By I. Esiel. Knox College. 2017.

Grab the attention of your audience right from the start; you can appeal to their curiosity 40 mg inderal la mastercard, tell an anecdote purchase 40 mg inderal la with mastercard, use a powerful and pertinent quote. Catch their eyes and engage them by being enthusiastic, even passionate, about your subject. Decide on your mode of delivery The medium of presentation needs some careful thought. Make your visual aids clear and simple Just as doctors can reinforce the information they give to patients with written materials or simple diagrams or drawings, your visual aids should illuminate or illustrate your words. If you are showing a slide for instance, it is enormously helpful to state what in general it is about as you show it. If your audience needs to read something on your slide or overhead, stay silent for a few seconds. You will be very familiar with your material but do not assume that your audience shares your understanding; for example say what the "x" and "y" axes represent on a graph; explain the key to your histograms. We would probably all like a pound for every slide or overhead that we have been shown in a scientific presentation that is impossible to see or interpret, for which the presenter apologises to the audience. Why not make a new slide which summarises the point that the original was attempting to make? Consider varying the delivery mode Attention span is limited, especially if your audience is sitting through a series of presentations. In a presentation lasting more than 15–20 minutes, it is worth thinking about switching modes of delivery – for instance, to use a video clip to illuminate a particular point which you wish to drive home. Think about the visual impact of being shown an operating technique, for instance, versus a verbal description of it. Or a real patient describing a condition they suffer from, versus your description of what such a patient might say. Don’t go over the top We have all been to presentations that were dazzling – dual projection, fancy animated PowerPoint slides, videoclips, etc.

Persons weighing less than 100 lb having mild cognitive impairment (but not meeting clin- (45 generic 40 mg inderal la with visa. For the pur- physicians identify older persons at risk for malnourish- poses of the systematic review 40mg inderal la sale, criteria for mild cognitive ment. Bloom Mini-Mental Status Exam (MMSE), the Short Portable (HHIE-S) are both valid screening tools with similar Mental Status Questionnaire, and the Clock-Drawing specificities and likelihood ratios, but audioscope testing Test. A very simple three-item recall test has a sensitiv- is the more sensitive test in both older120–122 and ity of 90% for patients unable to remember all three younger123 adults and is considered to be the gold stan- items after 1 min. The majority of older adults receiving both these tive impairment is indicated by scores between 18 and 24 screening tests in one primary care setting preferred on the Mini-Mental Status Exam. The MMSE must be audioscope testing (60%) to the HHIE-S (13%) because adjusted for high education or intelligence levels. The they believed it to be more "reliable," an important con- Clock-Drawing Test, despite multiple scoring systems, has sideration as many older adults are reluctant to follow a mean sensitivity and specificity of 85% and a likelihood through on recommendations to get further testing and ratio greater than 10. Depending on whether a quadrant of the clock alone are almost diagnostic of cutoff score of 8 or 24 is used, the HHIE-S has a sensi- dementia. The audioscope, depending on reference note that depression, language differences, hearing standard used, has a sensitivity range of 64% to 96%, impairment, and aphasia can affect the accuracy of cog- specificity of 80% to 91%, and positive likelihood ratio nitive screening tests. The setting due to broad variation in outcomes between Confusion Assessment Method has a high specificity for examiners. Screening for Visual Acuity and Glaucoma (See Chapter 59) Incontinence (See Chapters 50 and 63) Routine vision screening utilizing Snellen acuity testing Patients are often reluctant to mention or seek help for to detect diminished visual acuity is recommended for urinary or fecal incontinence, yet both are common prob- older individuals although there have not been any trials lems with aging, affecting independence and quality of in older individuals that primarily assessed vision per life. Frequent urinary (See Chapter 60) incontinence (weekly or more often) is associated with an increased risk of falls and nonspinal fractures in older A very common problem in older adults, hearing impair- women. Fecal incontinence can be ate persons and are smaller and consmetically more screened for in a similar manner. Appropriate exercise can include regimens easily integrated into a routine day such Regular physical activity has been shown in numerous as walking, climbing and descending stairs, swimming, studies to be an extremely important preventive interven- gardening, and bicycling (mobile or stationary). Exercise promotes health and stimu- viduals unable to ambulate or transfer independently, lates a sense of well-being. Regular exer- benefits of regular exercise for older people are the fol- cise is therefore appropriate for people at any age and lowing:an increase in lean body mass and strength;a reduc- almost all stages of functional status.

Finally buy 40mg inderal la visa, many programs have tive for a time and then no longer retain the same value begun adopting more of a systems approach to providing when the entire health care system and reimbursement care that also includes the community and patient as well system change buy 40mg inderal la free shipping. One approach has been to utilize geronto- management as a major philosophic tenet and practical logic nurse practitioners who are based at senior centers approach (e. In the best cases, there is partner- agement plan emphasizes physical activity and chronic ship with community agencies and resources to provide illness self-management, including attending a 7-week complementary education and services. Although the intervention did not demonstrate An important caveat in interpreting these new CGA- functional or health status benefits, total hospital days like interventions is that their effectiveness may be were reduced. Variations in health care delivery and have high predicted health care utilization is the Chronic 200 D. Reuben Care Clinics developed at Group Health Cooperative of reduction in new cases of delirium and hospitalized Puget Sound. In one ran- A major trend in the management of chronic illness has domized clinical trial, significant benefits on health, func- been disease management in which health care delivery tional status, or costs could not be demonstrated at 24 has been focused around a single disease (target condi- months. Another comprehensive care model that uses an These programs adopt the assessment and intervention interdisciplinary team of health professionals is the Co- approach of CGA, frequently using an interdisciplinary operative Health Care Clinics developed at Kaiser- team. The prototype condition has been congestive heart Permanente, Colorado, and widely replicated elsewhere. A multidisciplinary program (geriatrics car- This model of care focuses on older persons who have at diologist, nurse, dietitian, and social worker) for elderly least one of four chronic conditions (heart, lung, or joint patients with heart failure who were at risk for readmis- disease, or diabetes) and high outpatient utilization. At the end of these 90-min sessions, 30 min are set prehensive discharge planning and home follow-up has aside for brief one-on-one visits with the physician, if been developed and tested. In a randomized clinical trial, such care was criteria, a program of comprehensive discharge planning associated with increased visits and calls to nurses but (including multidimensional assessment), and home fewer emergency room and subspecialist visits and fewer follow-up with advanced practice nurses who visited the hospitalizations. Although there were no differences patients at least every other day during the hospitaliza- in health and functional status measures, participants tion and at least twice during the 4 weeks following dis- were more satisfied with their care and the overall costs charge; these visits were supplemented by telephone of care were less. In a randomized clinical trial, this intervention was associated with reduced hospital readmissions and costs (both reduced by approximately 50%). In-Hospital Settings Several interventions have incorporated CGA principles Case/Care Management into hospital care of older persons.

Local anesthetics discount inderal la 40mg overnight delivery, however generic inderal la 40 mg with mastercard, can cause weakness, and incoordination; altered bladder and bowel orthostatic hypotension, urinary retention, and muscle function with retention and constipation; and urinary and weakness, while the opioids cause urinary retention and fecal incontinence. The patient is given a button to push to deliver program for the measurement and enhancement of the a fixed dose of drug when needed. Predictors of because the patient must be conscious enough to push the immediate and 6 month outcome in hospitalized elderly patients. The risk of postoperative the patient must be able to understand the instructions deconditioning in older adults. Cardiac prog- becomes intense to maintain the effective level of pain nosis in noncardiac geriatric surgery. Prediction of cardiac and pulmonary complications related to elective References abdominal and noncardiac thoracic surgery in geriatric patients. Preoperative evalua- of anesthesia and surgery in people 100 years of age and tion of cardiac function and ischemia in elderly patients older. Cost- self-administered questionnaire to determine functional effectiveness of coronary artery bypass surgery in octo- capacity (the Duke’s Activity Status Index). What is sub- ment for the comparative assessment of the quality of sur- jective global assessment of nutritional status? In: Cassel CK, Cohen HJ, Larson cholecystectomy in the elderly: a longitudinal analysis of EB, et al. Perianesthetic considerations sion of the extracellular water in elderly patients with for the elderly patient. The first national, validated, clinical prediction rule for delirium after elective noncar- outcome-based, risk adjusted, and peer-controlled diac surgery. Long-term derived growth factors, epidermal growth factor, insulin, postoperative cognitive dysfunction in the elderly: transferrin, and dexamethasone.

Feminist therapists challenge both women and men to in- corporate instrumental and expressive behaviors into their repertoires and help the clients own and nurture their own needs generic 40 mg inderal la amex. Worell and Remer (1992) summarized some of the goals of feminist therapy as helping clients "be- come aware of their own sex-role socialization process generic 40mg inderal la amex, identify their inter- nalized sex-role messages/beliefs, [and] develop a full range of behaviors that are freely chosen, not dictated" (p. It is also important to learn to balance independence and dependence (interdependence) in one’s relation- ships and to cultivate a broad range of interpersonal and life skills for work, family, and social areas. Owning personal strengths, recognizing and utilizing anger appropriately, and developing skills for assertive but com- passionate conflict management are also desirable outcomes. Female skills, perspectives, and value systems are also valued for both women and men. Worell and Remer (1992, 2003) also described a number of techniques of feminist therapy. Sex-role analysis increases client awareness of gender-role expectations and consequences and how they differ for women and men by helping the client "identify how societal structures and expectations related to traditional gender arrangements have influenced their lives" (1992, p. Power analysis identifies the power differential that exists between men and women in a variety of arenas, assists clients "in understanding both the de- structive and effective uses of power" (1992, p. As- sertiveness training allows clients to own both their anger and their passiv- ity and teaches them to express their needs and viewpoints assertively. Feminist and Contextual Work 233 Consciousness-raising groups support clients by giving them a forum to dis- cuss their lives. Shifting the focus of client issues from the intrapsychic to the external may utilize the family therapy strategy of reframing or rela- beling. Therapy is demystified by therapists sharing information regarding the therapy process and their theoretical orientation, mutually developing a contract and goals, teaching new life skills to clients, and processing the progress of therapy together. Therapists may also teach clients how women and men may use language differently based on their gender-role socializa- tion (Lakoff, 1975, 1990; Spender, 1985; Tannen, 1990). FEMINIST THERAPY FOR COUPLES How are feminist therapy principles applied to couples therapy?