnerships. Implication for nursing policy Development of global skills can focus the nurse and midwife to influence policy-level decisions. Human resource planning that can impact countrywide provision of health care begins in the preservice setting for both nurses and midwives. A global experience can be a value-added component to the well-rounded education of future nurses. Education during preparation for entry into practice is a strategic way to develop a worldview. Incorporating reflective practice can build skills and shape attitudes to prepare the new nurse to be comfortable as a global healthcare provider. An expanded world view is the springboard to more robust and informed involvement and inclusion in policy-level discussions.

Nurse educators use a variety of clinical simulation strategies to promote cognitive, psychomotor, and affective learning. Statistically significant increases in self-confidence levels were found among senior-level nursing students in the assessment and management of medical and psychiatric symptoms after participating in strategically designed, complex, student-led clinical simulations. Having students role play simulation scenarios that are developed from real-life clinical experiences is a cost-effective interactive strategy that enhances their communication and technical skills.

The University of Central Missouri has experienced a 1,498% increase in students from India since 2012. These international students utilize interlibrary loan to request textbooks at a rate not evident in other student population groups. Their search for course textbooks impacted librarians, staff, and student workers at public desks and on chat as well as the interlibrary loan staff as requests were placed for the titles. In an effort to help meet the demand for textbooks by this student group, the library has implemented a textbook reserves program for the texts needed in the most popular classes.

Purpose/Objectives: To determine if serum prealbumin (PAB) levels can be used by nurses to predict patients who may be at higher risk for postoperative complications after pancreatic surgeries. Design: A quantitative, retrospective study. Setting: One cancer center at an urban medical center in Detroit, Michigan. Sample: A convenience sample of 41 patients with resectable pancreatic neoplasms. Methods: Descriptive study with cross-sectional data using chart review to obtain preoperative PAB levels and perioperative data. Main Research Variables: Pancreatic leak, chyle leak, gastroparesis, sepsis, heart attack, length of hospital stay, and readmissions. Findings: There was a higher incidence of pancreatic leak reported after a distal pancreatectomy; however, this complication was not associated with a low PAB of ≤20 mg/dl. Patients with a diagnosis of adenocarcinoma or who underwent a pancreaticoduodenectomy experienced a longer hospital stay. Conclusions: Results did not reinforce the relationship between preoperative nutritional status and outcomes in pancreatic surgery. Implications for Nursing: Surgical oncology nurses should be aware of the importance of presurgical risk assessment and optimization. Tailored implementation of nutritional prehabilitation to improve patient outcomes after resection of pancreatic neoplasms should be studied more comprehensively.

With the rise in genetic screening both pre- and postnatally, new variances in genes are being recognized. Some are of unknown significance, while other known genetic expressions have obvious phenotypical expressions. Transient neonatal diabetes mellitus is a result of the duplication of chromosome 6q24, but little is known about the phenotypic expression of a triplication of chromosome 6q24. This case study presents an infant with a postnatally diagnosed triplication of chromosome 6q24, meconium pseudocyst, and multiple congenital anomalies with unknown genetic significance.

Epidermolytic ichthyosis (EI) is a rare autosomal dominant genodermatosis that presents at birth as a bullous disease, followed by a lifelong ichthyotic skin disorder.1 Essentially, it is a defective keratinization caused by mutations of keratin 1 (KRT1) or keratin 10 (KRT10) genes, which lead to skin fragility, blistering, and eventually hyperkeratosis. Successful management of EI in the newborn period can be achieved through a thoughtful, directed, and interdisciplinary or multidisciplinary approach that encompasses family support. This condition requires meticulous care to avoid associated morbidities such as infection and dehydration. A better understanding of the disrupted barrier protection of the skin in these patients provides a basis for management with daily bathing, liberal emollients, pain control, and proper nutrition as the mainstays of treatment. In addition, this case presentation will include discussions on the pathophysiology, complications, differential diagnosis, and psychosocial and ethical issues.

Interprofessional education (IPE) provides an opportunity to explore health professionals' contributions to pain management and to develop students' competencies in interprofessional (IP) collaborative practice. The purpose of this IPE workshop was to measure students' knowledge gains and changes in perceptions of core competencies for IP collaborative practice. The objectives for the workshop were that students would be able to: 1) Identify roles of healthcare team members in pain management, 2) Describe means of effective communication with the pain management healthcare team members, 3) Describe two pharmacological and two non-pharmacological interventions for pain management to decrease the use of opioids and 4) Reflect on the core competencies for IP collaborative practice. This IPE workshop on pain management and opioid abuse included a keynote speaker, an interprofessional panel and a patient case study. This format provided a comprehensive learning experience in a reasonable amount of time and was logistically feasible for health care professional students at one university.Demographic questions and the Interprofessional Attitudes Scale (IPAS) post-workshop surveys. The IPAS was modified to decrease response bias by removing the five subscale headings and reordering the questions. The post-survey also had three questions to measure achievement of workshop objectives. Scores for the core competencies of Teamwork, Roles and Responsibilities and Community- Centeredness demonstrated statistically significant increases. Post-survey analysis revealed a statistically significant difference by gender (females higher than males) on Teamwork, Roles and Responsibilities. Following the workshop students and faculty participants were emailed an online evaluation. The participants were asked to rate the effectiveness of the workshop: 1) components (keynote speaker, panel discussion and case study), 2) in helping participants to develop competence in IPE, and 3) as a learning experience. The effectiveness of the workshop in all three of these areas was rated as good to excellent by a majority of respondents. This IPE workshop format was effective and could be replicated to develop healthcare professional students’ knowledge of interprofessional pain management and to develop the core competencies of collaborative practice.

How to Obtain Contact Hours by Reading this Article Instructions 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf . To obtain contact hours you must: 1. Read the article, “The Prevalence of Uncontrolled Pain in Long-Term Care: A Pilot Study Examining Outcomes of Pain Management Processes” found on pages 33–41, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until January 31, 2018. Contact Hours This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. Activity Objectives 1. Describe barriers to inadequate pain management and opportunities to improve this process for older adults residing in long-term care. 2. Identify outcomes of inadequate pain management in older adults residing in long-term care. Disclosure Statement Neither the planners nor the authors have any conflicts of interest to disclose. Pain in long-term care (LTC) is common among older residents despite the vast options available for optimal pain management. Inadequate pain management affects individual health care outcomes. Researcher evidence has shown that nurse practitioners (NPs) improve the quality of care in LTC but are challenged by multiple barriers that inhibit optimal pain control. The purpose of the current pilot study was to explore both the pain management processes used by nurses in LTC and the documented patient outcomes that come from these processes. In addition, factors were identified that may impact the NP role in providing adequate pain control in LTC. This descriptive study used a retrospective, case-controlled research design that incorporated reviewing 55 LTC resident medical records. Results show how the process of pain management in LTC can be improved by expanding the professional role of the NP. [ Journal of Gerontological Nursing, 41 (2), 33–41.]

In India, 1.7 million children did not reach their 5th birthday in 2010. Some of these deaths could have been avoided with knowledge and training on Helping Babies Breathe® and Essential Care for Every Baby. In international settings, where the ratio of health care providers to the population results in a scarcity of resources, task shifting of complex care to nurses rather than physicians is a common practice. According to the World Health Organization (2010), countries with the lowest healthcare workforce capacity have the poorest health outcomes and the highest infant mortality rates. This article addresses the knowledge gap in neonatal nursing care and newborn resuscitation skills among nurses and midwives in India using the Knowledge to Action Framework. Continuing education and Helping Babies Breathe in conjunction with Essential Care for Every Baby was provided every year for the last three years. The goal of this capacity building is a way of addressing and possibly reducing maternal and newborn morbidity and mortality.

Neonatal bacterial infections leading to sepsis occur frequently in the first few days or weeks of life. NPs must be able to recognize the early signs of sepsis and understand the need for rapid evaluation and treatment. This article discusses antibiotic treatments for various types and locations of bacterial infections and sepsis in the neonate.

The Pad Project is a women's health program used to educate women on their monthly menstrual cycles. Through this ministry, women who do not have access to menstrual hygiene products are given sustainable hygienic kits to promote menstrual health. This unique health education program also integrates stories from the gospel to illustrate Christ's love and caring commitment toward women and women's health.

Discusses problems for college publications advisers and student editors involving the issues of prior restraint, firing, suspension, and control of funding; describes court cases that have pertained to these issues. (GW)

The purpose of this pilot correlational study was to determine the association of health literacy with cognitive ability and level of education. A cross-sectional design was used with a convenience sample of 33 English-speaking adults (M= 78 years). Data was collected using the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Mini–Mental State Examination (MMSE) and analyzed using Pearson’s correlation coefficient and bivariate correlation analysis. A significant relationship was found between health literacy and education level, but the relationship between health literacy and MMSE scores and age were not significant. It is likely that the lowNand decrease in subject variability influenced this pilot study’s overall findings, nevertheless the significant relationship between health literacy and education level is compelling to health care providers to provide health information at a level of understanding appropriate to each individual.

Background Iron deficiency is a prevalent health problem in India affecting women and newborns. Delayed umbilical cord clamping at birth is a safe and effective means for increasing serum iron levels in newborns up to 6 months of age. Aim The study aim was to increase the utilization of delayed cord clamping in a group of midwives working in Hyderabad, India. Methods A single group pre- and post-test design was used to evaluate knowledge, beliefs and practice before and after a delayed cord clamping intervention including follow-up at 10 months after the original intervention. The intervention included lectures and simulation. Results Results show significant increases in knowledge and positive beliefs about the practice of delayed cord clamping. Simulation was effective for eliciting important feedback related to learning. Limitations Results represent a small group of midwives working with a non-profit foundation in Southern India. Language discordancy and cultural norms in this group of midwives may have influenced results. Conclusions Knowledge, beliefs and practice related to delayed cord clamping were all significantly improved after the intervention. The Knowledge to Action framework using simulation is an effective cross-cultural method for implementing education about evidence-based practice. Midwives are invested in learning practices that promote public health. Implications for nursing and health policy Changing institutional policy may have limitations without first considering normative practice. Using simulation combined with institutional health policy appears to result in significant uptake of practice change. Qualitative studies exploring the interconnections between cultural norms and decision making may be informative about promoting practice change particularly in this setting. Upscaling midwifery has been recommended to improve maternal and child health in India.

The diagnosis of trisomy 13 has been considered incompatible with life. Trisomy 13 is associated with a pattern of congenital anomalies and mental disabilities that make caring for these infants a challenge for both the family and health care professionals. The clinical management of trisomy 13 varies based on the organ systems involved. The current standard of care has been withholding intensive support and providing comfort care. Recent literature suggests there are improved outcomes in infants who receive intensive care at birth. In addition, case reports evaluating older children with trisomy 13 report that, although there are significant intellectual and psychomotor disabilities, these children do meet developmental milestones such as smiling in response to parents, sitting unassisted, and walking with a walker. This case review will include a discussion of the clinical course of an infant born with mosaic trisomy 13 where the parents requested intensive care.

Septo-optic dysplasia (SOD) is a rare congenital heterogeneous malformation. SOD was formerly known as de Morsier syndrome, which associated a midline brain defect such as an absent septum pellucidum with optic nerve hypoplasia. The diagnosis of SOD is made when there are two or more characteristics of the classic triad. The triad consists of optic nerve hypoplasia, pituitary hormone abnormalities, and midline brain defects, although it can vary in the severity of clinical presentation and phenotype. The purpose of this article is to review a case and analyze the literature regarding prevalence, etiology, clinical presentation, diagnosis, and management of SOD.

Staphylococcal scalded skin syndrome (SSSS) is a rare yet well-known exfoliative skin syndrome. It involves extensive desquamated areas caused by an exfoliative toxin from Staphylococcus aureus. The typical presentation of SSSS allows for early diagnosis and treatment of the disease. Knowing and understanding the prevalence, pathophysiology, risk factors, and diagnosis of SSSS will ensure that infants being treated and cared for by neonatal nurses and neonatal nurse practitioners will receive appropriate, comprehensive, and multidisciplinary care while in the NICU. The purpose of this case review is to inform neonatal nurses and practitioners of the current literature that focuses on the diagnosis and management of SSSS.

Corticosteroids administered to women in preterm labor are the standard of care for reducing neonatal morbidity and mortality associated with prematurity. These agents promote lung development and reduce the incidence of neonatal intraventricular hemorrhage. Several studies have investigated the method by which fetal lung fluid is cleared after birth. This exploration resulted in the elucidation of the Starling equation or the hypothesis that fluid filtration through capillary membranes is dependent on the balance between the pressure blood places on the capillary membranes and the osmotic pressure of the membranes. The clinical observation that a neonate experiences a vaginal squeeze during a vaginal birth may be important, but it can account for only a small percentage of the lung fluid absorbed. Perhaps more importantly, amiloride-sensitive sodium transport channels (ENaCs) have emerged as key factors in the movement of alveolar fluid from the lung into the vascular system. Several potential clinical applications have been developed from this new knowledge about the physiology of lung fluid clearance at birth. Neonates born late preterm or at term by elective cesarean before the onset of labor are more likely to develop respiratory distress than those born vaginally. Based on the mechanism of action of antenatal corticosteroids, these drugs may be beneficial in the clearance of fetal lung fluid in this population. This article reviews how fetal lung fluid is cleared; the pharmacologic effects of corticosteroids on the fetus; and the risks, benefits, and controversies associated with corticosteroid use.

The Preceptor Orientation Self-Learning Education (POSE) module was developed as a teaching/learning tool for preparing nurses in their role as preceptors to senior nursing students in the clinical practice area. Findings from this pilot study suggest that the POSE module offered nurse preceptors an effective and convenient teaching/learning option in preparing them for their roles as clinical preceptors to student nurses. Results of this study can be used to enhance nursing education on preceptor preparation.

Four separate focus group sessions were conducted in the Detroit metropolitan area to invite vital elders to speak freely about their health, health problems, health practices, and how they maintain their bio-psycho-social and spiritual well-being. Twenty-eight participants were interviewed. The majority were African American, female, widowed, Protestant, and had achieved a high school or greater educational level. Field notes and taped interviews were transcribed for data analysis. Together, two raters completed data reduction and coding for theme identification and categorization. A holistic nursing model was used to guide the content analysis. Five themes were revealed that described the context of well-being for community-dwelling elders: faith ways, positive energy, support systems, wellness activities, and affirmative self-appraisal. Well-being depended on an awareness of how lifestyle impacted the physical, psychological, social, and spiritual health of each individual. This study lends credence to interventions aimed at promoting holistic health care for community-dwelling elders.

SUMMARY The Electronic Resource (ER) librarian must be familiar with Web technology. Central to the electronic resource position is access. A critical aspect of ensuring access is providing access to users with disabilities. Laws requiring accessible resources and libraries are briefly discussed. Guidelines for accessible Web pages are discussed in detail, as are the elements that comprise accessible Web page design. Studies reviewing the general accessibility of Web resources in higher education, Web pages of college and university libraries, and the Web pages of library schools indicate that approximately 50% are accessible. A study at Oregon State University indicated that 95% of all subscription databases were accessible in 2002 whereas in 1995, 95% were inaccessible. Assistive technologies and additional resources to help ER Librarians better serve users with disabilities are identified.

There is a philosophical connection between elements of travel and elements of spirituality. Nurses can develop spiritual intelligence, hone transcultural skills, and develop cultural humility through travel. Concepts of spiritual intelligence are incorporated to distinguish spirituality from religion. This discussion is to describe the spiritual attributes of travel through exploration of unique cultural sameness and differences, stepping out of one's routine, experiences of solitude, and the application to nursing. Venues such as study abroad, mission trips, cultural exchange opportunities, and service learning projects all can provide meaningful times of transformation, spiritual growth, learning new ways of doing things, and of being in the world. Nurses who integrate these practices into the care they provide daily will be enriched personally and rewarded with improved outcomes.

Family dyadic beliefs about pain controllability were examined to determine what influence they had on patient symptom distress and subjective caregiver burden. The Calgary Family Assessment and Intervention Models and Illness Beliefs Model guided this investigation. Self-report questionnaires were administered to a sample of 81 family dyads that consisted of ambulatory cancer care older adult outpatients and their family caregivers. Inferential statistics indicated that family dyads were congruent in their beliefs about pain controllability. Descriptive statistics showed that family dyads with beliefs that the pain was controllable had less symptom distress and caregiver burden than dyads with beliefs that pain was not controllable. Results suggest that family dyadic beliefs that cancer-related pain is controllable have a positive influence on family pain control outcomes. Findings also support the need for nurses to include family members when developing pain management interventions for older adults.

Purpose/objectives To demonstrate the effects of a program, directed at homecare nurses, of structured educational interventions on the management of pain and opioid-related side effects in homecare patients with cancer. Design A longitudinal multilevel, randomized, controlled clinical trial. Setting Midwestern region in the United States. Sample 202 nurses caring for patients with cancer recruited from homecare agencies. Methods The two-tiered educational program focused on basic and advanced pain management strategies, particularly in the area of pharmacologic options and assertive communication skills. Instruments used were the Nurses' Knowledge and Attitudes Survey Regarding Pain, the barriers questionnaire, perception of control over pain, and a demographic questionnaire. Main research variables Knowledge and attitudes about pain management, barriers to pain management, and perception of control over pain. Findings Nurses in the intervention group had a significant increase in their knowledge, a more positive attitude about pain management, fewer perceived barriers to pain management, and an increase in perceived control over pain compared to the nurses who did not receive the intervention. Conclusions The educational program Power Over Pain has beneficial effects for homecare nurses caring for patients with cancer pain. Implications for nursing A need exists for homecare nurses to gain more insight into pain management strategies and enhance their advocacy skills to improve pain management for patients with cancer treated in the home.

This workshop introduced the barriers and challenges clients with disabilities face when using electronic resources. It introduced screen-readers and used them to evaluate the accessibility of three aggregator databases: EBSCOhost, INFOTRAC, and FirstSearch Electronic Collections Online. Conclusions about the accessibility of each database were presented.

The workshop discusses the ethical, legal, and economic reasons for making Web sites accessible to all. It includes a brief history of disability law, discusses myths about accessible Web site design, presents the Web Access Initiative's fourteen guidelines for designing accessible Web sites, and discusses the priority one checkpoints for each guideline.

Three aggregator databases, EBSCOhost, InfoTrac, and First Search Electronic Collections Online (ECO), were analyzed for compliance with the Web accessibility guidelines published by the Web Access Initiative section of the World Wide Web Consortium. A sighted librarian then used each database with JAWS for Windows 3.7, OpenBook 5.0, ZoomText 7.0, and the L&H Kurzweil 1000 and 3000. Results indicate that JAWS for Windows 3.7 works best for the blind, and that ZoomText 7.0 is acceptable for those needing screen magnification. None of the databases tested offers a perfect accessibility option for clients with visual impairment. Conclusions suggest that aggregator databases do not follow the accessibility guidelines and consequently are not supplying accessible products.

Of the five steps involved in disaster recovery (prevention, preparation, response, recovery, and follow-through) this Pre-con-ference session focused primarily on response and recovery. The elements of a disaster response plan and some of the decisions necessary immediately following a disaster are discussed. A disaster scenario is described, as are hands-on exercises undertaken by participants.

Jeanne and Kristine provided a historical overview of the paper deterioration process, summaries of surveys examining the pH of journals and monographs, and four different types of deacidification processes. The deacidification program at the Milton S. Eisenhower Library at Johns Hopkins University is presented in detail. Particular emphasis is placed on the workflow at the library and the procedures used at the deacidification facility. The four steps of the deacidification workflow are: identification, deacidification, recording the action in the library management system, and physically marking the volumes. The challenges at the Eisenhower library are keeping in-house costs low and limiting user-impact.

The Enneagram is a nine-point personality model focused on personal development. Workshop participants took the Riso Hudson Enneagram Type Instrument (RHETI) prior to attending the workshop and brought their scores as a beginning point for working with the model. Among the questions answered during the workshop were: What life experiences (stories) confirm that I am in the correct group? What is our preferred communication style? What leadership attributes are best expressed by our type? What are our leadership challenges? How can we develop our leadership capabilities?

Historically, libraries' dependence on student workers was viewed as a necessary evil; however, this attitude has become more positive, recognizing that the arrangement has the potential to benefit the institution, the students, and the profession. Central Missouri State University depends on student workers to help meet the needs of the campus community. In 1990, the implementation of a mandatory orientation program ensured that student employees are well-versed not only in their own unit, but that they possess general knowledge of areas outside their work assignment. Central's orientation program consists of a student employee handbook and contract, a video, a tour of the library, an evaluation process, and a way to recognize outstanding employees.

Fiscal and financial constraints present a challenge for nurse educators to broaden the diversity and scope of teaching/learning methodologies. One method designed to promote autonomy and self-direction of nursing students is self-reflection combined with reflective journal writing. This paper describes a three-step process of self-reflection encompassing critical appraisal, peer group discussion and self-awareness. This process of self-reflection was initiated with one group of clinical nursing students. Using student and teacher feedback, implications for employing this teaching/learning strategy in clinical practice are suggested.

Research has demonstrated that good mentoring is a key factor in determining success in a doctoral program. As a result, graduate mentoring programs are appearing with increasing frequency. Congress has funded the Ronald E. McNair Post-Baccalaureate Achievement Program to increase representation in doctoral study. Targeted groups include low-income, first-generation college students, and students from groups underrepresented in graduate education. Central Missouri State University's McNair program (McCAP) utilizes librarians as part of a mentoring team. The mentoring team is used to guide participants through four levels of activities: foundation, mentoring, internship, and transition. Librarian involvement provides advantages for the student as well as other faculty members involved with the mentoring team.

Purpose: The purpose of this study was to determine if there were any differences in the behavioral responses of persons with dementia while listening to nonreligious and religious music within a multisensory environment. Research Design: A within-subjects, repeated measures design was used. Method: Participants were exposed to both musical genres during multiple sessions over a 4-week period. Neuropsychiatric symptoms were recorded before and after the musical intervention. Behavioral responses to the music were recorded while listening to themusic. Findings: No significant difference was found between the numbers of neuropsychiatric behaviors observed before and after the participants listened to the nonreligious and religious music. A significant difference was found between the musical interventions as a whole and the number of agitated behaviors before and after intervention. No significant difference was found in the observed behavioral responses with the nonreligious and religious music. Conclusions: Music can be a useful intervention to reduce neuropsychiatric symptoms in persons with dementia.