Improving Early Detection of C. difficile Infections

Background: Patients with C. difficile will have liquid, loose, mucous like, or non formed stools. These infections can occur in both the inpatient and community settings and can range from diarrhea to life threatening illness. C. difficile positive stool samples collected within the first three calendar days of hospital admission is considered community acquired. Positive stool samples for C. difficile calendar day 4 or greater are considered hospital acquired. In 2019 and 2020, the P4 surgical intensive care unit (SICU) at Henry Ford Hospital (HFH) experienced high rates of hospital acquired C. difficile infections (CDI). Aim: The purpose of this project was to utilize an electronic health record (EHR) report to conduct early screening for patients to capture CDI during the community acquired timeframe rather than during the hospital acquired timeframe. Methods: Pre-post quasi-experimental retrospective study. Institutional Review Board approval was obtained. Incidence and rate of hospital acquired CDI were tracked from 2019-2022. All community-acquired CDI identified using the stool report were tracked from 2021-2022. Findings: Significant reductions occurred in unit incidence and rates of hospital acquired CDI (Table 2). During the study timeframe, 15 community acquired CDIs were successfully detected within the first 3 calendar days of hospital admission (7 in 2021, 8 in 2022). These infections were detected with the use of the stool report tool and CNS and/or IPC follow up. Without this tool, these CDIs may not have been identified during the community acquired infection timeline. Discussion: October 2021: A Loose Stool Best Practice Alert (BPA) was implemented. This electronic health record BPA alerts nursing staff of potential CDI during the community acquired window. The stool report remains a useful monitoring tool in the event that the Loose Stool BPA is bypassed. The CNS and IPC continue with daily screening of the stool report and follow up with nursing for all potential CDI patients. This quality improvement project is in the process of being expanded to additional units at the hospital. Implications: Delay in CDI detection can cause negative outcomes for patients and can result in inflated hospital acquired rates. Utilizing an electronic report in conjunction with clinical nurse specialist follow up, is an effective method for early screening for C. difficile.https://scholarlycommons.henryford.com/nursresconf2023/1000/thumbnail.jp

Using Interprofessional Collaboration to Reduce CLABSI Rates in an Intensive Care Setting

Background: Central line associated bloodstream infections (CLABSI) are preventable hospital-acquired infections associated with increased morbidity and mortality, and cost. CLABSIs are the most expensive healthcare associated infection (HAI) with a cost upwards of $90,000 per infection. This cost does not account for increased length of stay or future readmissions. The criteria used to define CLABSIs in an acute care setting is based on the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) definitions. An infection window period (IWP) is used to review infection criteria to meet the surveillance definition. This is defined as a 7 day period, which includes the 3 calendar days before and after the first positive diagnostic test (Table 1). If no secondary sources are identifiable as a cause of the bloodstream infection (BSI) within the IWP, it will qualify as a CLABSI based on the NHSN definition. Healthcare organizations are encouraged to adhere to evidence based central line (CL) insertion and maintenance practices to reduce infection, which include: Adherence to hand hygiene practices Insertion bundles Maintenance bundles Removal of CL when they are no longer indicated Despite improved compliance with these infection prevention interventions, the surgical intensive care unit (SICU) at Henry Ford Hospital (HFH) continued to experience high CLABSI rates in 2019 and 2020. Aims: Using an interprofessional proactive approach, this project\u27s goal was to reduce the number of NHSN reportable CLABSIs by identifying at risk patients and clinically assessing for alternative infection sources. Methods: An interprofessional team formed to better understand the occurrence of CLABSI on the surgical intensive care unit (SICU). The team included: Unit Medical Director Infection Prevention Specialist Clinical Nurse Specialist Multiple opportunities were identified when reviewing root cause analysis data: Care team documentation Assessments for alternative infection. Verification of blood culture indication following HFH Blood Culture Stewardship Guidelines IRB approval and a waiver of informed consent were obtained. The interprofessional team (Figure 1): Completed daily chart audits on patients with central access Screened patients for blood culture collection and result status Verified blood culture indication using the HFH Blood Culture Stewardship Guidelines Established an IWP and reviewed medical record for infection source once blood cultures were collected Shared findings with interprofessional team via secure messaging Communicated potential gaps with the patient care teams, which included collaborative efforts regarding the treatment plan and proper documentation of clinical findings This proactive approach ensured supporting evidence was present to meet NHSN definitions for secondary BSI to avoid CLABSIs This quasi experimental retrospective study compared data from the pre intervention period (January 2019 to January 2021) to the intervention period (March 2021 to December 2022): CLABSI rate per 1,000 CL days Blood culture order rate per 1,000 CL days CL utilization ratio per 1,000 patient days Standardized infection ratio The t test was used to compare the continuous variables and was determined statistically significant if P \u3c 0.05. All analyses were performed using IBM SPSS Statistics (Version 29; Armonk, NY). Results: After implementation, the interprofessional team identified alternative sources of bloodstream infection in 37 patients (17 in 2021 and 20 in 2022) with qualifying central access and positive blood culture. When comparing pre and post intervention periods, significant reductions were made (see Table 2). This included an 82$1.6 million difference in healthcare costs. Discussion: This project demonstrates that an interpersonal team reviewing potential CLABSIs and identifying alternative sources of BSI can decrease CLABSI rates, improve patient management and lead to better outcomes. In addition to being a safe and effective approach, this intervention had the additional benefit of cost savings for the health system. Healthcare institutions should consider implementing this intervention to reduce unnecessary CLABSI rates, as well as cost.https://scholarlycommons.henryford.com/nursresconf2023/1001/thumbnail.jp

Integrating Your New Faculty to Reinforce a Liberal Education

Recognizing a need to pivot new faculty onboarding from a two-day “information download” to a more meaningful and pedagogically sound delivery of information, the provost invited the Academic Support Division to reimagine new faculty orientation for 2022. Through collaboration, an asynchronous Learning Management System course shell was quickly created to “flip the classroom” to deliver best-practice content to new faculty in a space where they were able to interact with their LMS teaching technology (Canvas) as a student and establish relationships with their new faculty cohort while discussing teaching philosophies, DEI pedagogical practices, and authentic assessment. This prioritized faculty connection and a sense of belonging for the in-person orientation and ensured the notion of liberal education was woven into all our various programs as a dual mission, Hispanic Serving Institution. This new structure afforded new faculty across all disciplines and modalities to receive consistent onboarding to foster student success

Fever Dreams: WWU Art Studio BFA Exhibition Catalog

Fever Dreams is the 2019 Western Washington University Art Studio BFA Exhibition Catalog. It features the work of 10 artists, their artist statements, and responses by art historians. There is also a curatorial statement by Hafthor Yngvason, curator.https://cedar.wwu.edu/bfa_catalogs/1000/thumbnail.jp

Vocal learning-associated convergent evolution in mammalian proteins and regulatory elements.

Vocal production learning (vocal learning) is a convergently evolved trait in vertebrates. To identify brain genomic elements associated with mammalian vocal learning, we integrated genomic, anatomical, and neurophysiological data from the Egyptian fruit bat (Rousettus aegyptiacus) with analyses of the genomes of 215 placental mammals. First, we identified a set of proteins evolving more slowly in vocal learners. Then, we discovered a vocal motor cortical region in the Egyptian fruit bat, an emergent vocal learner, and leveraged that knowledge to identify active cis-regulatory elements in the motor cortex of vocal learners. Machine learning methods applied to motor cortex open chromatin revealed 50 enhancers robustly associated with vocal learning whose activity tended to be lower in vocal learners. Our research implicates convergent losses of motor cortex regulatory elements in mammalian vocal learning evolution

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Cuentos de nunca acabar. Aproximaciones desde la interculturalidad

Cuentos de nunca acabar. Aproximaciones desde la interculturalidad, surge después de la pandemia y su imposibilidad de socializar “en persona” con los compañeros de eventuales encuentros, porque la Comprensión Lectora tenía que reinventarse para su nueva reflexión cognitiva, adaptación contextual y reconstrucción del conocimiento. Este renovado enfoque de la realidad postpandemia, concebido en el marco de la educación intercultural comunitaria, busca potencializar los entornos naturales, sociales y culturales como recursos de aprendizaje multidisciplinario a través del lenguaje animado de los cuentos. En este marco, había que dinamizar la asignatura de Comunicación Oral y Escrita, que se dicta en los Primeros Niveles de los Centros de Apoyo de Otavalo, Cayambe, Latacunga y Riobamba, mediante un eje transversal donde los estudiantes escriban fundamentados en valores de la cosmovisión andina, considerando que provienen de varios lugares de la sierra y amazonía ecuatoriana. Todo surgió del encuentro presencial de un sábado cualquiera donde los estudiantes realizaban ejercicios narrativos, logrando una apreciable respuesta de imaginación, más emotiva que la clásica tarea de las Unidades, tanto así que, pasados unos días, seguían llegando sus escritos a mi correo. Entonces nos pusimos manos a la obra, cada estudiante tendría dos opciones como Actividad Integradora, la primera consistía en escribir un cuento de su propia inspiración, y la segunda analizar un clásico para comentar sus valores y antivalores. La mayor parte de estudiantes decidió escribir su propio cuento, de donde se escogieron algunas participaciones que podrían considerarse originales, para una edición que, respetando la transcripción de la tradición oral que prima en los sectores comunitarios, nos concretamos en revisar la puntuación y ortografía para publicarlos. Con esto buscamos innovar la Actividad Integradora, por algo más práctico y operativo para configurar los Objetos de Aprendizaje que buscamos. Así nació, en medio del camino, este libro de Cuentos de nunca acabar. Aproximaciones desde la interculturalidad, que ponemos en sus manos. Hernán Hermosa Mantilla Quito, junio de 202

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society