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Evaluating the Efficacy of Predischarge Referrals in Preventing Emergency Mental Health Hospital Readmissions: A Scoping Review
Full text linkBackground
Emergency mental health hospital readmissions present significant challenges to healthcare systems, often resulting in increased costs, prolonged hospital stays, and poor patient outcomes. Continuity of care through predischarge referrals to outpatient mental health services, psychosocial support, and community resources has been proposed as a strategy to reduce readmissions. However, the effectiveness of these interventions remains inconsistent across different populations and settings.
Objective
This scoping review aims to evaluate the effectiveness of predischarge referrals in reducing 30-day emergency mental health hospital readmissions, identify key components of successful programs, and assess the influence of demographic factors on readmission rates.
Methods
A systematic search of peer-reviewed literature from 2019 to 2024 was conducted using PubMed, PsycINFO, Elsevier, SCOPUS, and Web of Science. Studies focused on adult psychiatric patients (18 years and older) who received predischarge referrals before hospital discharge. The final synthesis included 10 studies comprising randomized controlled trials, cohort studies, and observational research. Data extraction emphasized referral interventions, patient demographics, follow-up adherence, and readmission outcomes.
Results
Findings suggest that predischarge referrals significantly reduce readmission rates, particularly when integrated with multidisciplinary coordination and structured follow-up. The most effective interventions included personalized discharge planning, risk assessment for high-readmission patients, and interdisciplinary collaboration between inpatient and outpatient care teams. However, barriers such as inadequate coordination between services and disparities in community mental health resources limited the efficacy of these programs. Socioeconomic status and age influenced outcomes, with lower-income patients and older adults benefiting more from structured predischarge interventions.
Implications for Nursing
The results of this scoping review illustrate the need for consistent continuation of care and the implementation of structured discharge processes to ensure patients emergently admitted for mental health needs are referred and connected to the appropriate outpatient mental health resources upon discharge. There is sufficient evidence that supports thorough coordination of care between hospitals and community-based outpatient mental health resources will significantly reduce the number of patients readmitted for emergency mental health needs or crisis within a 30-day period. Communication between the interdisciplinary team of inpatient and outpatient facilities is mandatory to improve patient quality of care, monitor patient adherence, and assess for and provide crisis interventions when warranted
Decreasing Extubation Times Using Adaptive Support Ventilation: A Scoping Review
Full text linkPurpose/Background:This scoping review explores the effectiveness of adaptive support ventilation (ASV) compared to conventional ventilation modes in reducing postoperative extubation times in adults undergoing general anesthesia with ventilatory support. Ventilator weaning is a critical determinant of recovery and outcomes in intensive care settings. ASV, a closed-loop ventilation mode, automatically adjusts ventilator parameters based on patient-specific respiratory mechanics and demand to optimize the weaning process. Although promising, evidence regarding ASV’s effectiveness remains inconsistent across different patient populations and surgical contexts.
Methods: A systematic literature search was conducted from August 2023 to December 2024 across PubMed, CINAHL, Medline, JAMA, and Google Scholar. Studies were eligible if published in English, focused on adult patients requiring ventilatory support, and reported extubation time as a primary or secondary outcome. Eight high-quality studies, including randomized controlled trials and systematic reviews, were selected after critical appraisal. Extracted data included extubation time, intubation duration, postoperative complications, ventilator adjustments, and ICU or hospital length of stay.
Results: Of the eight studies reviewed, five reported that ASV reduced extubation times, and three showed shorter intubation durations. All studies demonstrated a reduction in postoperative complications and fewer ventilator adjustments. Three studies associated ASV with decreased ICU or hospital stays. Variability in extubation outcomes appeared related to patient characteristics and clinical practices.
Implications for Nursing Practice: ASV has the potential to enhance patient outcomes by expediting weaning, reducing complications, and shortening ICU stays. Standardized protocols are needed to optimize ASV implementation across diverse clinical settings
GAD-7 Screening in Middle School Students: Evaluating the Effectiveness on Referral Rate Scoping Review
Full text linkPurpose/Background
The prevalence of anxiety disorders among adolescents, mainly middle school-aged students, highlights the critical need for practical screening tools to support early detection and intervention. The Generalized Anxiety Disorder-7 (GAD-7) scale is widely utilized in various settings, but its efficacy in this specific population remains underexplored. This scoping review examines the use of the GAD-7 in middle school-aged students, evaluating its reliability, validity, and impact on referral rates to mental health services. The review also considers factors influencing anxiety and identifies gaps in current research.
Methods
Ten articles, published in peer-reviewed journals within the past decade and involving human participants aged 10 to 19, were included. The review adhered to PRISMA guidelines utilizing databases such as PubMed, Elsevier, Medline and BMC Public Health. The Rapid Critical Appraisal (RCA) tool was used to evaluate the quality and relevance of the articles.
Results
The studies collectively underscore the GAD-7 scale\u27s reliability and validity in assessing generalized anxiety disorder (GAD). The significance of the assessment tool signifies its use for early detection and monitoring of anxiety symptoms in the adolescent population. The scoping review demonstrates the importance of early detection and supports timely referrals to mental health providers. It is acknowledged amongst all the studies that variables such as economic status, education level, gender, and psychosocial factors, such as suicidal ideation, depressive mood, loneliness, perceived stress, and subjective health status, influence the development and course of generalized anxiety disorder.
Implications for Nursing Practice
The outcomes of this scoping review demonstrate the efficacy of the GAD-7 in the early detection of anxiety disorders among adolescents. Positive findings suggest that improved outcomes are achieved by early identification and promoting prompt referrals to mental health services. Furthermore, according to the evidence gathered, using the GAD-7 as a standard in all middle schools helps prevent detrimental effects associated with undiagnosed and untreated anxiety
Assessing the Efficacy of Remimazolam vs. Midazolam in Short-Duration Gastrointestinal Endoscopy Procedures and How They Affect Patient Recovery Time: A Scoping Review
Full text linkPurpose
The purpose of this scoping review is to evaluate and compare the efficacy of Remimazolam and Midazolam as sedatives in short-duration gastrointestinal endoscopy procedures
Deciphering Genotype-Phenotype Connections: Leveraging Pangenomes and Comprehensive Genome Variation
Full text linkMy thesis explores the application of advanced techniques for discovery of genetic variation and pangenomic approaches to enhance our understanding of genetic variation and genotype-phenotype relationships in two key model organisms: the HXB/BXH recombinant inbred rat family and the BXD mouse family. Through deep sequencing and innovative computational methods, I constructed com- prehensive pangenome graphs that captured genetic diversity beyond what is accessible through conventional single-reference approaches. In the HXB rat family, I identified approximately 200 million base pairs of sequence absent from the reference genome and discovered novel variants associated with glucose metabolism and chromogranin expression through phenome-wide association studies. In the BXD mouse family, I leveraged linked-read sequencing data from 152 strains to create a detailed catalog of genetic variants, improving QTL mapping precision and enabling the identification of regions undergoing parallel evolution across independent populations. By develop- ing new methodologies for mapping reads to pangenome graphs and implementing pangenome-based QTL mapping, I demonstrated that these approaches significantly enhance variant discovery and resolution, particularly in complex genomic regions rich in repetitive elements.I also employed genotype-phenotype mapping to analyze adaptive signatures resulting from laboratory selection pressures. My work shows that even with short linked-reads, pangenomic analyses enable the detection of a truly comprehensive set of variants that would be missed by traditional methods. My research advances our understanding of complex genotype-phenotype relationships, establishes pangenomes as valuable tools for comprehensive genetic analysis in model organisms, and provides a foundation for future applications in precision medicine
2025 HEC Storytelling Recording 2
No full textThe art of storytelling is a vital component of oral history, serving as a primary method for preserving and transmitting cultural practices, knowledge, and history across generations. Historically, oral storytelling was the key to maintaining traditions before written language emerged. The oral traditions of storytelling been essential for passing down knowledge in societies without written records. Through interviews and recordings, oral histories capture individual experiences, enriching our understanding of past events. Storytelling exists universally across cultures and ages. Culturally, storytelling bridges cultures by offering insights into diverse perspectives, beliefs, and values. It dynamically connects generations and fosters a sense of community through shared narratives. Today, storytelling continues to connect generations, share personal narratives, and foster community bonds. It fuels the delivery of messages making stories effective tools for conveying information, sharing lessons, and inspiring actions that are relevant for modern times. We used storytelling during and following the health as expanding consciousness dialogue as a way to capture lessons learned and new messages about health as expanding consciousness (HEC) theory to create a shared meaning about theory use in nursing education, practice, and research. This site contains a few recorded stories from participants who attended the 2025 HEC dialogue. Additional stories will be uploaded for future listening
My Serials Checklist Manifesto: A Simple Tool to Deliver Consistent Results and Save Time
No full textThe purpose of this poster is to demonstrate the effectiveness of checklists and standardization in a small academic library, where librarian roles include technical, public, and administrative responsibilities. Since the publication of Atul Gawande\u27s Checklist Manifesto in 2010, leaders have paid greater attention to the role of the simple checklist in standardizing medical care. Checklists can also demonstrate positive impacts in librarianship. Managing serials subscriptions, primarily in electronic format, has required librarians to develop new skills, including the calculation of metrics from big package products which may not share consistent counter standards. Within serials management, greater standardization methods produce consistent evaluation data of publications at renewal time, enabling better decisions to save time and money
A Mindful Approach to Managing Stress in Stroke Survivors and Support Persons: Feasibility, Acceptability, and Impact of a Stroke-Tailored, Mindfulness-Based Intervention
No full textStroke recovery often presents psychosocial challenges not only for stroke survivors (SS) but also for their support persons (SP). Guided by the Theory of Dyadic Illness Management, which emphasizes the interdependence and mutual influence between survivor and support person during post-stroke recovery, this dissertation addresses the urgent need for integrative stress management approaches that consider both members of the stroke dyad. Chronic stress has been shown to negatively affect well-being, cognition, and overall quality of life, with detrimental consequences for both individuals within the dyad. A conceptual model, developed by Prather et al. (2022), provides a theoretical foundation for this work, illustrating how mindfulness-based interventions (MBIs) buffer stress, reduce inflammation, and enhance resilience to support both psychological and physical recovery in the context of chronic illness. This framework proposes that MBIs have the potential to disrupt negative feedback loops that drive chronic stress experienced by members of the dyad, thereby improving individual coping capacity and well-being. To inform measurement and intervention design, an integrative review by Prather & Stanfill (2023) examined the use of the Perceived Stress Scale (PSS) during stroke recovery. The review demonstrates that perceived stress is both a persistent and individualized challenge, and higher stress levels are associated with lower resilience, increased depression, cognitive complaints, and poorer functional outcomes. The PSS-10 was identified as the most widely used and reliable tool for capturing these experiences, affirming the need for regular stress assessment in stroke dyads. Building upon these foundations, this dissertation tested the feasibility and acceptability of the “A Mindful Approach to Managing Stress (A-MAMS)” intervention, an 8-week, virtual, asynchronous stroke-tailored MBI (modified, m-MBI) for SS, SP, and stroke dyads. High enrollment, retention, and completion rates were observed, and over 96% of participants found the program effective for managing stress and would recommend it to others, regardless of whether they were participating as individuals or dyads. While no significant differential “dyadic effect” was detected, the findings support the intervention’s broad acceptability and benefit, and emphasize the importance of dyadic frameworks in stroke care. In summary, this research advances the fields of neuroscience-nursing and rehabilitative science by demonstrating that remote, stroke-tailored mindfulness interventions are feasible and well-received among members of the stroke dyad. Findings underscore the value of targeting both survivors and support persons in stress management interventions and call for future large-scale trials to further evaluate the impact of dyadic strategies on well-being and quality of life throughout recovery and reintegration. This work supports the integration of dyadic theory into neuro-rehabilitative practice and provides a foundation for holistic and integrative, SS- and SP-centered post-stroke care
Rhabdomyolysis-induced Acute Kidney Injury in Sickle Cell Disease
No full textSickle cell syndromes increase the risk of rhabdomyolysis, a potentially life-threatening condition stemming from the destruction of skeletal muscle fibers. Acute kidney injury (AKI), a major complication of rhabdomyolysis, contributes to long-term morbidity through the development of chronic kidney disease and cardiovascular disease. Both of these are leading causes of mortality in individuals with sickle cell syndromes, namely sickle cell disease (SCD). Despite the elevated risk of rhabdomyolysis-induced sudden death in this population, the underlying mechanisms that contribute to the increased severity of rhabdomyolysis-induced AKI in SCD remain poorly understood. A better understanding of these mechanisms is critical for highlighting potential therapeutics to reduce renal complications arising from rhabdomyolysis-induced AKI and improving outcomes for individuals with SCD. In this project, we demonstrate that transgenic SCD mice (Townes model) are susceptible to glycerol-induced rhabdomyolysis, with a 100% mortality rate within 8-24 hours following intramuscular glycerol injection. Five hours after glycerol injection, both non-sickling (AA) and sickling (SS) mice exhibited positive indicators of rhabdomyolysis, noted by significant increases in myoglobinuria and plasma creatine kinase levels, with SS mice showing more significant increases. In vivo cardiac imaging showed that glycerol-induced rhabdomyolysis caused mild yet expected cardiac effects that were not anticipated to confound the severity of rhabdomyolysis-induced AKI. Rhabdomyolysis was shown to aggravate hemolysis parameters in SS, but not AA, mice when total hemoglobin, plasma hemoglobin, plasma heme, and lactate dehydrogenase were evaluated. Spleen weights were found to be unchanged following rhabdomyolysis in both AA and SS mice. In contrast to AA mice, which showed virtually no evidence of kidney tissue iron accumulation, oxidative stress, or increased AKI biomarkers, SS mice displayed highly significant changes in all parameters, indicating that SS mice are highly sensitive to iron-induced oxidative stress and AKI. Investigating this further showed that SS mice had significant levels of iron-induced lipid peroxidation, as indicated by a reduction in GPX4 and an increase in 4-HNE. The use of antioxidants (TEMPOL, ferrostatin-1, and hydroxyurea) and iron chelators (deferiprone and, potentially, hydroxyurea) were able to ameliorate renal iron accumulation, oxidative stress, lipid peroxidation, and rhabdomyolysis-induced AKI in SS mice. These findings provide evidence that free iron, released from hemoglobin during hemolysis and myoglobin during rhabdomyolysis, contributes to the amplified severity of rhabdomyolysis-induced AKI in SCD mice. This free iron accumulates in the kidneys and gives rise to renal oxidative stress, lipid peroxidation, and AKI. As such, antioxidants and iron chelation provide potential therapeutic targets to mitigate the more severe outcomes of rhabdomyolysis-induced AKI in SCD
