Documenting Body Mass Index and Lifestyle Counseling for Pediatric Patients: A Quality Improvement Project at a Federally Qualified Healthcare Facility

Background: Screening and monitoring growth throughout childhood and adolescence, as well as providing the necessary education on positive lifestyle choices is vital in combating the childhood obesity epidemic. Counseling children on the importance of nutrition and physical activity also helps to prevent numerous comorbid conditions associated with obesity. The United States. Preventive Services Task Force recommends that healthcare workers screen for obesity at least annually in all patients 3-17 years of age, as well as offer lifestyle counseling regardless of Body Mass Index ranking. Aim: The aim of this quality improvement project was to improve the current percentage of pediatric patients with up-to-date documentation of Body Mass Index percentile and proof of receiving counseling for both physical activity and nutrition. Specifically, this project aimed to increase child BMI screening and counseling rates at a federally qualified healthcare facility from 49% to the agency goal of 60% by July 30th, 2022. Interventions: A root-cause analysis was performed by completing an initial chart audit of 176 patient charts. After analyzing the audit results it was determined that the most common error was failure to document providing patient education on physical activity and nutrition. This information was then used to develop an educational presentation for clinical staff to learn about the measure and how to properly document patient counseling in the Electronic Medical Record. A focus group was then conducted to understand the current barriers staff face with meeting the measure, and receive feedback on ways to improve. The two providers with the lowest compliance rates were given additional education on documenting the measure and at-the-elbow support was provided. Results: The data revealed that the educational intervention had not been effective in improving compliance rates of the measure. By the end of June 2022, the percent compliance rate had actually decreased to 46%. During the focus group staff expressed concerns about not having enough time to complete education, along with having their patients present annually for physical exams. Discussion: Screening pediatric patients for obesity, in addition to providing the appropriate education for implementing healthy lifestyle habits is vital for growth and development. As the results have shown the educational intervention to be unsuccessful, a different approach should be taken in the future to help improve compliance. Implications for the CNL: Focusing on the role of the CNL, healthcare technologies were used to obtain and evaluate data regarding the quality of patient-centered care. Leadership and communication skills were utilized to strengthen interprofessional partnerships, which served as vital during the implementation phase. The necessary steps taken throughout this project has emphasized the roles of the CNL as a lifelong learner, continuously striving to improve the quality of healthcare

A Pediatric Intervention to Support Early Literacy

The purpose of this research project was to provide caregivers of children from age birth to four with facts and strategies about the promotion of early childhood literacy. In Chapter Four a pamphlet was developed that focuses on these specific areas: (a) literacy development, (b) emergent literacy, (c) creating a literate environment, (d) reading aloud to one\u27s child, (e) talking with one\u27s child, (f) choosing developmentally appropriate books, and (g) the reading stages. The pediatrician\u27s support in literacy intervention is vital. The pamphlet should be presented to caregivers during well child visits to (a) develop children\u27s literacy skills, (b) promote successful readers, and (c) encourage life long learners

Herbal highs: review on psychoactive effects and neuropharmacology

Background: A new trend among users of new psychoactive substances’ the consumption of “herbal highs”: plant parts containing psychoactive substances. Most of the substances extracted from herbs, in old centuries were at the centre of religious ceremonies of ancient civilizations. Currently, these herbal products are mainly sold by internet web sites and easily obtained since some of them have no legal restriction. Objective: We reviewed psychoactive effects and neuropharmacology of the most used “herbal highs” with characterized active principles, with studies reporting mechanisms of action, pharmacological and subjective effects, eventual secondary effects including intoxications and/or fatalities Method: The PubMed database was searched using the following key.words: herbal highs, Argyreia nervosa, Ipomoea violacea and Rivea corymbosa; Catha edulis; Datura stramonium; Piper methysticum; Mitragyna speciosa. Results: Psychoactive plants here reviewed have been known and used from ancient times, even if for some of them limited information still exist regarding subjective and neuropharmacological effects and consequent eventual toxicity when plants are used alone or in combination with “classical” drugs of abuse. Conclusion: Some “herbal highs” should be classified as harmful drugs since chronic administration has been linked with addiction and cognitive impairment; for some others taking into consideration only the recent trends of abuse, studies investigating these aspects are lacking

Fault Tolerance Analysis of a Bis-Ferrocene QCA Wire

Molecular Quantum Dot Cellular Automata (mQCA) are among the most promising emerging technologies for the expected theoretical operating frequencies (THz), the high device densities and the non-cryogenic working temperature. In this paper, we performed an analysis of the possible fabrication defects of a molecular QCA wire built with ad-hoc synthesized bis-ferrocene molecules. We then evaluated the fault tolerance of a real QCA device and assessed its performance in non-ideal conditions, by defining a new methodology for the fault analysis in the mQCA technolog

Detailed balance in mixed quantum-classical mapping approaches

The violation of detailed balance poses a serious problem for the majority of current quasiclassical methods for simulating nonadiabatic dynamics. In order to analyze the severity of the problem, we predict the long-time limits of the electronic populations according to various quasiclassical mapping approaches, by applying arguments from classical ergodic theory. Our analysis confirms that regions of the mapping space that correspond to negative populations, which most mapping approaches introduce in order to go beyond the Ehrenfest approximation, pose the most serious issue for reproducing the correct thermalization behaviour. This is because inverted potentials, which arise from negative electronic populations entering into the nuclear force, can result in trajectories unphysically accelerating off to infinity. The recently developed mapping approach to surface hopping (MASH) provides a simple way of avoiding inverted potentials, while retaining an accurate description of the dynamics. We prove that MASH, unlike any other quasiclassical approach, is guaranteed to describe the exact thermalization behaviour of all quantum\unicode{x2013}classical systems, confirming it as one of the most promising methods for simulating nonadiabatic dynamics in real condensed-phase systems

Electrosynthesized poly(o-aminophenol) films as biomimetic coatings for dopamine detection on Pt substrates

Dopamine (DA) is a neurotransmitter, and its levels in the human body are associated with serious diseases. The need for a suitable detection method in medical practice has encouraged the development of electrochemical sensors that take advantage of DA electroactivity. Molecularly imprinted polymers (MIPs) are biomimetic materials able to selectively recognize target analytes. A novel MIP sensor for DA is proposed here based on a thin film of poly(o-aminophenol) electrosynthesized on bare Pt. A fast and easy method for executing the procedure for MIP deposition has been developed based on mild experimental conditions that are able to prevent electrode fouling from DA oxidation products. The MIP exhibited a limit of detection of 0.65 µM, and appreciable reproducibility and stability. The high recognition capability of poly(o-aminophenol) towards DA allowed for the achievement of notable selectivity: ascorbic acid, uric acid, serotonin, and tyramine did not interfere with DA detection, even at higher concentrations. The proposed sensor was successfully applied for DA detection in urine samples, showing good recovery

Aulogous fibrin sealant (Vivostat®) in the neurosurgical practice: Part II: Vertebro-spinal procedures

Background: Epidural hematomas, cerebrospinal fluid fistula, and spinal infections are challenging postoperative complications following vertebro-spinal procedures. We report our preliminary results using autologous fibrin sealant as both fibrin glue and a hemostatic during these operations. Methods: Prospectively, between January 2013 and March 2015, 68 patients received an autologous fibrin sealant prepared with the Vivostat®system applied epidurally to provide hemostasis and to seal the dura. The surgical technique, time to bleeding control, and associated complications were recorded. Results: Spinal procedures were performed in 68 patients utilizing autologous fibrin glue/Vivostat®to provide rapid hemostasis and/or to seal the dura. Only 2 patients developed postoperative dural fistulas while none exhibited hemorrhages, allergic reactions, systemic complications, or infections. Conclusions: In this preliminary study, the application of autologous fibrin sealant with Vivostat®resulted in rapid hemostasis and/or acted as an effective dural sealant. Although this product appears to be safe and effective, further investigations are warranted