A Primer on Quality Assurance and Performance Improvement for Interprofessional Chronic Kidney Disease Care: A Path to Joint Commission Certification.

Interprofessional care for chronic kidney disease facilitates the delivery of high quality, comprehensive care to a complex, at-risk population. Interprofessional care is resource intensive and requires a value proposition. Joint Commission certification is a voluntary process that improves patient outcomes, provides external validity to hospital administration and enhances visibility to patients and referring providers. This is a single-center, retrospective study describing quality assurance and performance improvement in chronic kidney disease, Joint Commission certification and quality outcomes. A total of 440 patients were included in the analysis. Thirteen quality indicators consisting of clinical and process of care indicators were developed and measured for a period of two years from 2009-2017. Significant improvements or at least persistently high performance were noted for key quality indicators such as blood pressure control (85%), estimation of cardiovascular risk (100%), measurement of hemoglobin A1c (98%), vaccination (93%), referrals for vascular access and transplantation (100%), placement of permanent dialysis access (61%), discussion of advanced directives (94%), online patient education (71%) and completion of office visit documentation (100%). High patient satisfaction scores (94-96%) are consistent with excellent quality of care provided

ANALISIS PENGELOLAAN DAN PENATAUSAHAAN BARANG MILIK DAERAH PADA DISDUKCAPIL KABUPATEN JEPARA

Barang Milik Daerah merupakan bagian dari aset Pemerintah Daerah yang digunakan dan dimanfaatkan untuk menunjang berjalannya tugas dan fungsi kegiatan perangkat daerah. Tertibnya pengelolaan Barang Milik Daerah memberikan efek yang signifikan terhadap Laporan Keuangan Pemerintah Daerah. Penelitian ini bertujuan untuk mengetahui kesesuaian Pengelolaan dan Penatausahaan Barang Milik Daerah pada Disdukcapil Kabupaten Jepara dengan Permendagri Nomor 19 Tahun 2016 tentang Pedoman Pengelolaan Barang Milik Daerah dan kendala yang dihadapi dalam pengelolaan dan penatausahaan barang milik daerah serta upaya yang dilakukan untuk mengatasi kendala tersebut. Metodologipenelitian ini menggunakan analisis kualitatif deskriptif.Peneliti mengumpulkan data kualitatif dan regulasi yang berlaku kemudian membandingkan hasil yang diperoleh dengan literatur yang berhubungan dengan penelitian.Peneliti mencoba mengkaji pengelolaan dan penatusahaan BMD berdasarkan regulasi yang berlaku kemudian menarik kesimpulan. Objek penelitian adalah Disdukcapil Kabupaten Jepara. Hasil penelitian menunjukkan bahwa pengelolaan dan penatausahaan Barang Milik Daerah pada Disdukcapil Jepara secara umum sudah sesuai dengan regulasi yang berlaku, yaitu Permendagri Nomor 19 Tahun 2016. Namun dalam hal perencanaan kebutuhan dan anggaran belum dituangkan dalam RKBMD. Meskipun terdapat kendala dalam pengelolaan dan penatausahaan Barang Milik Daerah pada Disdukcapil Kabupaten Jepara, namun hal tersebut dapat diatasi dengan berbagai upaya, sehingga mampu meminimalisasi permasalahanyang ada

Perceived Readiness for Hospital Discharge in Adult Medical-Surgical Patients

Purpose: The purpose of the study was to identify predictors and outcomes of adult medical-surgical patients\u27 perceptions of their readiness for hospital discharge. Design: A correlational, prospective, longitudinal design with path analyses was used to explore relationships among transition theory-related variables. Setting: Midwestern tertiary medical center. Sample: 147 adult medical-surgical patients. Methods: Predictor variables included patient characteristics, hospitalization factors, and nursing practices that were measured prior to hospital discharge using a study enrollment form, the Quality of Discharge Teaching Scale, and the Care Coordination Scale. Discharge readiness was measured using the Readiness for Hospital Discharge Scale administered within 4 hours prior to discharge. Outcomes were measured 3 weeks postdischarge with the Post-Discharge Coping Difficulty Scale and self-reported utilization of health services. Findings: Living alone, discharge teaching (amount of content received and nurses\u27 skill in teaching delivery), and care coordination explained 51% of readiness for discharge score variance. Patient age and discharge readiness explained 16% of variance in postdischarge coping difficulty. Greater readiness for discharge was predictive of fewer readmissions. Conclusions: Quality of the delivery of discharge teaching was the strongest predictor of discharge readiness. Study results provided support for Meleis\u27 transitions theory as a useful model for conceptualizing and investigating the discharge transition. Implications for Practice: The study results have implications for the CNS role in patient and staff education, system building for the postdischarge transition, and measurement of clinical care outcomes

Teaching with Feminist Judgments: A Global Conversation

This conversational-style essay is an exchange among fourteen professors—representing thirteen universities across five countries—with experience teaching with feminist judgments. Feminist judgments are ‘shadow’ court decisions rewritten from a feminist perspective, using only the precedent in effect and the facts known at the time of the original decision. Scholars in Canada, England, the U.S., Australia, New Zealand, Scotland, Ireland, India, and Mexico have published (or are currently producing) written collections of feminist judgments that demonstrate how feminist perspectives could have changed the legal reasoning or outcome (or both) in important legal cases. This essay begins to explore the vast pedagogical potential of feminist judgments. The contributors to this conversation describe how they use feminist judgments in the classroom; how students have responded to the judgments; how the professors achieve specific learning objectives through teaching with feminist judgments; and how working with feminist judgments—whether studying them, writing them, or both—can help students excavate the multiple social, political, economic, and even personal factors that influence the development of legal rules, structures, and institutions. The primary takeaway of the essay is that feminist judgments are a uniquely enriching pedagogical tool that can broaden the learning experience. Feminist judgments invite future lawyers, and indeed any reader, to re-imagine what the law is, what the law can be, and how to make the law more responsive to the needs of all people

A maternal higher-complex carbohydrate diet increases bifidobacteria and alters early life acquisition of the infant microbiome in women with gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is associated with considerable imbalances in intestinal microbiota that may underlie pathological conditions in both mothers and infants. To more definitively identify these alterations, we evaluated the maternal and infant gut microbiota through the shotgun metagenomic analysis of a subset of stool specimens collected from a randomized, controlled trial in diet-controlled women with GDM. The women were fed either a CHOICE diet (60% complex carbohydrate/25% fat/15% protein, n=18) or a conventional diet (CONV, 40% complex carbohydrate/45% fat/15% protein, n=16) from 30 weeks’ gestation through delivery. In contrast to other published studies, we designed the study to minimize the influence of other dietary sources by providing all meals, which were eucaloric and similar in fiber content. At 30 and 37 weeks’ gestation, we collected maternal stool samples; performed the fasting measurements of glucose, glycerol, insulin, free fatty acids, and triglycerides; and administered an oral glucose tolerance test (OGTT) to measure glucose clearance and insulin response. Infant stool samples were collected at 2 weeks, 2 months, and 4–5 months of age. Maternal glucose was controlled to conventional targets in both diets, with no differences in Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). No differences in maternal alpha or beta diversity between the two diets from baseline to 37 weeks’ gestation were observed. However, women on CHOICE diet had higher levels of Bifidobacteriaceae, specifically Bifidobacterium adolescentis, compared with women on CONV. Species-level taxa varied significantly with fasting glycerol, fasting glucose, and glucose AUC after the OGTT challenge. Maternal diet significantly impacted the patterns of infant colonization over the first 4 months of life, with CHOICE infants showing increased microbiome alpha diversity (richness), greater Clostridiaceae, and decreased Enterococcaceae over time. Overall, these results suggest that an isocaloric GDM diet containing greater complex carbohydrates with reduced fat leads to an ostensibly beneficial effect on the maternal microbiome, improved infant gut microbiome diversity, and reduced opportunistic pathogens capable of playing a role in obesity and immune system development. These results highlight the critical role a maternal diet has in shaping the maternal and infant microbiome in women with GDM

Vancomycin-Resistant Staphylococcus aureus, Michigan, USA, 2007

Vancomycin-resistant Staphylococcus aureus (VRSA) infections, which are always methicillin-resistant, are a rare but serious public health concern. We examined 2 cases in Michigan in 2007. Both patients had underlying illnesses. Isolates were vanA-positive. VRSA was neither transmitted to or from another known VRSA patient nor transmitted from patients to identified contacts

Characterizing nutrient patterns of food items in adolescent diet using data from a novel citizen science project and the US National Health and Nutrition Examination Survey (NHANES)

IntroductionA healthy diet is essential for promoting good health during adolescence and mitigating disease risks in adulthood. This underscores the need for improved nutrition education and increased access to healthier food choices. However, the accuracy of dietary data poses a significant challenge in nutritional research.MethodsWe utilized and analyzed a novel dietary record dataset collected through a high school citizen science project to address this issue. We focused on nutrients rather than food groups to characterize adolescent dietary patterns. The same analyses were performed on the 2019–2021 National Health and Nutrition Examination Survey data for comparison.ResultsBased on the U.S. Food and Drug Administration’s recommended daily value (DV) for nutrients, the majority of food items in our citizen science dataset are low (i.e., <5% DV) in lipids, fiber, potassium, calcium, iron, sugar, and cholesterol. Only a minority of items are high (i.e., >20% DV) in macro and micronutrients. The clustering analysis identified nine food clusters with distinct nutrient profiles that vary significantly in size. The analyses on the NHANES data yielded similar findings, but with higher proportions of foods high in energy, lipids, carbohydrates, sugar, iron, and sodium compared with those of the citizen science dataset.DiscussionThis study demonstrates the potential of citizen science projects in gathering valuable dietary data and understanding adolescent nutrient intake. Identifying critical nutrient gaps can guide targeted nutrition education and the provision of accessible healthier food options, leading to positive health outcomes during adolescence and beyond

Comparative-Effectiveness of Oral Beta-Lactams and Fluoroquinolones for Stepdown Therapy in Patients With Enterobacterales Bloodstream Infections: A Retrospective Cohort Study

Background: This study compares treatment failure for patients who received oral beta-lactams (BLs) and fluoroquinolones (FQs) for stepdown treatment of Enterobacterales bloodstream infections (BSIs). Methods: We conducted a single-center, retrospective, age- and sex-matched, cohort study, at a Veterans Affairs (VA) hospital in South Texas. Eligible patients were at least 18 years of age with a monomicrobial BSI treated with a single oral BL or FQ antibiotic. Treatment failure was defined as recurrence or all-cause mortality within 90 days of documented BSI. Bivariate (chi-square, Fisher\u27s Exact, and Wilcoxon Rank Sum) and multivariate (logistic regression) statistical tests were used to compare groups. Results: A total of 130 patients were included in this study, with 65 patients per group. Groups were well balanced with respect to exact age, sex assigned at birth, Caucasian race, source control, intensive care unit admission, and Charlson Comorbidity Index. Importantly, 60% of patients in the BL group had cultures that were resistant to FQs and 71% were prescribed cefpodoxime. Patients in the BL group had higher median (interquartile range [IQR]) Pitt bacteremia scores than those in the FQ group: 2 (1-4) vs. 1 (1-2), p=0.04. Patients in the BL group also had a higher median (IQR) duration of intravenous (IV) antibiotics than those in the FQ group: 5 (3-7) vs. 4 (3-5), p=0.02. Treatment failure was statistically comparable for patients in the BL and FQ groups: 15% vs. 12%, p=0.61. This finding was consistent in a multivariate logistic regression model with group (BL vs. FQ) as the independent variable, treatment failure as the dependent variable, and Pitt bacteremia score and duration of IV antibiotics as covariates (OR: 0.76, 95% CI: 0.27-2.18). One patient in the FQ group experienced Clostridioides difficile infection. Conclusion: This study suggests that BLs may be as effective as FQs for oral stepdown treatment of Enterobacterales BSI without the potential associated risks. Furthermore, in the setting of FQ-resistant Enterobacterales BSI secondary to urinary source, third generation oral cephalosporins (i.e., cefpodoxime) may be reasonable alternatives

Expressions 1998-1999

https://openspace.dmacc.edu/expressions/1018/thumbnail.jp