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Bean 5 Turn Team: Improves Turing Interventions & Reduces HAPI Rates
Get PDFDoes implementing a turn team on hospital units aid in preventing pressure-related injuries as compared to standard of care, without a turning team?https://knowledgeconnection.mainehealth.org/nurseresidency/1099/thumbnail.jp
A Life-Threatening Emergency Exacerbated by Untreated Mental Illness in a Low-Barrier Health Center
Get PDFIntroduction: We report on a patient with untreated severe mental illness who presented with a life-threatening emergency: retained products of conception and hemorrhage.
Clinical Findings: A female patient experiencing homelessness developed life-threatening hemorrhage. Her mental illness impaired effective communication and treatment.
Clinical Course: The patient presented with fatigue, vaginal bleeding, and known retained products of conception. Her active mental illness complicated the situation as it limited effective communication and treatment due to delusions. She requested only treatment for an infectious cause of her symptoms. She refused most interventions and had a self-directed discharge from the hospital. Throughout this process, we assessed that she understood the implications of declining care, despite her mental illness. After extensive patient-centered and trauma-informed discussions, she accepted medical treatment.
Conclusions: This case highlights the importance of patient-centered communication and team-based care during emergencies and refusal of care. Shared decision-making and trauma-informed care are appropriate methods for assessing the capacity of patients with severe mental illness in acute and life-threatening conditions
Effects of Providing Discharge Instructions in Native Language
Get PDFHow effective is providing discharge instructions in native language for patients with limited English proficiency on decreasing adverse events when compared to those instructions provided in written English?https://knowledgeconnection.mainehealth.org/nurseresidency/1077/thumbnail.jp
Mental Health Interventions for the High-Risk Antepartum Inpatient Population
Get PDFIn the high-risk antepartum patient population, do tailored mental health interventions, compared to routine intervention, improve patients’ overall mental well-being during inpatient hospitalization?https://knowledgeconnection.mainehealth.org/nurseresidency/1088/thumbnail.jp
The Power of Empowerment: What Happens When We Include Patients in Nutritional Decision-Making
Get PDFIn hospitalized patients, how do personalized meal selections impact patient satisfaction and overall quality of life during hospital stays?https://knowledgeconnection.mainehealth.org/nurseresidency/1108/thumbnail.jp
Clinician Stakeholder Experience With Telemedicine Consults to Assess Neonatal Encephalopathy in a Rural State
No full textBACKGROUND: Serial neonatal encephalopathy (NE) examinations are difficult to perform in rural community hospitals as on-site experts are not readily available. We implemented a synchronous, acute care model of teleconsultation-the Maine Neonatal Encephalopathy Teleconsultation program (Maine NET)-to provide remote, joint assessment of NE by pediatric neurology and neonatology at nine community hospitals and one tertiary care center. We performed a qualitative study to interview clinicians about their experience of this program. METHODS: From April 2018 to October 2022, we employed a semistructured interview format with 16 clinicians representing all participating hospitals. We utilized deductive analysis to assign a set of predefined codes to the transcribed interviews. RESULTS: Thematic analysis supported the anticipated benefits of Maine NET, demonstrating that clinicians felt resource utilization, collaborative decision making, communication, and continuity of care were improved. Clinicians overwhelmingly supported the program: This program has truly saved babies\u27 lives and future function. I have not met any parents through this journey, who aren\u27t incredibly grateful for the care that is provided and emphasized the benefit of collaboration between all care team members. Teleconsultation was felt to be more than adequate to [assess] NE. Connectivity issues were cited as a limitation. CONCLUSIONS: Maine NET has positively impacted care delivery for newborns with clinical concerns for NE. Additionally, the program has improved resource allocation, collaborative decision making, communication, and equity of care. Addressing technological challenges will be vital to the success and sustainability of the planned Maine NET expansion
Association between CFTR modulators and changes in iron deficiency markers in cystic fibrosis
No full textBACKGROUND: Iron deficiency (ID) is a common extrapulmonary manifestation in cystic fibrosis (CF). CF transmembrane conductance regulator (CFTR) modulator therapies, particularly highly-effective modulator therapy (HEMT), have drastically improved health status in a majority of people with CF. We hypothesize that CFTR modulator use is associated with improved markers of ID. METHODS: In a multicenter retrospective cohort study across 4 United States CF centers 2012-2022, the association between modulator therapies and ID laboratory outcomes was estimated using multivariable linear mixed effects models overall and by key subgroups. Summary statistics describe the prevalence and trends of ID, defined a priori as transferrin saturation (TSAT) \u3c 20 % or serum iron \u3c 60 μg/dL (\u3c 10.7 μmol/L). RESULTS: A total of 568 patients with 2571 person-years of follow-up were included in analyses. Compared to off modulator therapy, HEMT was associated with +8.4 % TSAT (95 % confidence interval [CI], +6.3-10.6 %; p \u3c 0.0001) and +34.4 μg/dL serum iron (95 % CI, +26.7-42.1 μg/dL; p \u3c 0.0001) overall; +5.4 % TSAT (95 % CI, +2.8-8.0 %; p = 0.0001) and +22.1 μg/dL serum iron (95 % CI, +13.5-30.8 μg/dL; p \u3c 0.0001) in females; and +11.4 % TSAT (95 % CI, +7.9-14.8 %; p \u3c 0.0001) and +46.0 μg/dL serum iron (95 % CI, +33.3-58.8 μg/dL; p \u3c 0.0001) in males. Ferritin was not different in those taking modulator therapy relative to off modulator therapy. Hemoglobin was overall higher with use of modulator therapy. The prevalence of ID was high throughout the study period (32.8 % in those treated with HEMT). CONCLUSIONS: ID remains a prevalent comorbidity in CF, despite availability of HEMT. Modulator use, particularly of HEMT, is associated with improved markers for ID (TSAT, serum iron) and anemia (hemoglobin)
Does Cohort Selection Affect Machine Learning from Clinical Data?
No full textThis study investigates cohort selection and its effects on the quality of machine learning (ML) models trained on clinical data, focusing on measurements taken within the first 48 hours of hospital admission. It discusses the potential repercussions of making arbitrary decisions during data processing prior to applying ML methods. Experiments are performed within the framework of the National COVID Cohort Collaborative (N3C) dataset. The research aims to unravel biases and assess the fairness of machine learning models used to predict outcomes for hospitalized patients. Detailed discussions cover the data, decision-making processes, and the resulting impact on model predictions regarding patient outcomes. An experiment is conducted in which four arbitrary decisions are made, resulting in 16 distinct datasets characterized by varying sizes and properties. The findings demonstrate significant differences in the obtained datasets and indicate a high potential for bias based on inclusion or exclusion decisions. The results also confirm significant differences in the performance of models constructed on different cohorts, especially when cross-compared between ones based on different inclusion criteria. The study specifically chose to analyze gender, race, and ethnicity as these social determinants of health played a significant role in COVID-19 outcomes
Ovarian Cancer Risk-Reduction and Screening in Mutation Carriers
No full textTo determine the utilization of risk-reducing strategies and screening protocols for ovarian cancer in female carriers. This study was a sub-analysis of female participants from a larger multicenter, cross-sectional survey of mutation carriers unaffected by cancer. The questionnaire was administered electronically email at four institutions located in the northeast United States. Data were analyzed with Fisher\u27s exact test. The survey was completed by 104 female mutation carriers. subtypes included 54.3% , 41.0% , and 2.9% both. The age at which patients underwent genetic testing varied 21.2% were 18-24 years, 25.0% were 25-34 years, 29.8% were 35-44 years, and 24.0% were 45 years or older. Nearly, all respondents (97.1%) reported that a provider had discussed risk-reducing surgeries. Of the 79 females who underwent genetic testing before 45 years of age, 53.2% reported that a health care provider recommended taking combined oral contraceptive pills (COCs) to reduce their risk of ovarian cancer, and, of these women, 88.1% chose to use them. COCs were offered at higher rates among women who were younger at the age of genetic testing (18-24: 86%, 25-34: 62%, 35-44: 23%; \u3c 0.0001). Approximately half (55.8%) of the respondents reported having been offered increased screening for possible early detection of ovarian cancer, of which 81.0% chose to undergo screening. The majority utilized a combination of transvaginal ultrasound and serum CA125 measurements. There were no differences observed in screening utilization based on mutation type. In our cohort of female mutation carriers, risk-reducing surgery was offered to almost all women, whereas only half were offered risk-reducing medication and/or increased screening. Further investigation is needed to identify barriers to the utilization of risk-reducing strategies among this high-risk population