Institutional Research, Effectiveness, and Planning (IREP)

Katie Busby, Director of IREPhttps://egrove.olemiss.edu/research_presentations/1016/thumbnail.jp

The First 4 Weeks Postpartum: The Mother’s Breastfeeding Concerns and Support

Objective: The first four weeks postpartum are critical for establishing successful breastfeeding because many women wean or stop exclusive breastfeeding during this time. This study explored the breastfeeding concerns of mothers during the first 4 weeks postpartum and the support sought for those concerns. Design: A qualitative approach was used. Participants: Four mothers, recruited from central Indiana in 2014 through social media or word of mouth participated in the study. Inclusion criteria were women in their first four to six weeks postpartum, delivered full term healthy babies and were discharged from the hospital breastfeeding. Methods: Semi-structured telephone interviews were conducted and data were analyzed using content analysis. Interview transcripts were first coded. Codes with similar meaning were grouped into categories. Categories sharing similar features were again collapsed into common themes. Results: Concerns identified by mothers fell into the themes: Infant breastfeeding difficulties (latch), breast complications related to breastfeeding (pain and nipple trauma), and maternal concerns related to milk production (infant milk intake and milk supply). Four common themes of support were identified that mothers utilized to alleviate concerns: Professional support, informational support, peer support, and family support. Conclusions: Mothers identified concerns related to themselves and their infants with respect to breastfeeding in the first four weeks postpartum. These concerns indicate the women’s struggle with establishing a successful breastfeeding pattern and one that is compromised by infant latch difficulty, nipple pain and inadequate milk production. Support was sought at multiple levels from health care professionals to social media. The findings suggest that support from health care professionals who provide valuable information is important. However, postpartum women also utilize other support methods when encountering breastfeeding concerns in the first four weeks postpartum. When developing interventions to assist postpartum women with establishing breastfeeding outside of the hospital setting, nurses need to consider using social media and social networks as resources for breastfeeding information and support

Immigrant families' perceptions on walking to school and school breakfast: a focus group study

Background: Immigrant children face an increased risk of being overweight. Little is known about how immigrant families perceive school programs that may help prevent obesity, such as walking to school and school breakfast. Methods: Six focus groups (n = 53) were conducted with immigrant parents of school-aged children, two each in three languages: Vietnamese, Spanish, and Somali. A facilitator and translator conducted the focus groups using a script and question guide. Written notes and audio transcripts were recorded in each group. Transcripts were coded for themes by two researchers and findings classified according to an ecological model. Results: Participants in each ethnic group held positive beliefs about the benefits of walking and eating breakfast. Barriers to walking to school included fear of children's safety due to stranger abductions, distrust of neighbors, and traffic, and feasibility barriers due to distance to schools, parent work constraints, and large families with multiple children. Barriers to school breakfast participation included concerns children would not eat due to lack of appealing/appropriate foods and missing breakfast due to late bus arrival or lack of reminders. Although some parents acknowledged concerns about child and adult obesity overall, obesity concerns did not seem personally relevant. Conclusion: Immigrant parents supported the ideals of walking to school and eating breakfast, but identified barriers to participation in school programs across domains of the ecological model, including community, institution, and built environment factors. Schools and communities serving immigrant families may need to address these barriers in order to engage parents and children in walking and breakfast programs.Group Health Community Foundation (JC), Robert Wood Johnson Foundation Injury Free Coalition for Kids Obesity Synergy Grant (KB), Health Resources and Services Administration (HRSA) NRSA fellowship (MG)

A Feasibility Study for An Integrated Approach to Fall Prevention in Community Care: Stay Up and Active in Orange County

Introduction: Falls amongst persons over 60 present significant risks for serious injury or debility. Falls place burdens on Emergency Medical Services (EMS), hospitals, and the adults themselves. Recognizing a need to provide interventions to minimize risk, Orange County Emergency Services (OCES), the Orange County Department on Aging (OCDoA), and the University of North Carolina at Chapel Hill (UNC) partnered to create the Stay Up and Active Program (SUAA). Methods: A streamlined workflow algorithm between the OCES and OCDoA was created and employed to provide falls risk assessment and necessary services. Qualitative techniques were used to assess the need for such a program and its potential impact. A subset of individuals were interviewed three months after the intervention to assess the impact of the intervention on their fall risk. Results: In the first seven months, 478 instances of individuals who called OCES screened positive for falls risk. Of the 478 positive screenings, 55 individuals were identified as having received more than one positive fall screen due to multiple calls. The maximum number of positive screenings by one individual was 14. More women (61.3%) than men screened positive for fall risk. Individuals 88 years of age (6.9%) represented the mode of the individuals with positive screens. Nineteen (4.0%) people who called OCES and received the intervention completed a three month follow up survey. Of the nineteen, 86% (n=16) reported no recurrent fall.Conclusion: The number of individuals who screened positive supports the need for early identification and intervention through EMS. This program identified several challenges connecting older adults with services already available to keep them independent which provided insight to all stakeholders regarding factors that inhibit the program’s success. The program evaluation should continue to provide suggestions for improvement and ensure sustainability

Corticosteroid responsiveness following mepolizumab in severe eosinophilic asthma—a randomized, placebo-controlled crossover trial (MAPLE)

Mepolizumab inhibits interleukin-5 (IL-5) activity, reduces exacerbation frequency and maintenance oral corticosteroid (OCS) dosage in patients with severe eosinophilic asthma (SEA). Some patients remain dependent on OCS despite anti-IL-5 treatment suggesting residual corticosteroid responsive mechanisms. We aimed to determine the clinical and anti-inflammatory effects of OCS in patients with SEA on mepolizumab. We conducted a randomised, triple-blind, placebo-controlled crossover trial of prednisolone (0.5mg/kg/day, maximum 40mg/day, for 14±2 days) in adults with SEA after ≥12 weeks of mepolizumab. We compared change in asthma symptoms, quality of life, lung function measured by spirometry and airwave oscillometry, FeNO, and blood and sputum eosinophil cell count after prednisolone and placebo. 27 patients completed the study. Prednisolone did not improve ACQ-5 (mean difference in change for prednisolone vs placebo -0.23, 95% CI -0.58 to 0.11), mini-AQLQ (0.03, 95% CI -0.26 to 0.42), SGRQ (0.24, 95% CI -3.20 to 3.69) or VAS scores for overall asthma symptoms (0.11, 95% CI -0.58 to 0.80). The mean difference for FEV in favour of prednisolone was 105ml (95% CI -4 to 213 ml); FEF 484ml/s (95% CI 151 to 816 ml/s); FeNO reduction 41% (95% CI 25 to 54%); blood eosinophil count reduction 49% (95% CI 31 to 62%); and percentage of sputum eosinophil reduction 71% (95% CI 26 to 89%). OCS improved small airway obstruction and reduced biomarkers of type 2 inflammation but had no significant effect on symptoms or quality of life in patients with severe eosinophilic asthma receiving treatment with mepolizumab. [Abstract copyright: Copyright © 2022. Published by Elsevier Inc.

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Exploring Mentoring Relationships Among Novice Nurse Faculty: A Grounded Theory

Indiana University-Purdue University Indianapolis (IUPUI)The growing and aging population has created an increased demand for health care, resulting in a need for hundreds of thousands more nurses across the United States. As a result, additional nurse faculty are needed to teach the next generation of nurses. However, nurses who enter the faculty role in academia often come from various professional backgrounds with different educational preparation that may not equate to success with the tripartite faculty role of teaching, scholarship, and service. As a way to retain and develop novice faculty, mentoring relationships and programs are promoted as an intervention for career and psychosocial development within academia. Mentoring is an interpersonal process built on mutual trust and friendship to create a professional and personal bond. Mentoring relationships can help develop selfconfidence, productivity, and career satisfaction among nurse faculty members. Effective mentoring relationships can ease the transition into academia and provide a vital foundation for productive academic careers. However, the interpersonal process that is the hallmark of mentoring can differ between a mentor and protégé, leading to vast differences in quality and effectiveness. Although mentoring is widely recommended, little is known about the process of mentoring relationships in academia or how novice nurse faculty utilize mentoring to transition into academia. The purpose of this qualitative grounded theory study is to uncover a theoretical framework that describes how mentoring relationships, as experienced by novice nurse faculty, unfold. Charmaz's method of grounded theory was used to interview full-time novice nurse faculty (N = 21) with three years or less in the faculty role from nursing programs across the United States. The grounded theory theoretical framework, Creating Mentorship Pathways to Navigate Academia captures the process of mentoring as experienced by novice nurse faculty within academia. The theoretical framework contains five main phases as described by novice nurse faculty being assigned a formal mentor, not having mentoring needs met, seeking an informal mentor, connecting with mentor, and doing the work of mentoring. Participants created mentorship pathways through both formal and informal mentoring relationships to navigate academia by acquiring knowledge, meeting expectations, and functioning in the role as a faculty member

Devolution as a Vehicle for Human Rights Protection and Progress: Incorporation of International Human Rights Obligations

Devolution provides both a foundation and a vehicle for progressive reform in relation to human rights. The article examines progress within the current framework, including the incorporation of international treaties, as recommended by the National Taskforce for human rights leadership in Scotland. Scotland’s planned incorporation of a number of international treaties provides an opportunity to embrace a number of normative standards, including progressive realisation, minimum core obligations as well as substantive equality measures. The particular nature of devolution provides the opportunity to close the accountability gap in the protection of economic, social, cultural and environmental rights, many of which are devolved areas of law, such as the right to health, the right to housing and the right to a healthy environment. These measures of progress are examined in light of the risks posed to human rights by the erosion of devolution through a number of UK-led strategies, particularly in response to policy gaps as a result of Brexit. It is argued that devolution can act as an important anchor on national reform, mitigating threats to backslide on rights at the national level in this respect, however, increasing centralisation makes this difficult to realise in practice. The article sets out the potential opportunities if devolution was further enhanced, including a fully integrated operational human rights framework across a range of social and economic policy areas such as employment, social security, immigration and equality. Each of these areas are critically assessed offering insights into the potential reach as well as limitations of devolution as a force for human rights progress. It concludes with a reframing of human rights in the UK to reflect the more complex picture painted by diverging human rights trajectories in each of the UK jurisdictions and the roles played by different actors in relation to human rights reform.Output Status: Forthcomin

Subnational incorporation of economic, social and cultural rights – can devolution become a vehicle for progressive human rights reform?

Devolution acts as both a foundation and a potential vehicle for progressive human rights reform. This article examines progress within the current Scottish framework, including the incorporation of international treaties, as recommended by the National Taskforce for Human Rights Leadership. The particular nature of devolution provides the opportunity to close the accountability gap in the protection of economic, social and cultural rights which operate in devolved areas, including the right to health, the right to housing and the right to an adequate standard of living. This reform brings opportunities to embrace normative international standards that facilitate incorporation such as multi-institutional accountability, proportionality-inflected reasonableness review, dignity and collective justice, as well as substantive equality measures. Progress to date is examined against the risks posed to human rights by the erosion of devolution through a number of United Kingdom(UK)-led strategies, particularly in response to Brexit-related policy gaps. Although devolution can act as an important anchor on national reform, mitigating threats to backsliding on rights at the national level, increasing centralisation can make this difficult to realise in practice. The potential opportunities offered by enhanced devolution could provide a fully integrated human rights framework incorporating social and economic policy areas such as employment, social security, immigration and equality. However, given current constitutional arrangements, devolution’s promise as a force for human rights progress is limited. The article concludes with a reframing of human rights which reflects the more complex picture painted by diverging trajectories in each of the UK jurisdictions