11210 research outputs found
Sort by
Latching On: Equity in Breastfeeding Education
No full textBackground
Breastmilk is the optimal source of nutrition for newborns (WHO, 2019). Prenatal breastfeeding education best prepares families, yet not all patients attend hospital-offered classes due to associated fees. This gap may negatively impact knowledge and exclusive breastfeeding rates (Kehinde et al., 2022). To promote health equity, it is critical to provide accessible prenatal education to all patients, regardless of their ability to attend traditional classes.
Purpose
Our hospital aims to ensure all patients make informed infant feeding decisions. This project sought to provide prenatal breastfeeding education in outpatient Labor and Delivery Triage and evaluate its impact on patient knowledge and exclusive breastfeeding rates at the time of birth.
Method
Patients who had not received prenatal breastfeeding education were offered it during visits to Labor and Delivery Triage. A nurse or lactation consultant used a standardized, evidence-based toolkit including PowerPoint, donor milk education, hands-on positioning techniques, web resources, and a pre-education knowledge questionnaire. After delivery, patients completed a follow-up knowledge questionnaire. Staff education on toolkit use was conducted prior to project implementation to ensure consistent delivery of content.
Results
Between July 15 and October 31, exclusive breastfeeding rates increased from 62% in 2023 to 68% in 2024. Among surveyed patients, 73% demonstrated improved breastfeeding knowledge. Racial and ethnic subgroup analysis showed exclusive breastfeeding increased by 7% among Hispanic patients, 17% among Black patients, and 16% among Asian patients. Additionally, 100% of participants initiated breastfeeding after birth—exceeding the hospital’s average initiation rate of 90%. These findings support that providing prenatal education in Triage improves both breastfeeding exclusivity and patient knowledge.
Implications for Practice
Integrating breastfeeding education into Triage encounters reduces access barriers and supports informed patient choice. Future practice should include continuing Triage education and exploring expansion into outpatient obstetric office visits (Rosen-Carole et al., 2021)
Use of a Traveling Education Cart to Provide Interactive In-Situ Education
No full textBackground/Rationale: After analyzing safety events and learning needs assessments, an opportunity for improving cardiovascular and respiratory knowledge was found.
Aim: This intervention sought to improve learners’ knowledge, skills, and confidence with high-risk, low-volume equipment. Evidence shows that interactive, simulation-based activities effectively engage learners and enhance critical thinking through application to clinical scenarios. There is also support for implementing a traveling education cart to disseminate information in a concise, flexible, small-group format without impeding nursing workflow.
Implementation Plan: The education cart was piloted over 3 months in an ICU. A multimodal approach included case studies, gamification, discussions, and guided small-group simulations with high-risk, low volume equipment. One cart featured an interactive activity for recognizing electrocardiogram (ECG) rhythms and managing a defibrillator, and another included a Jeopardy-like game with hands-on respiratory devices. A facilitator captured available nurses by rounding at nurse stations twice weekly for 3 months during the day shift. Each week, 1 to 2 topics were covered, depending on attendance and prior participation. Teammates scanned a QR code before and after sessions to assess learning and provide feedback, which helped influence future topics.
Outcomes: Multiple-choice and short-answer questions assessed knowledge and a 5-point Likert scale measured confidence changes. Data on use of the ECG cart showed a 25% increase in confidence and an 18.75% improvement in knowledge. Data on the respiratory cart showed 21% knowledge improvement; with 1 erroneous question removed, this result increased to 44%. Qualitative feedback was positive overall, with comments such as “helpful,” “necessary,” and “great.”
Implications for Practice: Positive results and feedback indicate that the education cart can effectively meet learners’ needs with its flexible, brief, and engaging small-group format
Topical steroid withdrawal (TSW) syndrome: Developing diagnostic criteria through a modified Delphi method
No full textBackground: Topical steroid withdrawal syndrome (TSW) is an adverse event following discontinuation of topical corticosteroids (TCS) and is of growing interest among patients and dermatologists. The absence of well-defined diagnostic criteria and limited insights into the pathomechanisms make diagnosis and future research challenging.
Objective: To propose preliminary diagnostic criteria for TSW with the erythemato-edematous subtype applicable for adult and pediatric populations using a Delphi consensus approach informed by a thorough literature review that summarizes the signs, symptoms, and histology of TSW.
Methods: Eleven clinicians experienced in diagnosing and treating suspected TSW in both children and adults participated in a three-round modified Delphi process. Two rounds of surveys were conducted, with items ranked using a 5-point Likert scale. A predefined consensus threshold of ≥75% was established for any one feature to be deemed important. The third round involved a live video conference where the panel reached a consensus on essential diagnostic criteria.
Results: The panel identified 18 critical diagnostic items, encompassing elements from the patient\u27s clinical history, signs, and symptoms. This includes history of escalating TCS requirement; morphology and distribution differing from primary condition; regional or generalized spontaneous neuropathic pain; and severe burning sensation of the skin.
Conclusions: Differentiating TSW from conditions such as severe atopic dermatitis (AD)remains challenging. By emphasizing the common signs and symptoms of TSW, we aim to encourage discussions among healthcare professionals and progress towards the development of a reliable diagnostic tool
Disseminating acute care for elders principles in a geriatric observation unit: Preliminary data
No full textACE principles are implemented in the Geriatric Observation Unit through early intervention, interdisciplinary teamwork, mobility promotion, and continuous outcome review to improve care transitions and support at-risk older adults
Immunization coverage and clinical documentation of vaccine refusal in pediatric clinics: A retrospective analysis in the midwestern United States, 2022-2024
No full textObjective: Vaccine hesitancy has increased in recent years, prompting some pediatric practices to implement strict immunization policies. Accurate documentation of vaccine refusal is essential for monitoring trends and informing interventions. This retrospective analysis assessed immunization coverage and refusal documentation among pediatric patients in a Midwestern health care system with a policy requiring adherence to the Centers for Disease Control and Prevention immunization schedule.
Study design: We analyzed electronic health record data for patients born in 2022 who received primary care at pediatric clinics within the system. We assessed immunization coverage through 24 months of age and used International Classification of Diseases, Tenth Revision, Clinical Modification Z codes to identify documentation of underimmunization and refusal. We used logistic regression to examine associations between refusal documentation and patient characteristics.
Results: Among 2164 eligible patients, 300 (13.9%) had documented vaccine refusal. Coverage for most immunizations was comparable with national estimates. Refusal documentation was more common among White non-Hispanic patients and those with Medicaid or self-pay insurance. Patients from greater-income neighborhoods had greater odds of documented refusal. Among refusal codes, 39.6% used the designation patient refusal, a code intended for individuals making their own health care decisions.
Conclusions: This analysis highlights the frequency of vaccine refusal documentation and variation by sociodemographic characteristics. Use of International Classification of Diseases, Tenth Revision, Clinical Modification codes to document refusal limited interpretability by not specifying the immunization refused or whether it was a true refusal or delay. Improved coding specificity and integration of refusal tracking into electronic health records may enhance the utility of clinical data for monitoring immunization trends and informing policy
NT-pro brain natriuretic peptide in infants with single ventricle heart disease in the CHAMP® multi-site registry
No full textThe role of NT-pro Brain Natriuretic Peptide (NT-proBNP) and BNP in single ventricle (SV) patients during the interstage period is not well understood. We sought to describe NT-proBNP and BNP in a large group of SV infants and to determine if there is an association between pre-discharge NT-proBNP and interstage outcomes (unplanned hospitalizations [UPH]/interventions). We identified SV infants at 11 Cardiac High Acuity Monitoring Program (CHAMP) centers from 2014 to 2021 using the CHAMP multisite registry. Patients with NT-proBNP/BNP drawn prior to neonatal discharge were included, with the last value identified. Demographics, clinical characteristics, and events were collected. zlog transformation was used to convert NT-proBNP values to a normal distribution. Two-sided t-tests (α = 0.05) were used to evaluate average differences in zlog transformed NT-proBNP between patients with an UPH/intervention versus those with neither. 268 patients (male = 178, 66.4%) were included. The most common diagnosis was hypoplastic left heart syndrome, (N = 105, 39.2%). Median NT-proBNP (N = 136) and BNP (N = 132) were 5295 (IQR 2905-8590) and 299 (IQR 158-543), respectively, with median zlog-NT-proBNP 2.87 (IQR 2.24, 3.55). UPH/interventions occurred in 142 patients (53%). There was no significant difference in zlog-NT-proBNP in patients with UPH/interventions versus neither (p-value = 0.872). We described BNP, NT-proBNP, and zlog-NT-proBNP in SV infants at interstage discharge. Further investigation is needed to understand whether NT-proBNP/BNP and zlog-NT-proBNP can prognosticate outcomes after initial SV/interstage discharge
ICD removal complicated by right ventricle injury in a patient with hypertrophic obstructive cardiomyopathy
No full textIntroduction: Lead extraction is an essential component of cardiovascular implantable electronic device (CIED) management, particularly as the number of implanted devices continues to rise. While over 500,000 implantable cardioverter-defibrillators (ICDs) have been implanted in the U.S. since 2010, lead extractions remain relatively infrequent, with an estimated 10,000 to 15,000 procedures performed annually worldwide. Complications, though rare, can be life-threatening. Case Presentation: A 76-year-old male with a history of hypertrophic obstructive cardiomyopathy (HOCM), non-sustained ventricular tachycardia, paroxysmal atrial fibrillation (s/p Watchman device and cryoablation), and multiple comorbidities underwent an ICD lead extraction for a malfunctioning right ventricular (RV) dual-coil lead. Initial attempts at retrieval via the left subclavian and right femoral vein approaches were unsuccessful. A right internal jugular vein approach was then used, employing bronchial biopsy forceps under fluoroscopic guidance. During lead retrieval, the patient experienced cardiac arrest, requiring immediate chest compressions. Transesophageal echocardiography (TEE) revealed pericardial effusion with tamponade, necessitating pericardiocentesis. Despite drainage, tamponade recurred, prompting placement of a parasternal pigtail catheter. The patient required massive transfusion and escalating vasopressor support. Surgical exploration identified right ventricular and vascular injuries at the innominate vein-superior vena cava (SVC) junction, which were repaired under cardiopulmonary bypass. Postoperatively, the patient developed refractory coagulopathy and succumbed to multi-system failure the following morning. Conclusion: ICD lead extraction carries significant risks, including ventricular rupture, valvular injury, tamponade, and massive hemorrhage. This case highlights the importance of vigilance, preparedness for major complications, and the challenges posed by underlying cardiac pathology such as HOCM in managing tamponade. Multidisciplinary coordination is crucial in optimizing outcomes for high-risk patients undergoing lead extraction procedures. Nitesh Sood, et al. (2018) Circ Arrhythm Electrophysiol 11(2):e004768
Urgent femoral fracture repair in a 106-year-old oxygendependent patient with pulmonary hypertension
No full textIntroduction: Anesthetic management in very elderly patients with multiple comorbidities presents unique challenges. In this population, preserving cardiopulmonary stability and minimizing cognitive decline are paramount. Strategies that maintain spontaneous ventilation and maintain strict hemodynamic control can significantly impact perioperative outcomes. Case Presentation: 106-year-old female with a complex past medical history—pulmonary hypertension (pHTN) with elevated right ventricular systolic pressure (RVSP), oxygen-dependent COPD, HTN, HLD, prior CVA, CKD, Alzheimer’s dementia, and MDD following a fall at her care facility presented for urgent proximal femur repair. Her candidacy for neuraxial anesthesia was poor due to receiving a dose of prophylactic enoxaparin. Additionally, the patient was acutely anemic, prompting pre-induction arterial line placement for continuous blood pressure monitoring. Given her advanced age, oxygen dependency, and significant pHTN with elevated RVSP, the plan favored a laryngeal mask airway (LMA) insertion over endotracheal intubation to preserve spontaneous ventilatory drive. It took multiple attempts to find an appropriate model of a LMA to provide adequate ventilation, however an AirQ size 3.5 was found to seat well. This approach was also chosen to avoid controlled positive pressure ventilation modes (PPV), which could potentially worsen right heart function and exacerbate pHTN. Total intravenous anesthesia (TIVA) was administered with bispectral index (BIS) monitoring used to titrate adequate anesthetic depth and mitigate the risk of postoperative cognitive dysfunction. The patient was hemodynamically stable throughout the case and uneventfully extubated without complications in the postoperative period. Conclusion: This case highlights the importance of tailoring anesthetic strategies for elderly patients with significant cardiopulmonary comorbidities. The use of an LMA allowed for maintenance of spontaneous ventilation, avoiding the potential adverse effects of PPV on right heart function and pHTN. The added benefit of an AirQ LMA was that it provided a route of intubation should there be a need for urgent endotracheal intubation intraoperatively. A BIS-guided TIVA technique provided effective anesthetic maintenance while minimizing the risk of cognitive decline associated with inhaled agents and avoiding anesthetic overdose. 1. Duggappa DR, Rao GV, Kannan S. (2015 Sep). Indian J Anaesthesia. 59(9):574–583 2. Ortega, R. Connor, C et al; (January 2013) Advances in Pulmonary Hypertension 12 (1): 18–2