Developing a Patient Care Standard for Adolescents Based on a Nursing Needs Assessment

Mental health patients often suffer from chronic medical conditions and psychiatric comorbidities requiring frequent emergency, primary care, and acute care visits (Douzenis et al., 2012). Caring for psychiatric patients in acute care hospitals has become an increasing burden on healthcare systems with processes in place to care for acute and critical care patients. Healthcare leaders, providers, emergency departments, and medical/surgical hospitals are straining to provide care for complex patients with acute medical conditions and complex mental health needs (Reiss-Brennan, Briot, Savitz, Cannon, & Staheli, 2010). Caring for children and adolescents with medical and psychiatric problems creates the need for a structured, evidence-based plan as well as systems to provide the safest environment for these children to heal. This project created a Patient Care Standard based on a nursing needs assessment to provide a structured plan of care to utilize available resources and identify opportunities for future quality service line improvements. The Model for Improvement was utilized to guide this process. The Model for Improvement is utilized and recommended by the Institute for Healthcare Improvement (IHI) for process improvement. This project highlights the ongoing needs of adolescent mental health patients who are receiving care in medical centers all over the country and the struggle for the healthcare team to meet those needs. This project continues to advocate for the needs of the mental health community as well as the healthcare team who are providing care for them. A Patient Care Standard for pediatric patients receiving care in a non-mental health facility will further define processes and give the healthcare team the tools necessary to advocate for this fragile patient population. Ongoing development of resources and defining the expectations of the mental health practitioners will create a program that comprehensively meets the needs of children, adolescents, healthcare team members, and families

Process versus product: which determines consumer demand for genetically modified apples?

One debate in the literature regarding consumers’ reactions to genetically modified food (GMF) centres on whether consumers react to the process of gene technology or to the specific GMF products. Results from a choice experiment survey in New Zealand indicate that consumers are heterogeneous with regard to GMF and that some modifications are viewed more positively than others. These findings suggest that for some consumers the process of gene technology is the decisive factor in evaluatingGMF, while for others the different potential GMF products are valued according to their enhanced attributes.choice modelling, consumer surveys, food, genetic modification, preferences, Consumer/Household Economics, Demand and Price Analysis,

Asthma in Sickle Cell Disease: Implications for Treatment

Objective. To review issues related to asthma in sickle cell disease and management strategies. Data Source. A systematic review of pertinent original research publications, reviews, and editorials was undertaken using MEDLlNE, the Cochrane Library databases, and CINAHL from 1947 to November 2010. Search terms were [asthma] and [sickle cell disease]. Additional publications considered relevant to the sickle cell disease population of patients were identified; search terms included [sickle cell disease] combined with [acetaminophen], [pain medications], [vitamin D], [beta agonists], [exhaled nitric oxide], and [corticosteroids]. Results. The reported prevalence of asthma in children with sickle cell disease varies from 2% to approximately 50%. Having asthma increases the risk for developing acute chest syndrome , death, or painful episodes compared to having sickle cell disease without asthma. Asthma and sickle cell may be linked by impaired nitric oxide regulation, excessive production of leukotrienes, insufficient levels of Vitamin D, and exposure to acetaminophen in early life. Treatment of sickle cell patients includes using commonly prescribed asthma medications; specific considerations are suggested to ensure safety in the sickle cell population. Conclusion. Prospective controlled trials of drug treatment for asthma in patients who have both sickle cell disease and asthma are urgently needed

Localization of the transcriptional coactivator PGC-1Α to GABAergic neurons during maturation of the rat brain

The transcriptional coactivator peroxisome proliferator activated receptor Γ coactivator 1Α (PGC-1Α) can activate a number of transcription factors to regulate mitochondrial biogenesis and cell-specific responses to cold, fasting, and exercise. Recent studies indicate that PGC-1Α knockout mice exhibit behavioral abnormalities and progressive vacuolization in various brain regions. To investigate the roles for PGC-1Α in the nervous system, we evaluated the temporal and cell-specific expression of PGC-1Α in the normal developing rat brain. Western blot of whole brain homogenates with a PGC-1Α-specific antibody revealed that PGC-1Α protein was most abundant in the embryonic and early postnatal forebrain and cerebellum. Using quantitative reverse-transcriptase polymerase chain reaction (RT-PCR), we determined that PGC-1Α mRNA expression increased most markedly between postnatal days 3 (P3) and 14 in the cortex, striatum, and hippocampus. Immunohistochemical and immunofluorescence analyses of brain tissue indicated that while PGC-1Α was found in most neuronal populations from embryonic day 15 to P3, it was specifically concentrated in GABAergic populations from P3 to adulthood. Interestingly, PGC-1Α colocalized with the developmentally regulated chemoattractant reelin in the cortex and hippocampus, and the survival-promoting transcription factor myocyte enhancing factor 2 was highly concentrated in GABAergic populations in the striatum and cerebellum at times of PGC-1Α expression. These results implicate PGC-1Α as a regulator of metabolism and/or survival in GABAergic neurons during a phase of mitochondrial and synaptic changes in the developing brain and suggest that PGC-1Α may be a good target for increasing metabolism in GABAergic populations in neurodevelopmental and neurodegenerative disorders. J. Comp. Neurol. 502:1–18, 2007. © 2007 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55932/1/21211_ftp.pd

The effect of sugar-sweetened beverage price increases and educational messages on beverage purchasing behavior among adults

There is a paucity of evidence regarding the impact of sugar sweetened beverage (SSB) price increases on beverage consumption, using individual-level data, for the population overall and for different socioeconomic groups. This study aimed to predict the impact of altered beverage prices and educational messages on consumer purchasing behavior. 2020 adults representative of the Australian population by age, gender and income completed a discrete choice experiment online in 2016. Each subject completed 20 choice scenarios in a hypothetical convenience store setting where subjects chose between seven SSB and non-SSB beverage options or a no beverage option. Beverage prices and volumes varied between scenarios. Half of participants (n = 1012) were randomly exposed to an educational poster discouraging SSB consumption prior to completing choice scenarios. We used discrete choice models to predict purchases under several policy proposals, overall and for income and SSB consumption frequency sub-groups. Compared to baseline prices, a 10% SSB price increase was predicted to reduce SSB purchases by 15.0% [95%CI -15.2, -14.7], and increase purchases of non-SSBs by +11.0% [95%CI 10.8, 11.2] and no beverage by +15.5% [95%CI 15.1, 15.9]. Effects were greater with a 20% SSB price increase. Across all policy scenarios, the highest income quintile had a similar absolute and slightly greater relative decrease in SSB purchases compared to the lowest quintile. Educational poster exposure reduced SSB choice for all groups, with a greater reduction in the lower compared to higher income group, and additively increased response to price changes. Our results support the use of population-wide SSB pricing and educational interventions to reduce demand across all income groups.This research was funded by a Monash University Faculty of Businessand Economics Interdisciplinary Grant. MB is supported by an AustralianGovernment Research Training Program Scholarship and a MonashUniversity Departmental Scholarship. KB is supported by a post-doctoralfellowship from the National Heart Foundation of Australia (grant numberPH 12 M 6824). AP is supported by a National Health and Medical ResearchCouncil (NHMRC) fellowship. EL is supported by an Australian ResearchCouncil (ARC) fellowship (grant number DE140101260

Review Article Asthma in Sickle Cell Disease: Implications for Treatment

Objective. To review issues related to asthma in sickle cell disease and management strategies. Data Source. A systematic review of pertinent original research publications, reviews, and editorials was undertaken using MEDLlNE, the Cochrane Library databases, and CINAHL from 1947 to November 2010. Search terms were [asthma] Results. The reported prevalence of asthma in children with sickle cell disease varies from 2% to approximately 50%. Having asthma increases the risk for developing acute chest syndrome , death, or painful episodes compared to having sickle cell disease without asthma. Asthma and sickle cell may be linked by impaired nitric oxide regulation, excessive production of leukotrienes, insufficient levels of Vitamin D, and exposure to acetaminophen in early life. Treatment of sickle cell patients includes using commonly prescribed asthma medications; specific considerations are suggested to ensure safety in the sickle cell population. Conclusion. Prospective controlled trials of drug treatment for asthma in patients who have both sickle cell disease and asthma are urgently needed

Importance of decision support implementation in emergency department vancomycin dosing

INTRODUCTION: The emergency department (ED) plays a critical role in the management of life-threatening infection. Prior data suggest that ED vancomycin dosing is frequently inappropriate. The objective is to assess the impact of an electronic medical record (EMR) intervention designed to improve vancomycin dosing accuracy, on vancomycin dosing and clinical outcomes in critically ill ED patients. METHODS: Retrospective before-after cohort study of all patients (n=278) treated with vancomycin in a 60,000-visit Midwestern academic ED (March 2008 and April 2011) and admitted to an intensive care unit. The primary outcome was the proportion of vancomycin doses defined as “appropriate” based on recorded actual body weight. We also evaluated secondary outcomes of mortality and length of stay. RESULTS: The EMR dose calculation tool was associated with an increase in mean vancomycin dose ([14.1±5.0] vs. [16.5±5.7] mg/kg, p<0.001) and a 10.3% absolute improvement in first-dose appropriateness (34.3% vs. 24.0%, p=0.07). After controlling for age, gender, methicillin-resistant staphylococcus aureus infection, and Acute Physiology and Chronic Health Evaluation II score, 28-day in-hospital mortality (odds ratio OR 1.72; 95% CI [0.76–3.88], p=0.12) was not affected. CONCLUSION: A computerized decision-support tool is associated with an increase in mean vancomycin dose in critically ill ED patients, but not with a statistically significant increase in therapeutic vancomycin doses. The impact of decision-support tools should be further explored to optimize compliance with accepted antibiotic guidelines and to potentially affect clinical outcome

Towards a new model of attentional biases in the development, maintenance, and management of pain

Individuals with chronic pain demonstrate attentional biases towards pain-related stimuli. However, the clinical importance of these biases is yet to be determined and a sound theoretical model for explaining the role of attentional biases in the development and maintenance of pain is lacking. Within this article, we (1) systematically review prospective and experimental research exploring attentional biases and pain outcomes in light of current theoretical models and (2) propose a theoretical framework for understanding attention bias in pain. Across prospective research, an attentional pattern of vigilance-avoidance was observed. Interventions targeting attentional biases were less consistent; however, there were promising findings amongst studies that found attentional training effects, particularly for laboratory research. The proposed Threat Interpretation Model suggests a relationship between threat, interpretation and stimuli in determining attentional processes, which whilst tentative generates important testable predictions regarding the role of attention in pain, and builds upon previous theoretical and empirical work in this area