Decreasing Hospital Readmission with Post-Hospital Discharge Primary Care Clinic Appointments

ABSTRACT The Centers for Medicare and Medicaid Services (CMS) continue to apply costly financial penalties for hospital readmission. Hospital readmission can stem from multiple causes which can lead to poor health outcomes or increased healthcare financial costs. However, with the use of an implemented 14-day post-hospital follow-up appointment with a primary care provider, hospital readmission could be reduced, and patient care improved. The multiple factors that can lead to hospital readmission include non-adherence to medication, socioeconomic factors, patient-related factors, condition-related factors, or health system-related factors. Through the implementation of post-hospital discharge follow-up visits within 14 days of discharge, hospital readmissions could be reduced. The purpose of the Doctor of Nursing Practice (DNP) project was to identify factors that affect a patient’s hospital readmission in an identified hospital facility with a general nonspecific discharge patient population with multi-discharge diagnoses. To identify these factors patients had a scheduled follow-up visit completed within 14 days of discharge from the selected hospital facility. In the follow-up visit the identified provider and researcher addressed the patient\u27s concerns, medication reconciliation, pending or needed laboratory tests, or other concerns. A post-hospital transition of care form could also be completed within one to two business days post-hospital discharge. The results of the DNP project found that due to an unforeseen stoppage of the study the limited data did not support the use of a hospital discharge follow-up visit within 14 days. The results provided no evidence of any decreased rate of hospital readmission as the data was limited with small sample size. The DNP project suggested that further research is needed to determine if follow-up visits within 14 days of hospital discharge provide decreased hospital readmissions

Studies on bovine Petechial fever and ovine tick-borne fever

A comparative study was made of tick-borne fever in sheep in Scotland, and bovine petechial fever in sheep and cattle in Kenya. The results obtained demonstrated the similarity of the two diseases.Both are caused by rickettsia-like organisms observable principally in the neutrophils, and tentatively classified in the genus Cytoecetea. These were considered to be morphologically identical.Clinical signs and necropsy lesions of experimental animals were noted. The parameters of normal infections with both diseases were defined, with reference to haernatological, febrile, and parasitaemic responses. The distribution of the causative organisms in infected host at different stages of reaction was investigated by infectivity studies; spleen and lung were found to contain the highest titros.A latent infection was a more common sequel to tick-borne fever than to bovine petechial fever.A complement fixation test was de^loped for tick-borne fever, antigen being prepared from infected leucocytes. Similar methods proved only partially successful for bovine petechial fever.A hitherto unsuspected breed difference in susceptibility to bovine petechial fever was observed, and thereafter Sahiwal cross cattle were used routinelyInvestigations were made into the potential role of wild ruminants in the epidemiology of bovine petechial fever, by experimental inocul¬ ation of captive wild animals. Several species were found to allow multiplication; as a corollary to this, isolates of the causative organism were made from wild bushbuck in an enzootic area.Three antibiotics were compared in the treatment of patent bovine petechial fever reactions in sheep, and the most efficacious of these (dithiosemicarbazone) was used successfully to treat the disease in cattle

Infectious diarrhoea in young animals

The aetiology of infectious diarrhoea in young animals, particularly calves, was investigated, using techniques appropriate to the detection of viral, bacterial and protozoal pathogens. Rotavirus was established as of prime significance, and the classic 'white scour' syndrome in calves was usually caused by rotavirus with, on occasion, the simultaneous involvement of coronavirus or Cryptosporidium. Enterotoxigenic Escherichia coli (ETEC) infections were much less common, with under 6% of E. coli isolates possessing K99 fimbriae. Outbreaks of cryptosporidiosis were described for the first time from the U.K. The technique for the detection of the characteristic migration pattern of rotaviral double-stranded RNA segments in silver-stained polyacrylamide gels has proved of especial value in diagnostic and epidemiological investigations.Infection of gnotobiotic lambs with lamb rotavirus produced dullness, inappetance, and diarrhoea, and provided a most useful model for pathogenesis studies. A rapid and extensive infection and defoliation of small intestinal epithelium leading to partial villus atrophy was followed within 2-3 days by a return to apparent morphologic normality. However, the underlying continuing dysfunction of an increased cell turnover rate was demonstrated by metaphase accumulation. Animals with acute enteritis were tolerant to levels of lactose normally found in milk, but their ability to digest and absorb increased oral doses of lactose was impaired. In calves, a concurrent rotavirus infection facilitated intestinal ETEC colonisation beyond the normal age of resistance.Studies on passive immunisation in young lambs demonstrated that protection against rotavirus infection by antibody in the gut lumen was more effective than that provided by circulating antibody. The potential value of this technique was shown in experiments in lambs using rotavirus and immunoglobulin of human origin. Experimental adjuvanted vaccines of inactivated rotavirus given to ewes and cows in pregnancy significantly increased the titre of antibody of IgGl isotype in colostrum and milk. Neonates ingesting these secretions were protected to various degrees against rotavirus infection and diarrhoea. The incorporation of commercially-produced K99 fimbriae from ETEC allowed the successful experimental testing and subsequent field trialling of a vaccine which substantially reduced rotavirus and ETEC diarrhoea problems in the progeny of vaccinated cows. Sero¬ logical variation in rotavirus strains was of potential significance to successful vaccination: atypical rotaviruses with no serological relationship to 'conventional' rotaviruses were identified and characterised serologically and genomically, but occurred too infrequently in calves to present a major clinical problem. Distinct calf rotavirus serotypes that did not confer passive cross protection were identified. Cows produced a heterotypic immune response to all serotypes to which they had pre-existing antibody after vaccination with a single serotype. Passive immunisation may therefore largely overcome the practical problems posed by the existence of many rotavirus serotypes.In the course of this work on neonatal diarrhoea, studies on diagnosis, epidemiology, pathogenesis and biochemistry of other enteropathogens, particularly astrovirus, Cryptosporidium, E. coli and Campylobacters were made. A method for exploiting the genetic control of susceptibility of piglets to adhesion with K88 fimbriae from ETEC was devised and tested

Cattle develop neutralizing antibodies to rotavirus serotypes which could not be isolated from faeces of symptomatic calves

Neutralizing antibodies against 10 serotypes of rotavirus were measured in sera from different age groups of German cattle. Only five of 143 sera did not neutralize heterologous serotypes. Sera from 64 of 76 calves younger than 1 year neutralized bovine rotavirus NCDV (serotype 6). From these calves, sera 54, 26, 51, 24, 12, 10 and 37, in neutralized addition, the heterologous serotypes 1, 2, 3, 4, 5, 7 and 9, respectively. Thirty-eight of 46 rotavirus isolates from Bavarian calves with diarrhoea were serotyped by neutralization: 22, 2 and 14 isolates were typed as serotype 6, serotype 10 (B223) and a newly defined subtype of serotype 10 (V1005), respectively. All serotype 6 isolates and none of the serotype 10 or V1005-like viruses tested hybridized to a NCDV-specific cDNA probe. Eight isolates gave equivocal results by neutralization. We failed however to identify serotype 1, 2, 3, 4 or 8 bovine rotavirus isolates by neutralization with hyperimmune sera and dot blot hybridization with serotype-specific cDNA probes. Thus cross-reacting antibodies in cattle might not represent an anamnestic response, but the recognition of a cross-reacting neutralization epitope shared by many rotavirus serotype

Antigenic and biochemical characterization of bovine rotavirus V1005, a new member of rotavirus serotype 10

Bovine rotavirus (BRV) V1005 is serologically distinct from rotavirus serotypes 1, 2, 3, 4, 5, 6, 8 and 9. BRV V1005 showed cross-reactions with BRV B223, the American prototype of serotype 10 rotavirus, and with BRV E4049, a British serotype 10 isolate. BRV V1005 was, however, not neutralized by four monoclonal antibodies directed against VP7 of BRV B223. Two-way cross-reactions were observed between BRV V1005 and a reassortant rotavirus containing the VP4 from BRV UK. In addition the major tryptic cleavage product of VP4, VP5*, from BRV V1005 is indistinguishable by peptide mapping and its isoelectric point from the homologous protein of BRV UK, but is clearly different from VP5* of BRV NCDV. The peptide map of VP7 from BRV V1005 differed from that obtained for VP7 of BRV U

A portable device for nucleic acid quantification powered by sunlight, a flame or electricity.

A decentralized approach to diagnostics can decrease the time to treatment of infectious diseases in resource-limited settings. Yet most modern diagnostic tools require stable electricity and are not portable. Here, we describe a portable device for isothermal nucleic-acid quantification that can operate with power from electricity, sunlight or a flame, and that can store heat from intermittent energy sources, for operation when electrical power is not available or reliable. We deployed the device in two Ugandan health clinics, where it successfully operated through multiple power outages, with equivalent performance when powered via sunlight or electricity. A direct comparison between the portable device and commercial qPCR (quantitative polymerase chain reaction) machines for samples from 71 Ugandan patients (29 of which were tested in Uganda) for the presence of Kaposi's sarcoma-associated herpesvirus DNA showed 94% agreement, with the four discordant samples having the lowest concentration of the herpesvirus DNA. The device's flexibility in power supply provides a needed solution for on-field diagnostics

Dreams of Development in Mexico and Spain: A Comparative History of Guestworkers and Migration Diplomacy

Abstract: This history of Cold War-era migration policy compares two emblematic guestworker programs that recruited several million Mexican and Spanish migrants to labor in the United States and Germany. Proponents of the bilateral accords defended them as diplomatic achievements that secured contractual labor rights, improved foreign relations, and sent migrants home with savings and skills to achieve the diverse development goals of the sending states. The study traces the programs’ historical and ideological roots, juxtaposes the guestworkers’ experiences, and uses the cases of Mexican braceros and Spanish gastarbeiter to explore the contested nexus between migration and development