Meconium aspiration syndrome

This issue of eMedRef provides information to clinicians on the pathophysiology, diagnosis, and therapeutics of meconium aspiration syndrome

It\u27s Just a Way of Fitting In: Tobacco Use and the Lived Experience of Lesbian, Gay, and Bisexual Appalachians

Lesbian, gay, and bisexual (LGB) people are affected by multiple health disparities and risk factors, including tobacco use. Few studies to date have examined tobacco use specifically in rural LGB populations, and none has investigated the intersections of identity, rural LGB culture, and tobacco. The purpose of this study was to explore the perspective of Appalachian LGB people regarding tobacco use. METHODS: Nineteen LGB-identified Appalachian residents participated in audiotaped, semi-structured interviews. Two authors analyzed and coded transcripts through constant comparison, and determined themes through consensus. RESULTS: Five themes emerged: the convergence of Appalachian and LGB identities, tacit awareness of LGB identity by others, culture and tobacco use, perceived associations with tobacco use, and health beliefs and health care. CONCLUSIONS: LGB Appalachians connect stress and culture to tobacco, but seem less aware that partial concealment of their identity might be a source of the stress that could influence their smoking

Vitamin D An Examination of Physician and Patient Management of Health and Uncertainty

Vitamin D has been a topic of much research interest and controversy, and evidence is mixed concerning its preventive effects and health benefits. The purpose of our study was to explore the decision-making strategies used by both primary care providers and community members surrounding vitamin D in relation to uncertainty management theory. We conducted semistructured interviews with primary care providers (n = 7) and focus groups with community members (n = 89), and transcribed and coded using the constant comparative method. Themes for providers included awareness, uncertainty, patient role, responsibility, skepticism, uncertainty management, and evolving perceptions. Community member focus group themes included uncertainty, information sources, awareness/knowledge, barriers, and patient–provider relationship. Both providers and community members expressed uncertainty about vitamin D but used conflicting strategies to manage uncertainty. Awareness of this disconnect might facilitate improved patient–provider communication

Teach Students, Empower Patients, Act Collaboratively and Meet Health Goals: An Early Interprofessional Clinical Experience in Transformed Care

Purpose: Transformation of care teaching is often didactic and conceptual instead of practical and operational. Clinical environments, slow to transform, limit student exposure to key experiences that characterize transformed care. We describe the design and implementation of TEAM Clinic (Teach students, Empower patients, Act collaboratively, Meet health goals) – an early clinical learning experience to address this gap. Methods: The TEAM Clinic curriculum was based on a review of existing curricula and best practice recommendations for the transformation of care. Three key elements were selected as the focus for a low-volume, high-service clinic: patient centeredness, interprofessional collaboration and team-based care. Learners and medically and socially complex patients were recruited for voluntary participation and completed anonymous surveys about the experience during and afterward. Results: Nine first-year medical students, two first-year social work students and one pharmacy resident were integrated into the interprofessional team. Students were assigned roles adapted to their level and skill set; deliberate interprofessional pairing was assigned to broaden perspectives on scope and role of team members. Upon completion of this two-semester experience, 11 of the 12 learners returned surveys; all rated the experience as positive (strongly agree or agree) on the Authentic Clinical Interprofessional Experience – Evaluation of Interprofessional Site tool. Patient surveys indicated satisfaction with multiple aspects of the visit. Conclusion: TEAM Clinic provided a practical example of transformation of care teaching in a not-yet-transformed environment. Logistical barriers included space, schedule and staffing. Facilitators included alignment with the goals of core curricula and faculty. Limitations included that this description of these curricula and this pilot come early in our longitudinal development of TEAM Clinic, constraining our ability to measure behavioral changes around interprofessional education, teamwork or patient centeredness. Next steps would examine the trajectory to these outcomes in the preclinical student group

The Emergency Department as a Potential Intervention Recruitment Venue Among Vulnerable Rural Residents

Meeting the health care needs of rural residents is complicated by their substantial medical burdens that frequently outstrip patient and community resources. Nowhere is this more evident than in central Appalachia. Preventive procedures are often sacrificed as patients and providers attend to more pressing medical issues. We report the results of a pilot study designed to explore the need for and appropriateness of a potential intervention placed in an emergency department (ED), with the eventual goal of using the ED to link traditionally underserved patients to preventive services. We used a convenience sample of 49 ED patients to explore their characteristics and health needs and compare them with a sample of 120 case management clients participating in the Kentucky Homeplace Program (KHP), and a general sample of 3,165 Appalachian Kentuckians. The recruited ED patients had low socio-economic status, numerous health conditions, and several unmet health needs, including need for colorectal, cervical, and breast cancer screening. Compared to their KHP counterparts, more ED patients were uninsured. Participants in the ED and KHP groups had particularly low income, were less educated, and had less insurance coverage than an average Appalachian resident. Although case management services, including the KHP have been successful in increasing access to health care by those in need, certain segments of the population remain underserved and continue to be missed by such programs. Our study suggests the need for and appropriateness of reaching out to such underserved populations in the ED and involving them into potential interventions designed to enhance preventive health services

The Emergency Department as a Potential Intervention Recruitment Venue Among Vulnerable Rural Residents

Meeting the health care needs of rural residents is complicated by their substantial medical burdens that frequently outstrip patient and community resources. Nowhere is this more evident than in central Appalachia. Preventive procedures are often sacrificed as patients and providers attend to more pressing medical issues. We report the results of a pilot study designed to explore the need for and appropriateness of a potential intervention placed in an emergency department (ED), with the eventual goal of using the ED to link traditionally underserved patients to preventive services. We used a convenience sample of 49 ED patients to explore their characteristics and health needs and compare them with a sample of 120 case management clients participating in the Kentucky Homeplace Program (KHP), and a general sample of 3,165 Appalachian Kentuckians. The recruited ED patients had low socio-economic status, numerous health conditions, and several unmet health needs, including need for colorectal, cervical, and breast cancer screening. Compared to their KHP counterparts, more ED patients were uninsured. Participants in the ED and KHP groups had particularly low income, were less educated, and had less insurance coverage than an average Appalachian resident. Although case management services, including the KHP have been successful in increasing access to health care by those in need, certain segments of the population remain underserved and continue to be missed by such programs. Our study suggests the need for and appropriateness of reaching out to such underserved populations in the ED and involving them into potential interventions designed to enhance preventive health services