Minimizing Obstetric Hemorrhage

Patients undergoing cesarean deliveries are at risk for hemorrhage. In fact, hemorrhage is the leading cause of preventable maternal mortality and accounts for more than 140,000 deaths each year worldwide (O’Brien & Ulh, 2016). Hemorrhage has been associated with a number of well-established risk factors which could be recognized prior to delivery. Women who do not have these risk factors could still experience postpartum hemorrhage, but using a risk assessment tool has been shown to identify 60-85% of women who will experience hemorrhage (Shields, Goffman, & Caughey, 2017). The postpartum hemorrhage (PPH) risk assessment tool, developed by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), identifies women with PPH risk factors. The tool allows clinicians to prepare for possible interventions and close monitoring of women at increased risk of bleeding, to ultimately prevent mortality. At a metropolitan hospital PPH risk assessments were not being discussed during standard pre-procedure huddles. This quality improvement project added the PPH risk assessment tool to the pre procedure huddle sheet. This facilitated interdisciplinary team discussion of PPH risk factors for patients undergoing cesarean deliveries. There were a total of 575 mothers in the study with 297 in the pre intervention period and 278 in the post. There was a statistically significant increase in estimated blood loss (EBL) between the pre and post intervention groups. While the study tool did not result in a decrease in EBL, it increased awareness among the interdisciplinary care team by facilitating discussion about PPH

Towards Unified Data Exchange Formats for Reporting Molecular Drug Susceptibility Testing

Background: With the rapid development of new advanced molecular detection methods, identification of new genetic mutations conferring pathogen resistance to an ever-growing variety of antimicrobial substances will generate massive genomic datasets for public health and clinical laboratories. Keeping up with specialized standard coding for these immense datasets will be extremely challenging. This challenge prompted our effort to create a common molecular resistance Logical Observation Identifiers Names and Codes (LOINC) panel that can be used to report any identified antimicrobial resistance pattern. Objective: To develop and utilize a common molecular resistance LOINC panel for molecular drug susceptibility testing (DST) data exchange in the U.S. National Tuberculosis Surveillance System using California Department of Public Health (CDPH) and New York State Department of Health as pilot sites. Methods: We developed an interface and mapped incoming molecular DST data to the common molecular resistance LOINC panel using Health Level Seven (HL7) v2.5.1 Electronic Laboratory Reporting (ELR) message specifications through the Orion Health™ Rhapsody Integration Engine v6.3.1. Results: Both pilot sites were able to process and upload/import the standardized HL7 v2.5.1 ELR messages into their respective systems; albeit CDPH identified areas for system improvements and has focused efforts to streamline the message importation process. Discussion: The common molecular resistance LOINC panel is designed to be generalizable across other resistance genes and ideally also applicable to other disease domains. Conclusion: The study demonstrates that it is possible to exchange molecular DST data across the continuum of disparate healthcare information systems in integrated public health environments using the common molecular resistance LOINC panel. Keywords: Data Exchange Formats, Electronic Laboratory Reporting, Health Information Exchange, LOINC, Health Level Seven, Public Health Surveillance

特集第2部 地域医療

Constitutive NF-κB signaling promotes survival in multiple myeloma (MM) and other cancers; however, current NF-κB-targeting strategies lack cancer cell specificity. Here, we identify the interaction between the NF-κB-regulated antiapoptotic factor GADD45β and the JNK kinase MKK7 as a therapeutic target in MM. Using a drug-discovery strategy, we developed DTP3, a D-tripeptide, which disrupts the GADD45β/MKK7 complex, kills MM cells effectively, and, importantly, lacks toxicity to normal cells. DTP3 has similar anticancer potency to the clinical standard, bortezomib, but more than 100-fold higher cancer cell specificity in vitro. Notably, DTP3 ablates myeloma xenografts in mice with no apparent side effects at the effective doses. Hence, cancer-selective targeting of the NF-κB pathway is possible and, at least for myeloma patients, promises a profound benefit