Enhancing Discharge Transitions at Gifford Health Care

Enhancing Discharge Transitions at Gifford Health Care Megan L. O’Brien, MS, FNP-BC, APRN Purpose. During transitions of hospital discharge, errors and lack of education pose risks to patients resulting in dissatisfaction with hospital care, poorly attended follow-up appointments, and readmissions. Discharge planning that encompasses patient centered, multidisciplinary principles have been proven to reduce health care costs while increasing satisfaction among patients and staff. At Gifford Health Care in Randolph, Vermont, hospital readmission rates were below the national average of 15.9%, but the patient satisfaction scores were lower than state and national averages. To improve discharge transitions, this project utilized the Boston University evidenced-based ReEngineered Discharge (ProjectRED) principles to develop three aims: 1) increase patient preparedness for self-management, 2) timely access to follow-up appointments, and 3) support the transition of care from discharge until primary care appointment. Methods. This project set three objectives 1) improve the discharge instructions provided to patients and families at discharge, 2) access to follow-up appointments within 5 days of discharge, 3) enhance the transition period from discharge to follow-up appointment by creating a process for a structured telephone call with documentation. Process measures regarding follow-up appointments and phone calls were evaluated by random sampling chart audit. Outcome measures were evaluated using the Hospital Consumer Assessment of Healthcare Provider and Systems (HCAHPS) survey to evaluate satisfaction scores. Implementation involved multi-disciplinary meetings involving staff, administration, technical support, pharmacy, quality team, and care management to revise the discharge order set and develop an electronic form for phone call documentation. Results. This project yielded improved overall hospital rating (5.3%), earlier access to follow up (by 2 days), and reduced readmissions (1%). Despite these positive trends, a decrease in follow- up appointment attendance (3%) and lack of consistent follow-up phone calls was noted ( Conclusions. Improving discharge systems has been demonstrated to improve patient care and satisfaction. ProjectRED was originally developed in large, urban, tertiary care facilities. This project has demonstrated that similar outcomes can be achieved on a smaller scale by using a multidisciplinary team to implement selected evidenced based components. Data generated from this project can be used as a foundation to partner with the primary care teams to improve the follow up appointment process, and use the responses from the discharge follow-up phone call to develop further quality improvement projects around the discharge process. Future areas of work may include replication at additional smaller institutions. Keywords. ProjectRED, discharge, transitions, patient satisfaction, readmission

Constructing graphs with no immersion of large complete graphs

In 1989, Lescure and Meyniel proved, for $d=5, 6$, that every $d$-chromatic graph contains an immersion of $K_d$, and in 2003 Abu-Khzam and Langston conjectured that this holds for all $d$. In 2010, DeVos, Kawarabayashi, Mohar, and Okamura proved this conjecture for $d = 7$. In each proof, the $d$-chromatic assumption was not fully utilized, as the proofs only use the fact that a $d$-critical graph has minimum degree at least $d - 1$. DeVos, Dvo\v{r}\'ak, Fox, McDonald, Mohar, and Scheide show the stronger conjecture that a graph with minimum degree $d-1$ has an immersion of $K_d$ fails for $d=10$ and $d\geq 12$ with a finite number of examples for each value of $d$, and small chromatic number relative to $d$, but it is shown that a minimum degree of $200d$ does guarantee an immersion of $K_d$. In this paper we show that the stronger conjecture is false for $d=8,9,11$ and give infinite families of examples with minimum degree $d-1$ and chromatic number $d-3$ or $d-2$ that do not contain an immersion of $K_d$. Our examples can be up to $(d-2)$-edge-connected. We show, using Haj\'os' Construction, that there is an infinite class of non-$(d-1)$-colorable graphs that contain an immersion of $K_d$. We conclude with some open questions, and the conjecture that a graph $G$ with minimum degree $d - 1$ and more than $\frac{|V(G)|}{1+m(d+1)}$ vertices of degree at least $md$ has an immersion of $K_d$

Temporal introduction patterns of invasive alien plant species to Australia

We examined temporal introduction patterns of 132 invasive alien plant species (IAPS) to Australia since European colonisation in 1770. Introductions of IAPS were high during 1810–1820 (10 species), 1840– 1880 (51 species, 38 of these between 1840 and 1860) and 1930–1940 (9 species). Conspicuously few introductions occurred during 10-year periods directly preceding each introduction peak. Peaks during early European settlement (1810–1820) and human range expansion across the continent (1840-1860) both coincided with considerable growth in Australia’s human population. We suggest that population growth during these times increased the likelihood of introduced plant species becoming invasive as a result of increased colonization and propagule pressure. Deliberate introductions of IAPS (104 species) far outnumbered accidental introductions (28 species) and were particularly prominent during early settlement. Cosmopolitan IAPS (25 species) and those native solely to South America (53 species), Africa (27 species) and Asia (19 species) have been introduced deliberately and accidentally to Australia across a broad period of time. A small number of IAPS, native solely to Europe (5 species) and North America (2 species), were all introduced to Australia prior to 1880. These contrasting findings for native range suggest some role for habitat matching, with similar environmental conditions in Australia potentially driving the proliferation of IAPS native to southern-hemisphere regions. Shrub, tree and vine species dominated IAPS introduced prior to 1840, with no grasses or forbs introduced during early colonisation. Since 1840, all five growth forms have been introduced deliberately and accidentally in relatively large numbers across a broad period of time. In particular, a large number of grass and forb IAPS were deliberately introduced between 1840 and 1860, most likely a direct result of the introduction of legislation promoting intensive agriculture across large areas of the continent. Since the 1980s, only three IAPS have been introduced (all deliberately introduced forbs). The decline in IAPS introductions is most likely a reflection of both increased surveillance and biosecurity efforts and the likelihood that many potential IAPS are still within a pre-expansion lag period

Incidence and post-pollination mechanisms of nonrandom mating in Arabidopsis thaliana

Compatible pollinations from many differenttaxa display nonrandom mating. Here we describe a systemfor examining questions of nonrandom mating in Arabidopsisthaliana. Using this system, we demonstrate thatArabidopsis thaliana displays nonrandom mating betweendistinct accessions. Statistical analysis of these data demonstratesaspects of both pollen competition and male–female complementarity in these matings. Cytologicalexperiments implicate pollen germination and pollen tubegrowth rates as possible causal factors in these nonrandommating efficiencies

Early Academis Science and the Birth of Industrial Research Laboratories in the U.S. Pharmaceutical Industry

The establishment and growth of industrial research laboratories is one of the key organizational innovations affecting technological progress in the United States in the 20th century. In this paper, we investigate the rise of industrial research laboratories in the U.S. pharmaceutical industry between 1927 and 1946. Our evidence suggests that institutional factors, namely the presence of universities dedicated to research, played a significant role in the establishment and diffusion of private pharmaceutical research laboratories. Specifically, we document that the growth of industrial pharmaceutical laboratories between 1927 and 1946 is positively and significantly correlated with the extent of local university research, after controlling for other observable factors likely to influence the geographic distribution of industrial research. We supplement our core results with case histories illustrative of early university-industry interaction and an examination of the determinants of university-industry research cooperation. Our qualitative historical evidence and analyses of the birth of chemical engineering programs suggest that industry also played a role in influencing university research agendas. We correct for feedback effects from industry to universities using instrumental variables. Overall, our analyses suggest that while the presence of industrial facilities helped shape the direction of university research programs, there was a significant, positive, and causal effect running from university research to the growth of pharmaceutical research laboratories in the first half of the twentieth century in the United States.

Got Caries? Breast milk and Early Childhood Caries?

Objective: To provide an analysis of the association between the longevity of breastfeeding and development of ECC. Determine the optimal time frame in which mothers should cease breastfeeding to reduce ECC development. Methods: Dr. Brickhouse, PubMed, Google Scholar and other scholarly databases were utilized to find current scientific evidence on the effects of breast milk on ECC. Relevant articles were summarized to write a review of literature. 16 articles published from 2015 to the present date were reviewed and cited. Results: From the studies, there is strong evidence to support breastfeeding beyond 12 months of age increases the prevalence of ECC. Furthermore, increased frequency and duration of breastfeeding leads to higher incidence of ECC. Conclusion: Findings indicate dental health care providers should recommend either ceasing breastfeeding at 12 months of age or provide ECC prevention education to caregivers. Further research is required to minimize data discrepancies between US and international countries.https://scholarscompass.vcu.edu/denh_student/1002/thumbnail.jp

Investigation of possible causes for human-performance degradation during microgravity flight

The results of the first year of a three year study of the effects of microgravity on human performance are given. Test results show support for the hypothesis that the effects of microgravity can be studied indirectly on Earth by measuring performance in an altered gravitational field. The hypothesis was that an altered gravitational field could disrupt performance on previously automated behaviors if gravity was a critical part of the stimulus complex controlling those behaviors. In addition, it was proposed that performance on secondary cognitive tasks would also degrade, especially if the subject was provided feedback about degradation on the previously automated task. In the initial experimental test of these hypotheses, there was little statistical support. However, when subjects were categorized as high or low in automated behavior, results for the former group supported the hypotheses. The predicted interaction between body orientation and level of workload in their joint effect on performance in the secondary cognitive task was significant for the group high in automatized behavior and receiving feedback, but no such interventions were found for the group high in automatized behavior but not receiving feedback, or the group low in automatized behavior