Discontinuation of Routine Postpartum Complete Blood Count in Uncomplicated Vaginal Deliveries

Introduction The aim of this prospective study is to assess the clinical utility and safety of discontinuing routine Complete Blood Count (CBC) testing in uncomplicated vaginal deliveries with a focus on identifying potential benefits, risks, and overall cost-effectiveness of this practice. This routine CBC is used to assess for postpartum anemia and the need for a blood transfusion but is currently performed regardless of initial blood count on admission or estimated blood loss during delivery. However, recent evidence suggests that routine CBC testing may not significantly impact clinical outcomes in low-risk pregnancies. In this study, we hypothesize that routine postpartum CBC testing is not indicated following uncomplicated vaginal delivery if hemoglobin upon admission is \u3e10 g/dL and if estimated blood loss during delivery is \u3c500mL. Methods A postpartum complete blood count (CBC) is currently obtained from all obstetric patients at Cabell Huntington Hospital who have had a successful vaginal delivery. A prospective study was performed on 88 consecutive patients presenting to Cabell Huntington Hospital Labor and Delivery. A protocol was instituted whereby a postpartum-day-1 CBC was not indicated on patients undergoing vaginal delivery with an admission hemoglobin of \u3e10 g/dL and an estimated blood loss at the time of delivery of Results Analysis of the case series revealed no difference in blood transfusions, symptomatic anemia, postpartum complications, or maternal length of hospital stay before and after the institution of the protocol. There was a significant difference (p= Conclusion The findings from this prospective study have the potential to inform evidence-based postpartum care guidelines for low-risk pregnancies. If discontinuing routine CBC testing in uncomplicated vaginal deliveries is proven to be safe and cost-effective, it could lead to more efficient healthcare resource allocation, reduced healthcare costs, and improved patient experience. This study contributes valuable insights to the ongoing efforts in optimizing postpartum care protocols and may influence future clinical practice guidelines for low-risk pregnancies

The Urban/Rural Divide in Access to Medication-Assisted Treatment for Opioid Use Disorder in Utah

Death by drug poisoning is the leading cause of death due to injury in the state of Utah (UDOH, 2014). From 2013-2015, Utah ranked seventh in the nation for drug overdose deaths, the majority of which were opioid-related (CDC, 2018a). In 2017, the age-adjusted mortality rate from drug overdose in Utah was 15.5 per 100,000, putting the state above the national average of 14.9 per 100,000 (CDC, 2018b). Opioid overdose death rates in most of rural Utah far exceeds rates across the urban counties of the state. The higher rates of deaths in rural Utah is indeed concerning. Evidence indicates that rural areas are particularly hard hit due to limited access to care and resources (USDA, 2019). Three kinds of medication-assisted treatment (MAT) approved for treatment of opioid use disorder (OUD) include: methadone, buprenorphine, and naltrexone (SAMHSA, 2019a). These medications block the euphoric effect of drugs, relieve cravings, and stabilize brain chemistry without the negative side effects of the previously abused drug (SAMHSA, 2019b). This fact sheet gives details about MAT for opioid use disorder

A Crisis of Her Own: Fatal Opioid Overdose, Opioid Use Disorder, and Intimate Partner Violence Among Rural Utah Women

The Centers for Disease Control report that the rate of overdose deaths among women is rapidly increasing, with women experiencing a 532% increase in fatal opioid overdose deaths between 1999 and 2017, compared to a 355% increase for men. Among women, those in rural areas have disproportionately higher drug overdose death rates than women in urban areas (Mazure & Fiellin, 2018), indicating an opportunity for targeted rural public health interventions to slow overdose fatality increases among women. This fact sheet reviews Utah trends, potential factors increasing fatal opioid overdose, intimate partner violence and substance use disorders, and provides resources for getting help

Using a stakeholder-engaged, iterative, and systematic approach to adapting collaborative decision skills training for implementation in VA psychosocial rehabilitation and recovery centers

Background: Adaptation of interventions is inevitable during translation to new populations or settings. Systematic approach to adaptation can ensure that fidelity to core functions of the intervention are preserved while optimizing implementation feasibility and effectiveness for the local context. In this study, we used an iterative, mixed methods, and stakeholder-engaged process to systematically adapt Collaborative Decision Skills Training for Veterans with psychosis currently participating in VA Psychosocial Rehabilitation and Recovery Centers. Methods: A modified approach to Intervention Mapping (IM-Adapt) guided the adaptation process. An Adaptation Resource Team of five Veterans, two VA clinicians, and four researchers was formed. The Adaptation Resource Team engaged in an iterative process of identifying and completing adaptations including individual qualitative interviews, group meetings, and post-meeting surveys. Qualitative interviews were analyzed using rapid matrix analysis. We used the modified, RE-AIM enriched expanded Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME) to document adaptations. Additional constructs included adaptation size and scope; implementation of planned adaptation (yes–no); rationale for non-implementation; and tailoring of adaptation for a specific population (e.g., Veterans). Results: Rapid matrix analysis of individual qualitative interviews resulted in 510 qualitative codes. Veterans and clinicians reported that the intervention was a generally good ft for VA Psychosocial Rehabilitation and Recovery Centers and for Veterans. Following group meetings to reach adaptation consensus, 158 adaptations were completed. Most commonly, adaptations added or extended a component; were small in size and scope; intended to improve the effectiveness of the intervention, and based on experience as a patient or working with patients. Few adaptations were targeted towards a specific group, including Veterans. Veteran and clinician stakeholders reported that these adaptations were important and would benefit Veterans, and that they felt heard and understood during the adaptation process. Conclusions: A stakeholder-engaged, iterative, and mixed methods approach was successful for adapting Collaborative Decision Skills Training for immediate clinical application to Veterans in a psychosocial rehabilitation center. The ongoing interactions among multiple stakeholders resulted in high quality, tailored adaptations which are likely to be generalizable to other populations or settings. We recommend the use of this stakeholder-engaged, iterative approach to guide adaptations

Alcohol Exposure Decreases CREB Binding Protein Expression and Histone Acetylation in the Developing Cerebellum

Fetal alcohol exposure affects 1 in 100 children making it the leading cause of mental retardation in the US. It has long been known that alcohol affects cerebellum development and function. However, the underlying molecular mechanism is unclear.We demonstrate that CREB binding protein (CBP) is widely expressed in granule and Purkinje neurons of the developing cerebellar cortex of naïve rats. We also show that exposure to ethanol during the 3(rd) trimester-equivalent of human pregnancy reduces CBP levels. CBP is a histone acetyltransferase, a component of the epigenetic mechanism controlling neuronal gene expression. We further demonstrate that the acetylation of both histone H3 and H4 is reduced in the cerebellum of ethanol-treated rats.These findings indicate that ethanol exposure decreases the expression and function of CBP in the developing cerebellum. This effect of ethanol may be responsible for the motor coordination deficits that characterize fetal alcohol spectrum disorders

Review of Racially Equitable Admissions Practices in STEM Doctoral Programs

This study reviews literature on racially equitable admissions practices relevant to graduate programs in STEM. Graduate Record Exam (GRE) scores correlate more strongly with race, gender, and socioeconomic status than performance metrics for research during or after graduate school. Structural changes to admissions processes that can improve equity of admissions decisions and reduce correlations between admissions decisions and demographic data include using holistic review or composite scores that quantize more components of an application, removing hard limits on course requirements, admitting students as a cohort instead of to individual faculty sponsors, and diversifying admissions committees. Some alternative scoring methods attempt to measure personality traits, but performing these measurements during admissions may present difficulties. Bridge programs—whether they are implemented as collaborations with a minority-serving institution, a personalized educational program for each student admitted to a program, or a stand-alone program before the doctoral degree program—may be able to improve both recruitment and retention of students with underrepresented racial and ethnic identities in their field of study. Finally, financial barriers to applications can disproportionately affect underrepresented applicants due to systemic racism. We end with recommendations for graduate programs to improve equity in admissions processes

Using a stakeholder-engaged, iterative, and systematic approach to adapting collaborative decision skills training for implementation in VA psychosocial rehabilitation and recovery centers

Abstract Background Adaptation of interventions is inevitable during translation to new populations or settings. Systematic approach to adaptation can ensure that fidelity to core functions of the intervention are preserved while optimizing implementation feasibility and effectiveness for the local context. In this study, we used an iterative, mixed methods, and stakeholder-engaged process to systematically adapt Collaborative Decision Skills Training for Veterans with psychosis currently participating in VA Psychosocial Rehabilitation and Recovery Centers. Methods A modified approach to Intervention Mapping (IM-Adapt) guided the adaptation process. An Adaptation Resource Team of five Veterans, two VA clinicians, and four researchers was formed. The Adaptation Resource Team engaged in an iterative process of identifying and completing adaptations including individual qualitative interviews, group meetings, and post-meeting surveys. Qualitative interviews were analyzed using rapid matrix analysis. We used the modified, RE-AIM enriched expanded Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME) to document adaptations. Additional constructs included adaptation size and scope; implementation of planned adaptation (yes–no); rationale for non-implementation; and tailoring of adaptation for a specific population (e.g., Veterans). Results Rapid matrix analysis of individual qualitative interviews resulted in 510 qualitative codes. Veterans and clinicians reported that the intervention was a generally good fit for VA Psychosocial Rehabilitation and Recovery Centers and for Veterans. Following group meetings to reach adaptation consensus, 158 adaptations were completed. Most commonly, adaptations added or extended a component; were small in size and scope; intended to improve the effectiveness of the intervention, and based on experience as a patient or working with patients. Few adaptations were targeted towards a specific group, including Veterans. Veteran and clinician stakeholders reported that these adaptations were important and would benefit Veterans, and that they felt heard and understood during the adaptation process. Conclusions A stakeholder-engaged, iterative, and mixed methods approach was successful for adapting Collaborative Decision Skills Training for immediate clinical application to Veterans in a psychosocial rehabilitation center. The ongoing interactions among multiple stakeholders resulted in high quality, tailored adaptations which are likely to be generalizable to other populations or settings. We recommend the use of this stakeholder-engaged, iterative approach to guide adaptations