Lobowings: A Pilot Study of Interprofessional Patient Safety Training

UNMHSC has endorsed Interprofessional Education (IPE) and is committed to developing meaningful curriculum and IPE experiences that will allow students to learn with and from each other about interprofessional collaborative practices. LoboWings training (developed by UNM Hospital) is designed to promote a culture of patient safety and teamwork through application of Crew Resource Management (CRM) techniques similar to those used in airline safety programs.https://digitalrepository.unm.edu/hsc_ipe_posters/1000/thumbnail.jp

Training Faculty in the Principles of Inter-Professional Education: A Pilot Faculty Development Program

After several site visits, conferences and a review of the IPE literature, the IPE team decided that interprofes-sionalfaculty development was an early priority. Five IPE team members (MD, KS, LK, CA, and BW) attended the EHPIC Faculty Development Certificationtraining course in Toronto, Ontario in 2013. Our project was to begin to design three core IPE Faculty Development workshops for the HSC.https://digitalrepository.unm.edu/hsc_ipe_posters/1004/thumbnail.jp

UNM HSC Environmental Scan Survey Results

According to the definition of the World Health Organization (WHO 2010) all learning activities in the IPE curriculum must be interprofessional. There are currently pockets of IPE activities across the UNM HSC campus. There have been IPE courses offered in the past on campus with great success and strong faculty support and commitment. An IPE Team was formally organized through the support of HSC professional programs. The IPE Teams goal is to build critical capacity by identifying where we can connect or expand with faculty who are engaged in IPE activities and increase and sustain UNM HSC IPE programming. The HSC IPE Environmental Scan was designed by the IPE Team to gather UNM HSC IPE information about: 1) What IPE Activity is currently occurring, 2) What IPE activity occurred in the past, and 3) What is the quality of IPE on campus, present and past.\u27https://digitalrepository.unm.edu/hsc_ipe_posters/1002/thumbnail.jp

An Interprofessional Community Engaged Educational Curriculum for Health Professions Students

Population health management requires cross-sectoral collaboration within and outside of health sciences professions to effectively address our current societal health priorities and inequities. Exposing health professions students to a competency-based framework that focuses on community engagement early in their educational training lays the foundation for building the necessary partnerships with communities to promote health. Aligned with our institutions mission, the University of New Mexico Health Sciences Center\u27s Interprofessional Education (IPE) Team is designing a required interprofessional community engaged curriculum for all nursing, medicine, pharmacy, physician assistant, and occupational and physical therapy students to be implemented in Fall of 2015.\u27https://digitalrepository.unm.edu/hsc_ipe_posters/1005/thumbnail.jp

Process Improvement for Implementation of a Verified Substance Use Screening Tool for all Patients in a General Medicine Inpatient Unit

Introduction: As of 2017, an estimated 21 million US adults, equivalent to 1 in 13 people, had a substance use disorder. Of those with a substance use disorder it was estimated that only 2.2 million received treatment. In 2015, New Mexico had the 8th highest overdose death rate in the nation with the highest number of overall deaths attributed to Bernalillo County. The most common drugs used in overdose related deaths included heroin, benzodiazepines and prescription opioids. At the time of this study, it was found that the University of New Mexico Hospital did not have an identification tool for patients with Substance Use Disorder (SUD) as part of their intake protocols. The DAST-10 (Drug Abuse Screening Tool 10 question) is a verified screening tool that has been shown to be an accurate predictor with good specific identification of substance use. This screening tool is a short and efficient and has been easily integrated into clinical flow and is also highly sensitive in other studies. Similar studies conducted previously found that important factors to success and implementation included comprehensive education and training, intra and inter-organization communication and collaboration, host site and practitioner support, and champions to lead and direct management of the program. Methods: This pilot was conducted on 4 West, the largest inpatient adult medical-surgical unit at UNMH, over a 14 day period in 2019. All patients admitted to the unit over the course of the pilot were screened for eligibility. Exclusion criteria included non-English speaking, encephalopathic or if otherwise deemed inappropriate for screening by the surveyor (e.g. clinically inappropriate). Eligible patients were then consented for willingness to participate. For eligible and willing patients, the validated SUD screening tool, DAST-10, was performed. In the result of a positive screen, patients were assessed for interest in treatment and offered a compilation of local resources for support. Results: A total of 67 patients admitted to the unit were reviewed. Of the 67 patients, 33 patients (49.2%) were eligible for screening. Main identified reasons for ineligibility included inappropriate for screening based on surveyor judgment (27.3%), non-English speaking (21.2%), and patient were encephalopathic (15.2%). In total, 22 patients agreed to participate in the survey, while 11 patients declined. Of the 22 willing participants, there were 3 (13.6%) who screened positive on the DAST-10. Of the patients who screened positive for substance use, one patient was interested in receiving resources. Conclusions: The inpatient hospitalization can serve as a critical time to engage patients with SUD in treatment discussions. This pilot demonstrated that ability of a validated screening tool to identify a large portion of patients with SUD in an adult inpatient unit at UNMH. Additionally the screening process itself facilitated linkage to treatment resources. Barriers to screening included patient clinical status and language barriers, the latter of which may improve with translating the tool into other languages. Further efforts to improve tool utilization are being considered including inclusion of the tool within the electronic health record

The What’s, Where’s, and Why’s of What Your Family Eats: The Burlington Children’s Space Farm To Table Program

Introduction: Preventing childhood obesity is a national priority, and changing dietary behavior in both children and adults is challenging. Burlington Children’s Space, Inc. (BCS), a private, non-profit early education and childcare center providing services for families in the Burlington area, is trying to do just that. The Farm to Table Project was designed to positively influence the food choices of students and their families as well as to cultivate a relationship between families and local farmers. In an effort to secure expanded funding for the school’s food program, BCS requested that we assess the effectiveness of their Food Programhttps://scholarworks.uvm.edu/comphp_gallery/1032/thumbnail.jp

Looking beyond the exome: a phenotype-first approach to molecular diagnostic resolution in rare and undiagnosed diseases.

PurposeTo describe examples of missed pathogenic variants on whole-exome sequencing (WES) and the importance of deep phenotyping for further diagnostic testing.MethodsGuided by phenotypic information, three children with negative WES underwent targeted single-gene testing.ResultsIndividual 1 had a clinical diagnosis consistent with infantile systemic hyalinosis, although WES and a next-generation sequencing (NGS)-based ANTXR2 test were negative. Sanger sequencing of ANTXR2 revealed a homozygous single base pair insertion, previously missed by the WES variant caller software. Individual 2 had neurodevelopmental regression and cerebellar atrophy, with no diagnosis on WES. New clinical findings prompted Sanger sequencing and copy number testing of PLA2G6. A novel homozygous deletion of the noncoding exon 1 (not included in the WES capture kit) was detected, with extension into the promoter, confirming the clinical suspicion of infantile neuroaxonal dystrophy. Individual 3 had progressive ataxia, spasticity, and magnetic resonance image changes of vanishing white matter leukoencephalopathy. An NGS leukodystrophy gene panel and WES showed a heterozygous pathogenic variant in EIF2B5; no deletions/duplications were detected. Sanger sequencing of EIF2B5 showed a frameshift indel, probably missed owing to failure of alignment.ConclusionThese cases illustrate potential pitfalls of WES/NGS testing and the importance of phenotype-guided molecular testing in yielding diagnoses

From Select Agent to an Established Pathogen: The Response to \u3ci\u3ePhakopsora pachyrhizi\u3c/i\u3e (Soybean Rust) in North America

The pathogen causing soybean rust, Phakopsora pachyrhizi, was first described in Japan in 1902. The disease was important in the Eastern Hemisphere for many decades before the fungus was reported in Hawaii in 1994, which was followed by reports from countries in Africa and South America. In 2004, P. pachyrhizi was confirmed in Louisiana, making it the first report in the continental United States. Based on yield losses from countries in Asia, Africa, and South America, it was clear that this pathogen could have a major economic impact on the yield of 30 million ha of soybean in the United States. The response by agencies within the United States Department of Agriculture, industry, soybean check-off boards, and universities was immediate and complex. The impacts of some of these activities are detailed in this review. The net result has been that the once dreaded disease, which caused substantial losses in other parts of the world, is now better understood and effectively managed in the United States. The disease continues to be monitored yearly for changes in spatial and temporal distribution so that soybean growers can continue to benefit by knowing where soybean rust is occurring during the growing season

Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study

Objective: To compare the predictive accuracy and clinical utility of five risk scoring systems in the assessment of patients with upper gastrointestinal bleeding. Design: International multicentre prospective study. Setting: Six large hospitals in Europe, North America, Asia, and Oceania. Participants: 3012 consecutive patients presenting over 12 months with upper gastrointestinal bleeding. Main outcome measures: Comparison of pre-endoscopy scores (admission Rockall, AIMS65, and Glasgow Blatchford) and post-endoscopy scores (full Rockall and PNED) for their ability to predict predefined clinical endpoints: a composite endpoint (transfusion, endoscopic treatment, interventional radiology, surgery, or 30 day mortality), endoscopic treatment, 30 day mortality, rebleeding, and length of hospital stay. Optimum score thresholds to identify low risk and high risk patients were determined. Results: The Glasgow Blatchford score was best (area under the receiver operating characteristic curve (AUROC) 0.86) at predicting intervention or death compared with the full Rockall score (0.70), PNED score (0.69), admission Rockall score (0.66, and AIMS65 score (0.68) (all P<0.001). A Glasgow Blatchford score of ≤1 was the optimum threshold to predict survival without intervention (sensitivity 98.6%, specificity 34.6%). The Glasgow Blatchford score was better at predicting endoscopic treatment (AUROC 0.75) than the AIMS65 (0.62) and admission Rockall scores (0.61) (both P<0.001). A Glasgow Blatchford score of ≥7 was the optimum threshold to predict endoscopic treatment (sensitivity 80%, specificity 57%). The PNED (AUROC 0.77) and AIMS65 scores (0.77) were best at predicting mortality, with both superior to admission Rockall score (0.72) and Glasgow Blatchford score (0.64; P<0.001). Score thresholds of ≥4 for PNED, ≥2 for AIMS65, ≥4 for admission Rockall, and ≥5 for full Rockall were optimal at predicting death, with sensitivities of 65.8-78.6% and specificities of 65.0-65.3%. No score was helpful at predicting rebleeding or length of stay. Conclusions: The Glasgow Blatchford score has high accuracy at predicting need for hospital based intervention or death. Scores of ≤1 appear the optimum threshold for directing patients to outpatient management. AUROCs of scores for the other endpoints are less than 0.80, therefore their clinical utility for these outcomes seems to be limited. Trial registration: Current Controlled Trials ISRCTN16235737