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

The Worth of Water: A Look at the Water Scarcity Crisis and the Perceptions of the Basic Need of Water in South Africa

Not every South African has access to the same amount of water, quality of water, or infrastructure for water. A core question for me during this research was if and how attitudes towards water and daily water consumption vary along with different levels of water accessibility. Considering both the emerging global water scarcity crisis and the legacy of Apartheid, evident by the institutional inequalities in South Africa, I unravel the current system of water allocation. First, I discuss the definition of water scarcity, the politics surrounding water allocation, and South Africa’s Constitutional right to water as well as the Free Basic Water Policy of 2001, which illustrates how the South African government understands its responsibility to provide water to all SA citizens. Second, I analyze the role of water as both a commodity and a human necessity, and discuss the economic perspective, humanitarian perspective, and an alternative perspective about water allocation. Lastly, I present my research in Mowbray and Lwandle, which are two areas in Cape Town that differ substantially in terms of family income, race and access to water. Based on a total of 37 interviews, participant observation, and considering the local discourse, I argue that a person’s level of water accessibility influences how he/she understands the value of water and his/her willingness to save water. I found that people who currently consume the least amount of water reported that they are willing to save the most, which goes against a core economic principle of the law of diminishing marginal utility. In addition, I discuss the boundaries of ethnography and the efficacy of my research methods

CHARM will get you everywhere: Student Reflections on the Inaugural EU Master\u27s in Global Challenges for Sustainability

CHARM-EU is an innovative alliance to create a European campus comprising the University of Barcelona, Trinity College Dublin, Utrecht University, the University of Montpellier, and Eötvös Loránd University. Each semester, students are registered in one of the five partner universities and connect to the remainder of the campuses to complete a range of learning activities for the duration of CHARM-EU’s 18-month pilot master’s programme, MSc in Global Challenges for Sustainability; the programme is aligned with the European Green Deal and the United Nations’ 17 Sustainable Development Goals. It offers students a unique international learning opportunity and the skills to address the pressing need for sustainability in a transdisciplinary and challenge-based environment. The programme consists of three phases: preparatory, flexible, and the capstone phase. In the flexible phase, students choose to focus on the thematic area of either Food, Water, or Life and Health. Two students, Megan O’Brien and Pien Barnas, who are pursuing the Food stream recount their experience so far with CHARM-EU. They reflect upon why they chose to pursue the Food stream, the highlights and challenges they have encountered, and how this master’s programme is preparing them for the future

VEILING LAWS AND AFFILIATED PROTESTS IN IRAN

Veiling laws in Iran are the obligation for women to wear hijabs or headscarves and are based on Muslim religious beliefs that women must cover their head to remain modest and submit themselves to God.1 The Quran is not explicit on the topic of hijabs or headscarves and, as a result, some followers interpret it as a personal preference and others interpret it as a requirement.2 Iran’s veiling laws have been the topic of great scrutiny due to a horrific event that occurred on September 13, 2022, where a young woman, Mahsa Amini, was accused by the police of improperly wearing a headscarf.3 This led to her being arrested and beaten so brutally that she slipped into a coma and died only a couple days later.4 Mahsa Amini’s death has led to protests around Iran.5 These protests have become increasingly violent and resulted in thousands of Iranian citizens being injured, imprisoned, and killed.6 Further, it led to Iran being removed from the United Nations (UN) Commission on the Status of Women.7 This article will discuss in further detail the history of the veiling laws from their implementation up to current events and the future implications of these laws

Perception of Rural Caregiving

Families providing informal care for loved ones face challenges with aging population expansion, shrinking families, and rising health care costs. Analysts predict a doubling of the aging population in the next half century, while concurrent decreasing birth rates propose a future mismatch of family caregiving resources. Similar trends are expected for the state of Vermont. With the majority of aging adults living in rural areas, an estimated 64,000 informal caregivers provide between 64 and 69 million hours of care annually, at an estimated market value of $683 million dollars. Partnering with families to provide care within these constraints will necessitate understanding the impact of caregiving from the family perspective. Role theory posits the experience of caregiving is influenced by personal and external resources. The purpose of this research was to investigate which variables produce strain or facilitate well-being within the rural informal caregiving role by investigating five identified domains: a) disrupted schedule, b) financial problems, c) lack of family support, d) health problems, and e) caregiver self-esteem. The previously validated Caregiver Reaction Assessment was distributed by six Vermont agencies serving rural elders to solicit subjective experiences to caregiving through a one-time survey. When working with families, practitioners need to be sensitive to the dynamics of the caregiving relationship. The results of this study promote the understanding of variables influencing the caregiving role for rural Vermonters. Findings identified the domain of „disrupted schedule‟ as the most impacted by assuming the caregiving role. The advance practice nurse can use these findings to advocate for families through barrier identification, education and resource allocation

Investigating the Role of the Synaptic Transcriptome in Ethanol-Responsive Behaviors

Alcoholism is a complex neurological disorder characterized by loss of control in limiting intake, compulsion to seek and imbibe ethanol, and chronic craving and relapse. It is suggested that the characteristic behaviors associated with the escalation of drug use are caused by long-term molecular adaptations precipitated by the drug’s continual administration. These lasting activity-dependent changes that underlie addiction-associated behavior are thought, in part, to depend on new protein synthesis and remodeling at the synapses. It is well established that mRNA can be transported to neuronal distal processes, where it can undergo localized translation that is regulated in a spatially restricted manner in response to stimulation. Through two avenues of investigation, the research herein demonstrates that behavioral responses to ethanol result, at least in part, from alterations in the synaptic transcriptome which contribute to synaptic remodeling and plasticity. The synaptoneurosome preparation was utilized to enrich for RNAs trafficked to the synapse. Two complementary methods of genomic profiling, microarrays and RNA-Seq, were used to survey the synaptic transcriptome of DBA/2J mice subjected to ethanol-induced behavioral sensitization. A habituating expression profile, characteristic of glucocorticoid-responsive genes, was observed for a portion of synaptically targeted genes determined to be sensitive to repeated ethanol exposure. Other ethanol-responsive genes significantly enriched for at the synapse were related to biological functions such as protein folding and extra-cellular matrix components, suggesting a role for local regulation of synaptic functioning by ethanol. In a separate series of experiments, it was shown that altered trafficking of Bdnf, an ethanol-responsive gene, resulted in aberrant ethanol behavioral phenotypes. In particular, mice lacking dendritically targeted Bdnf mRNA exhibited enhanced sensitivity to low, activating doses and high, sedating doses of ethanol. Together these experiments suggest that ethanol has local regulatory effects at the synapse and lays the foundation for further investigations into the role of the synaptic transcriptome in ethanol-responsive behaviors. Supported by NIAA grants R01AA014717, U01 AA016667 and P20AA017828 to MFM, F31AA021035 to MAO, and NIDA T32DA007027 to WLD

Bringing Upstairs Care Downstairs; Integration of Rehabilitation Medicine, Care Management, and the Hospital Elder Life Program (HELP) into an Emergency Department.

Introduction: Services such as physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), social work (SW), care management, and elder life specialists have long been an established part of care for patients admitted to Maine Medical Center (MMC) but not for patients in the Emergency Department (ED). Methods and Results: Driven in part by changes in Medicare reimbursement models, care management established a presence in the Emergency Department (ED) in 2003 with a focus on care planning and cost avoidance. In recent years PT, OT, SLP, SW, and the Hospital Elder Life Program (HELP) have increased their ED involvement substantially. These services not only support care management decisions but have become an invaluable part of the ED team. The timing, staffing models, and roles of these services in our emergency department are described. Discussion: There was strong leadership support to create these positions in the ED. Increased patient volume hospital wide has required staffing flexibility. Initial concerns for slowing the ED where anecdotally resolved. Other hospitals in our system are interested in this approach. Conclusions: While the value of this work feels self-evident and is already established for admitted patients, descriptive and outcome-oriented studies for ED patients would be enlightening

Molecular analyses reveal consistent food web structure with elevation in rainforest Drosophila – parasitoid communities

The analysis of interaction networks across spatial environmental gradients is a powerful approach to investigate the responses of communities to global change. Using a combination of DNA metabarcoding and traditional molecular methods we built bipartite Drosophila – parasitoid food webs from six Australian rainforest sites across gradients spanning 850 m in elevation and 5°C in mean temperature. Our cost-effective hierarchical approach to network reconstruction separated the determination of host frequencies from the detection and quantification of interactions. The food webs comprised 5–9 host and 5–11 parasitoid species at each site, and showed a lower incidence of parasitism at high elevation. Despite considerable turnover in the relative abundance of host Drosophila species, and contrary to some previous results, we did not detect significant changes to fundamental metrics of network structure including nestedness and specialisation with elevation. Advances in community ecology depend on data from a combination of methodological approaches. It is therefore especially valuable to develop model study systems for sets of closely-interacting species that are diverse enough to be representative, yet still amenable to field and laboratory experiments

Monitoring the Progression of Spontaneous Articular Cartilage Healing with Infrared Spectroscopy

Objective. Evaluation of early compositional changes in healing articular cartilage is critical for understanding tissue repair and for therapeutic decision-making. Fourier transform infrared imaging spectroscopy (FT-IRIS) can be used to assess the molecular composition of harvested repair tissue. Furthermore, use of an infrared fiber-optic probe (IFOP) has the potential for translation to a clinical setting to provide molecular information in situ. In the current study, we determined the feasibility of IFOP assessment of cartilage repair tissue in a rabbit model, and assessed correlations with gold-standard histology. Design. Bilateral osteochondral defects were generated in mature white New Zealand rabbits, and IFOP data obtained from defect and adjacent regions at 2, 4, 6, 8, 12, and 16 weeks postsurgery. Tissues were assessed histologically using the modified O’Driscoll score, by FT-IRIS, and by partial least squares (PLS) modeling of IFOP spectra. Results. The FT-IRIS parameters of collagen content, proteoglycan content, and collagen index correlated significantly with modified O’Driscoll score (P = 0.05, 0.002, and 0.02, respectively), indicative of their sensitivity to tissue healing. Repair tissue IFOP spectra were distinguished from normal tissue IFOP spectra in all samples by PLS analysis. However, the PLS model for prediction of histological score had a high prediction error, which was attributed to the spectral information being acquired from the tissue surface only. Conclusion. The strong correlations between FT-IRIS data and histological score support further development of the IFOP technique for clinical applications, although further studies to optimize data collection from the full sample depths are required