Littleton Adventist Hospital

Purpose To describe the effects of consistent levels of testosterone in a pellet form and it’s potential to reverse osteoporosis. Methods This is a descriptive case report of a 54 year male with a spontaneous fracture and osteoporosis in the presence of what many consider a normal male testosterone level. Results After discovering and documenting osteoporosis by DXA scan, the patient was shown to reverse the diagnosis of osteoporosis in a year on pelleted testosterone therapy. Consistent levels of 943 ng/dL were achieved; the patient also experienced improvements in quality of life and sleep apnea. Conclusion Testosterone deficiency (TD) is a clinical syndrome and osteoporosis can be found in levels above standard “criteria” of 300. This patient did not realize a benefit on injections both physical and clinically and both improved on pelleted testosterone. This should be further studied and considered for TD in men.

The recent introduction of clinically available next generation sequencing (NGS) cancer panels has presented new challenges for genetic counselors. Determining which patients are appropriate for NGS panel testing is complex. Due to the large number of genes included in the NGS panels, thorough and appropriate pre-test counseling and interpretation of NGS results can be a time-consuming and difficult process. Many of the genes associated with increased cancer risk lack published clinical management guidelines and estimates of cancer risk for individuals with deleterious mutations. In order to efficiently and effectively review the clinical utility of NGS panels, Colorado cancer genetic counselors formed a working group to gain a better understanding of the genes included in NGS cancer panels. This publication reports on the approach of this group, the process used to evaluate a selected NGS panel, future directions for this collaboration, and ideas for other genetic counselors to form similar groups to efficiently evaluate new technologies and improve practice.

Acute stroke can result in neurological impairment or death. The Colorado Stroke Alliance and the Colorado Stroke Registry have made progress toward improving stroke care through their statewide quality improvement efforts. This report is a follow-up to a previous publication in the Journal of Neuroscience Nursing. The previous report focused on the organization and structure of the Colorado Stroke Alliance. The present report describes some of the successes and insights that have been achieved, including adherence to stroke quality indicators, gender disparities, process times for intravenous recombinant tissue plasminogen activator/alteplase, the impact of emergency medical services, and the role that nurses continue to have as agents of change in improving hospital care.

To describe a healthy mother, a healthy pregnancy, a healthy baby, and the resources essential for achieving these goals from the perspective of Mexican women in a new destination immigrant community in the United States. Traditional care and health behaviors are often cited to explain the favorable birth outcomes of Mexican-born women in the United States. Little is known about the approaches Mexican women use to have healthy babies in new destination communities. Eleven Mexican women of childbearing age in the early years of their settlement participated in semifocused ethnographic interviews. Healthy mothers have good nutrition and abstain from substance use. Healthy pregnancies are worry-free and tranquil, and healthy behaviors are supported by networks of people with good morals who motivate women and provide sound advice. Information needs include vitamin supplementation before and after pregnancy and family planning. English skills and having the courage to go out and meet people are vital for healthy childbearing. Informed prenatal care programs preserve diet and low substance use behaviors, reduce stress, and provide networking opportunities and information about family planning, prenatal care services, nutrition, and folic acid supplementation.