Provider Perceptions on the Outcome of Postpartum Depression Screening During Well- Child Visits

The US Preventative Task Force and Centers for Medicare and Medicaid Services recommend screening for perinatal and postpartum depression (PPD) during well-child visits that occur during the first year of the baby’s life. Postpartum means the time after childbirth, and postpartum depression is defined as a variant of major depressive disorder that occur during pregnancy or within 4 weeks of delivery. Current pediatric guidelines recommend that PPD screening occur at three to five days after birth and at one, two, four, six, nine and twelve month well-child evaluations during the first year of life. This DNP clinical inquiry project brought to light an of understand primary care providers’ (PCP) perceptions of PPD screening practices during well-child checks by surveying the providers about their PPD practices. The participants took a survey to measure understanding of PPD in their practice, and frequency of PPD screening during the well child visits. This DNP clinical inquiry project measured providers reported wide-ranging (PPD) screening practices and use of various validated PPD screening tools during well child visits. Screening practices have improved among PCP’s, according to the AAP, but still less than half of providers screen mothers for PPD

Extending awareness of healthcare ethics at Cabrini Health: Junior clinicians\u27 perspectives

As Catholic healthcare organizations form a substantive part of healthcare delivery in the USA and Australia, ethical standards for Catholic health care were developed to guide practice. This study examined junior staff’s understanding of Catholic ethics. Using a qualitative descriptive design, we recruited 22 medical and nursing staff to interviews/focus groups. Though Catholic ethics seldom informed ethical approaches, the principles were acknowledged as being useful to support development of confident and respectful care approaches. Findings provide early insights into challenges faced in considering implementation of ethical codes across both secular and religious healthcare organizations, suggesting that a more creative and pastoral approach to dialoguing and implementing Catholic ethics is required

Very Important Discharge Appointment (VIDA)

To improve patient flow, access, and decrease strain on resources by enhancing the current process of Discharge and Loop Back Huddle by identifying two patients for early discharge the next day. Current Practices: Discharge huddle and Loopback (Discuss care progression for all pts) Discharge planning using the IDEAL Model (Patient and Family Engagement with Discharge) Electronic Discharge Readiness Tools (Exp Discharge Date, Discharge milestones, etc.) Next piece of the puzzle: VIDA: a framework to identify 2 patients to be discharged before 11 am – so the bulk of our discharges do not occur between Noon and 4:00 pm. Decreasing the strain on internal and external resources.https://digitalcommons.centracare.com/nursing_posters/1131/thumbnail.jp

Simulation-Based Interdisciplinary Team Learning—Pilot Study

Background: Currently, interprofessional education (IPE) is becoming widely integrated into healthcare professional education with regulating bodies including IPE as a curricular requirement. Although recent studies have concluded that students value IPE, there are a number of challenges associated with initial engagement. Many schools are unsure how to approach this interdisciplinary integration. In addition to IPE, simulation has become an important tool in the education of health professionals. As the first exercise at Wright State University involving interprofessional groups composed completely of undergraduates, interested students from the Boonshoft School of Medicine, the WSU College of Nursing and Health, and the Cedarville University School of Pharmacy collaborated to conduct a series of IPE cases in the Department of Emergency Medicine’s high-fidelity simulation lab. In order to support a continuous improvement process and identify strengths and weaknesses of the interprofessional simulation, data was collected from all participating students. Methods: This study was approved as an exempt protocol by the University IRB. Repeat surveys were conducted on an interprofessional group of students assessing their attitudes prior to and upon completion of a series of simulations. The survey included 6 Likert scale questions and a comments section. Paired t-test and frequency analysis were utilized for each of the survey questions to determine baseline status and determine any statistically significant change from baseline. Results: Students from all health professions demonstrated positive attitudes toward IPE and simulation training. Results from four of the survey questions demonstrated a statistically significant positive increase in differences between pre-simulation and post-simulation survey. Baseline responses indicate a strongly positive attitude towards IPE. In comparison to pre-simulation survey responses, post-simulation responses demonstrated significant increases in students’ experience and perceived value of high-fidelity healthcare clinical simulation. Additionally, there were statistically significant changes in students’ perceived value of interdisciplinary team training and its importance in the future of medical education. Conclusion: This study found that students from all three participating health professions demonstrated overall positive baseline attitudes toward IPE that could be further enhanced through participation in simulation-based exercises. This study provides a model of one method for integrating IPE into curricula for healthcare professionals

Low levels of viral suppression among refugees and host nationals accessing antiretroviral therapy in a Kenyan refugee camp.

BACKGROUND: Refugees and host nationals who accessed antiretroviral therapy (ART) in a remote refugee camp in Kakuma, Kenya (2011-2013) were compared on outcome measures that included viral suppression and adherence to ART. METHODS: This study used a repeated cross-sectional design (Round One and Round Two). All adults (≥18 years) receiving care from the refugee camp clinic and taking antiretroviral therapy (ART) for ≥30 days were invited to participate. Adherence was measured by self-report and monthly pharmacy refills. Whole blood was measured on dried blood spots. HIV-1 RNA was quantified and treatment failures were submitted for drug resistance testing. A remedial intervention was implemented in response to baseline testing. The primary outcome was viral load <5000 copies/mL. The two study rounds took place in 2011-2013. RESULTS: Among eligible adults, 86% (73/85) of refugees and 84% (86/102) of Kenyan host nationals participated in the Round One survey; 60% (44/73) and 58% (50/86) of Round One participants were recruited for Round Two follow-up viral load testing. In Round One, refugees were older than host nationals (median age 36 years, interquartile range, IQR 31, 41 vs 32 years, IQR 27, 38); the groups had similar time on ART (median 147 weeks, IQR 38, 64 vs 139 weeks, IQR 39, 225). There was weak evidence for a difference between proportions of refugees and host nationals who were virologically suppressed (<5000 copies/mL) after 25 weeks on ART (58% vs 43%, p = 0.10) and no difference in the proportions suppressed at Round Two (74% vs 70%, p = 0.66). Mean adherence within each group in Round One was similar. Refugee status was not associated with viral suppression in multivariable analysis (adjusted odds ratio: 1.69, 95% CI 0.79, 3.57; p = 0.17). Among those not suppressed at either timepoint, 69% (9/13) exhibited resistance mutations. CONCLUSIONS: Virologic outcomes among refugees and host nationals were similar but unacceptably low. Slight improvements were observed after a remedial intervention. Virologic monitoring was important for identifying an underperforming ART program in a remote facility that serves refugees alongside host nationals. This work highlights the importance of careful laboratory monitoring of vulnerable populations accessing ART in remote settings

Short-Term Post-Harvest Stress that Affects Profiles of Volatile Organic Compounds and Gene Expression in Rocket Salad During Early Post-Harvest Senescence

Once harvested, leaves undergo a process of senescence which shares some features with developmental senescence. These include changes in gene expression, metabolites, and loss of photosynthetic capacity. Of particular interest in fresh produce are changes in nutrient content and the aroma, which is dependent on the profile of volatile organic compounds (VOCs). Leafy salads are subjected to multiple stresses during and shortly after harvest, including mechanical damage, storage or transport under different temperature regimes, and low light. These are thought to impact on later shelf life performance by altering the progress of post-harvest senescence. Short term stresses in the first 24 h after harvest were simulated in wild rocket (Diplotaxis tenuifolia). These included dark (ambient temperature), dark and wounding (ambient temperature), and storage at 4 °C in darkness. The effects of stresses were monitored immediately afterwards and after one week of storage at 10 °C. Expression changes in two NAC transcription factors (orthologues of ANAC059 and ANAC019), and a gene involved in isothiocyanate production (thiocyanate methyltransferase, TMT) were evident immediately after stress treatments with some expression changes persisting following storage. Vitamin C loss and microbial growth on leaves were also affected by stress treatments. VOC profiles were differentially affected by stress treatments and the storage period. Overall, short term post-harvest stresses affected multiple aspects of rocket leaf senescence during chilled storage even after a week. However, different stress combinations elicited different responses

Clinical and biological heterogeneity of multisystem inflammatory syndrome in adults following SARS-CoV-2 infection: a case series

ImportanceMultisystem inflammatory syndrome in adults (MIS-A) is a poorly understood complication of SARS-CoV-2 infection with significant morbidity and mortality.ObjectiveIdentify clinical, immunological, and histopathologic features of MIS-A to improve understanding of the pathophysiology and approach to treatment.DesignThree cases of MIS-A following SARS-CoV-2 infection were clinically identified between October 2021 – March 2022 using the U.S. Centers for Disease Control and Prevention diagnostic criteria. Clinical, laboratory, imaging, and tissue data were assessed.FindingsAll three patients developed acute onset cardiogenic shock and demonstrated elevated inflammatory biomarkers at the time of hospital admission that resolved over time. One case co-occurred with new onset Type 1 diabetes and sepsis. Retrospective analysis of myocardial tissue from one case identified SARS-CoV-2 RNA. All three patients fully recovered with standard of care interventions plus immunomodulatory therapy that included intravenous immunoglobulin, corticosteroids, and in two cases, anakinra.ConclusionMIS-A is a severe post-acute sequela of COVID-19 characterized by systemic elevation of inflammatory biomarkers. In this series of three cases, we find that although clinical courses and co-existent diseases vary, even severe presentations have potential for full recovery with prompt recognition and treatment. In addition to cardiogenic shock, glucose intolerance, unmasking of autoimmune disease, and sepsis can be features of MIS-A, and SARS-CoV-2 myocarditis can lead to a similar clinical syndrome

Imaging in breast cancer: Diffuse optics in breast cancer: detecting tumors in pre-menopausal women and monitoring neoadjuvant chemotherapy

Diffuse optical spectroscopy (DOS) and diffuse optical imaging (DOI) are non-invasive diagnostic techniques that employ near-infrared (NIR) light to quantitatively characterize the optical properties of centimeter-thick, multiple-scattering tissues. Although NIR was first applied to breast diaphanography more than 70 years ago, quantitative optical methods employing time- or frequency-domain 'photon migration' technologies have only recently been used for breast imaging. Because their performance is not limited by mammographic density, optical methods can provide new insight regarding tissue functional changes associated with the appearance, progression, and treatment of breast cancer, particularly for younger women and high-risk subjects who may not benefit from conventional imaging methods. This paper reviews the principles of diffuse optics and describes the development of broadband DOS for quantitatively measuring the optical and physiological properties of thick tissues. Clinical results are shown highlighting the sensitivity of diffuse optics to malignant breast tumors in 12 pre-menopausal subjects ranging in age from 30 to 39 years and a patient undergoing neoadjuvant chemotherapy for locally advanced breast cancer. Significant contrast was observed between normal and tumor regions of tissue for deoxy-hemoglobin (p = 0.005), oxy-hemoglobin (p = 0.002), water (p = 0.014), and lipids (p = 0.0003). Tissue hemoglobin saturation was not found to be a reliable parameter for distinguishing between tumor and normal tissues. Optical data were converted into a tissue optical index that decreased 50% within 1 week in response to neoadjuvant chemotherapy. These results suggest a potential role for diffuse optics as a bedside monitoring tool that could aid the development of new strategies for individualized patient care

Urban Air Mobility Airspace Integration Concepts and Considerations

Urban Air Mobility (UAM) - defined as safe and efficient air traffic operations in a metropolitan area for manned aircraft and unmanned aircraft systems - is being researched and developed by industry, academia, and government. Significant resources have been invested toward cultivating an ecosystem for Urban Air Mobility that includes manufacturers of electric vertical takeoff and landing aircraft, builders of takeoff and landing areas, and researchers of the airspace integration concepts, technologies, and procedures needed to conduct Urban Air Mobility operations safely and efficiently alongside other airspace users. This paper provides high-level descriptions of both emergent and early expanded operational concepts for Urban Air Mobility that NASA is developing. The scope of this work is defined in terms of missions, aircraft, airspace, and hazards. Past and current Urban Air Mobility operations are also reviewed, and the considerations for the data exchange architecture and communication, navigation, and surveillance requirements are also discussed. This paper will serve as a starting point to develop a framework for NASA's Urban Air Mobility airspace integration research and development efforts with partners and stakeholders that could include fast-time simulations, human-in-the-loop (HITL) simulations, and flight demonstrations