Patient Transitions Between Acute and Post-Acute Care Organizations: Can Nursing Communication Prevent Patient Readmission?

Preventing Patient Readmission Background and Review of Literature: Communication is the foundation of patient safety. As patients move from the acute to post-acute care setting, risk for insufficient communication rises. Research demonstrates a vast array of communication hand-off tools currently exist for and between different care arenas. No one tool has been standardized for patients transitioning from acute to post-acute care settings. The Institute of Medicine (IOM) and The Joint Commission (TJC) have published multiple documents discussing communication plagues within health care resulting in readmission. Purpose: The purpose of this project is multifaceted: 1) identifying current nursing communication practices between a large quaternary care, academic medical center and post-acute in-patient physical rehabilitation hospital; 2) capture nursing perceptions of transitional care communications quality and timeliness; 3) hand-off communication tool creation; and 4) pilot implementation of communication tool with analysis of pre- and post-project findings. Methods: This is a quasi-experimental research approach using quantitative data for two distinct groups. Retrospective data comparative analysis evaluating patient readmissions was obtained at the start of the project to determine baseline readmission rate for previous three-months followed by one-month post-implementation medical record review of patients transferred from an academic medical center to inpatient rehabilitation hospital (IRF). Patients were included based on age and discharged location (age18 years or greater; only transferred to Methodist Rehabilitation Hospital). Exclusion criteria included less than 18 years of age, transferred to location other than identified IRF, discharged against medical advice, deceased during IRF admission, non-cooperative or non-compliant with care or admission status other than inpatient. Second distinct group was registered nurses surveyed within one-month pre-implementation of new hand-off communication tool and immediately post-project completion for comparative analysis of survey responses related to nursing perception of hand-off communication processes: 1) time it takes to complete hand-off communication process; 2) communication elements are appropriate to prevent patient readmission; 3) process of patient hand-off is consistent (no variation from patient-to-patient); 4) identifies use of a current patient hand-off process; 5) identifies if there is a personal belief hand-off communication prevents patient readmission; and 6) if the receiving facility has questions concerning the patient post-transfer, how does the nurse respond to these queries. Inclusions were registered nurses with any level of nursing degree, working on trauma or neurology type unit or in care coordination. Exclusions were those employed less than 90-days. Implementation Plan/Procedure: The Iowa Evidence-Based Model was utilized to guide implementation and evaluation of the project. Results: The study identified statistically significant difference in readmission events occurring in patients transitioned from acute to post-acute IRF when nursing hand-off communication is utilized, standardized and consistent. Conclusion: A 22% reduction in patient readmission is identified between patient populations of pre- and post-project implementation. This indicates standardized hand-off nursing communication statistically impacts (reduces) readmission in patients when information is shared actively and timely between organizations

Engineering a stem cell house into a home

In the body, tissue homeostasis is established and maintained by resident tissue-specific adult stem cells (aSCs). Through preservation of bidirectional communications with the surrounding niche and integration of biophysical and biochemical cues, aSCs actively direct the regeneration of aged, injured and diseased tissues. Currently, the ability to guide the behavior and fate of aSCs in the body or in culture after prospective isolation is hindered by our poor comprehension of niche composition and the regulation it imposes. Two-and three-dimensional biomaterials approaches permit systematic analysis of putative niche elements as well as screening approaches to identify novel regulatory mechanisms governing stem cell fate. The marriage of stem cell biology with creative bioengineering technology has the potential to expand our basic understanding of stem cell regulation imposed by the niche and to develop novel regenerative medicine applications

Five More Massive Binaries in the Cygnus OB2 Association

We present the orbital solutions for four OB spectroscopic binaries, MT145, GSC 03161-00815, 2MASS J20294666+4105083, and Schulte 73, and the partial orbital solution to the B spectroscopic binary, MT372, as part of an ongoing study to determine the distribution of orbital parameters for massive binaries in the Cygnus OB2 Association. MT145 is a new, single-lined, moderately eccentric (e=0.291+/-0.009) spectroscopic binary with period of 25.140+/-0.008 days. GSC 03161-00815 is a slightly eccentric (e=0.10+/-0.01), eclipsing, interacting and double-lined spectroscopic binary with a period of 4.674+/-0.004 days. 2MASS J20294666+4105083 is a moderately eccentric (e=0.273+/-0.002) double-lined spectroscopic binary with a period of 2.884+/-0.001 days. Schulte 73 is a slightly eccentric (e=0.169+/-0.009), double-lined spectroscopic binary with a period of 17.28+/-0.03 days and the first "twin" in our survey with a mass ratio of q=0.99+/-0.02. MT372 is a single-lined, eclipsing system with a period of 2.228 days and low eccentricity (e~0). Of the now 18 known OB binaries in Cyg OB2, 14 have periods and mass ratios. Emerging evidence also shows that the distribution of log(P) is flat and consistent with Oepik's Law.Comment: Accepted to Astronomical Journa

Neonatal neurobehavioral abnormalities and MRI brain injury in encephalopathic newborns treated with hypothermia

Background Neonatal Encephalopathy (NE) is a prominent cause of infant mortality and neurodevelopmental disability. Hypothermia is an effective neuroprotective therapy for newborns with encephalopathy. Post-hypothermia functional–anatomical correlation between neonatal neurobehavioral abnormalities and brain injury findings on MRI in encephalopathic newborns has not been previously described. Aim To evaluate the relationship between neonatal neurobehavioral abnormalities and brain injury on magnetic resonance imaging (MRI) in encephalopathic newborns treated with therapeutic hypothermia. Study design Neonates with hypoxic ischemic encephalopathy (HIE) referred for therapeutic hypothermia were prospectively enrolled in this observational study. Neurobehavioral functioning was assessed with the NICU network neurobehavioral scale (NNNS) performed at target age 14 days. Brain injury was assessed by MRI at target age 7–10 days. NNNS scores were compared between infants with and without severe MRI injury. Subjects & outcome measures Sixty-eight term newborns (62% males) with moderate to severe encephalopathy underwent MRI at median 8 days (range 5–16) and NNNS at median 12 days of life (range 5–20). Fifteen (22%) had severe injury on MRI. Results Overall Total Motor Abnormality Score and individual summary scores for Non-optimal Reflexes and Asymmetry were higher, while Total NNNS Z-score across cognitive/behavioral domains was lower (reflecting poorer performance) in infants with severe MRI injury compared to those without (p \u3c 0.05). Conclusions Neonatal neurobehavioral abnormalities identified by the NNNS are associated with MRI brain injury in encephalopathic newborns post-hypothermia. The NNNS can provide an early functional assessment of structural brain injury in newborns, which may guide rehabilitative therapies in infants after perinatal brain injury

KELT-7b: A hot Jupiter transiting a bright V=8.54 rapidly rotating F-star

We report the discovery of KELT-7b, a transiting hot Jupiter with a mass of $1.28 \pm 0.18$ MJ, radius of $1.53_{-0.047}^{+0.046}$ RJ, and an orbital period of $2.7347749 \pm 0.0000039$ days. The bright host star (HD33643; KELT-7) is an F-star with $V=8.54$, Teff $=6789_{-49}^{+50}$ K, [Fe/H] $=0.139_{-0.081}^{+0.075}$, and $\log{g}=4.149 \pm 0.019$. It has a mass of $1.535_{-0.054}^{+0.066}$ Msun, a radius of $1.732_{-0.045}^{+0.043}$ Rsun, and is the fifth most massive, fifth hottest, and the ninth brightest star known to host a transiting planet. It is also the brightest star around which KELT has discovered a transiting planet. Thus, KELT-7b is an ideal target for detailed characterization given its relatively low surface gravity, high equilibrium temperature, and bright host star. The rapid rotation of the star ($73 \pm 0.5$ km/s) results in a Rossiter-McLaughlin effect with an unusually large amplitude of several hundred m/s. We find that the orbit normal of the planet is likely to be well-aligned with the stellar spin axis, with a projected spin-orbit alignment of $\lambda=9.7 \pm 5.2$ degrees. This is currently the second most rapidly rotating star to have a reflex signal (and thus mass determination) due to a planetary companion measured.Comment: Accepted to The Astronomical Journa

Origin of Life

The evolution of life has been a big enigma despite rapid advancements in the fields of biochemistry, astrobiology, and astrophysics in recent years. The answer to this puzzle has been as mind-boggling as the riddle relating to evolution of Universe itself. Despite the fact that panspermia has gained considerable support as a viable explanation for origin of life on the Earth and elsewhere in the Universe, the issue remains far from a tangible solution. This paper examines the various prevailing hypotheses regarding origin of life like abiogenesis, RNA World, Iron-sulphur World, and panspermia; and concludes that delivery of life-bearing organic molecules by the comets in the early epoch of the Earth alone possibly was not responsible for kick-starting the process of evolution of life on our planet.Comment: 32 pages, 8 figures,invited review article, minor additio