Enhancing Depression Care Outcomes in Primary Care Patients through Secure E-mail Structured Follow-Up Monitoring by Mental Health Nurse Practitioner

Improving Antidepressant Medication Follow-Up Management Sophia Lawrence, MSN, RN, PMHNP-BC Doctor of Nursing Practice Student Faculty Chair: Kathy James, DNSc, APRN, FAAN Clinical Mentor: Henry Kane, MD, Psychiatrist Purpose: The purpose of this evidence-based practice project is to integrate a structured follow-up management protocol for patients prescribed antidepressant in primary care and improve HEDIS antidepressant medication management scores. Background: Depression is a highly prevalent condition affecting 14 million adults in the United States annually. Antidepressant is an effective treatment. However adherence to antidepressant medication remains a significant problem and treatments have failed to improve in primary care. Methods and evaluation: Using the Plan-Do-Study-Act method of quality improvement, the standardized was implemented and integrated into practice. Using the project facility’s past HEDIS Antidepressant medication management data as a baseline, data collection points include pre and post intervention to determine project impact on the HEDIS scores. Outcomes: Data collected demonstrated a 10% increase in HEDIS antidepressant scores for the continuation phase and a 4% increase for the acute phase of treatment. Conclusions: Organized follow-up care management for patients prescribed antidepressants in primary care that employed the use of a structured protocol delivered by secure e-mail has the potential to improve adherence to treatment, make a profound impact on HEDIS measurements, and patient outcome

Generalized multiresolution analyses with given multiplicity functions

Generalized multiresolution analyses are increasing sequences of subspaces of a Hilbert space \H that fail to be multiresolution analyses in the sense of wavelet theory because the core subspace does not have an orthonormal basis generated by a fixed scaling function. Previous authors have studied a multiplicity function $m$ which, loosely speaking, measures the failure of the GMRA to be an MRA. When the Hilbert space \H is $L^2(\mathbb R^n)$, the possible multiplicity functions have been characterized by Baggett and Merrill. Here we start with a function $m$ satisfying a consistency condition which is known to be necessary, and build a GMRA in an abstract Hilbert space with multiplicity function $m$.Comment: 16 pages including bibliograph

Evaluation of the mechanism of action of Bacillus spp. to manage Meloidogyne incognita with split root assay, RT-qPCR and qPCR

The goal of this research is to determine the mechanism of action of two Bacillus spp. that can manage Meloidogyne incognita population density in cotton. The overall objectives are 1) determine the efficacy and direct antagonistic capabilities of the Bacillus spp. and 2) determine the systemic capabilities of the Bacillus spp. The greenhouse in planta assay indicated B. amyloliquefaciens QST713 and B. firmus I-1582 could manage M. incognita similarly to the chemical standard fluopyram. An in vitro assay determined that B. firmus I-1582 and its extracted metabolites were able to directly manage M. incognita second stage juveniles by increasing mortality rate above 75%. A split root assay, used to determine systemic capabilities of the bacteria, indicated B. amyloliquefaciens QST713 and B. firmus I-1582 could indirectly decrease the nematode population density. Another species, B. mojavensis strain 2, also demonstrated systemic capabilities but was not a successful biological control agent because it supported a high population density in greenhouse in planta assay and in the split root assay. A RT-qPCR assay was used to confirm any systemic activity observed in the split root assay. At 24 hours both B. amyloliquefaciens QST713 and B. firmus I-1582 upregulated one gene involved in the initial stages of JA synthesis pathway but not another gene involved in the later stages of JA synthesis. These results point to a JA intermediate molecule, most likely OPDA, stimulated by the bacteria rather than JA in a short-term systemic response. After 1 week, the Bacillus spp. stimulated a SA-responsive defense related gene. The long-term systemic response to the Bacillus spp. indicates salicylic acid also plays a role in defense conferred by these bacteria. The final assay was a qPCR to determine the concentration of the bacteria on the cotton roots after 24 days. Bacillus amyloliquefaciens QST713 and B. firmus I-43 1582 were able to colonize the root successfully, with the concentration after 24 days not significantly differing from the concentration at inoculation. This study identifies two bacteria that work via systemic resistance and will help aid in implementing these species in an integrated management system

Venous Thromboembolic Disease in Trauma and Surveillance Ultrasonography

Background. The literature reports a wide variation in the incidence of venous thromboembolic (VTE) disease in trauma patients. The performance of routine surveillance venous duplex ultrasound of bilateral lower extremities is controversial. Furthermore, recent examinations of the national trauma databank registry have suggested that routine duplex surveillance is associated with higher deep venous thrombosis (DVT) detection rates. Materials and Methods. We examined the incidence and risk factors for VTE disease in 2827 trauma patients admitted over a 2-y period to a state-verified level I trauma center. Detailed chart review was carried out for patients with VTE disease. We then evaluated the effects of a routine bilateral lower extremity duplex surveillance guideline on VTE detection in the subset of injury patients admitted to the trauma service. Results. We found an approximately 2% incidence of venous thromboembolic disease in a mostly blunt trauma population. Amongst patients with VTE disease, the most common risk factors were obesity and significant head injury. We then evaluated the 998 patients with injury who were admitted to the trauma service 1 y before and after surveillance guideline implementation. Despite a nearly 5-fold increase in the number of duplex scans, with a substantial increase in cost, we found no significant difference in the incidence of DVT. Conclusions. Our preliminary data argue against the use of routine duplex surveillance of lower extremities for DVT in trauma patients. A larger, prospective analysis is necessary to confirm these findings

Generalized multiresolution analyses with given multiplicity functions

Generalized multiresolution analyses are increasing sequences of subspaces of a Hilbert space H that fail to be multiresolution analyses in the sense of wavelet theory because the core subspace does not have an orthonormal basis generated by a fixed scaling function. Previous authors have studied a multiplicity function m which, loosely speaking, measures the failure of the GMRA to be an MRA. When the Hilbert space H is L2(Rn), the possible multiplicity functions have been characterized by Baggett and Merrill. Here we start with a function m satisfying a consistency condition which is known to be necessary, and build a GMRA in an abstract Hilbert space with multiplicity function m