Jacobs Institute of Women's Health
George Washington University: Health Sciences Research Commons (HSRC)Not a member yet
51297 research outputs found
Sort by
Bridging the Gap: Enhancing Primary Palliative Care Knowledge and Self-Efficacy among Home Health Interprofessional Staff: A Doctor of Nursing Practice Quality Improvement Project
No full textBackground: Palliative care is vital for improving the quality of life for individuals with serious illnesses, yet many interprofessional home health providers lack adequate training. Addressing this educational gap is essential for delivering comprehensive, compassionate care to patients with chronic and life-limiting conditions.
Objectives: This Doctor of Nursing Practice (DNP) project aimed to develop, implement, and evaluate a structured primary palliative care training tailored to the needs of interprofessional home health providers. The objectives were to: (1) enhance knowledge of palliative care principles, (2) reinforce each team member’s role in primary palliative care delivery, (3) improve self-efficacy and perceived competence, and (4) gather participant feedback to guide future training initiatives.
Methods: A mixed-methods pre- and post-intervention design was used with a cohort of 16 home health professionals, including seven nurses, six physical therapists, two social workers, and 1 occupational therapist. Participants completed the Competency Assessment in Reasoning and Evaluation for Self in Primary Care (CARES-PC) tool and the Interprofessional Palliative Care Knowledge Assessment (IPCKA) before and after the intervention. Qualitative data from open-ended responses were analyzed thematically.
Results: Post-intervention results demonstrated an overall improvement in knowledge and perceived competence. Statistical significance (p ≤ 0.05) was achieved for 11 out of 17 CARES- PC items, supporting increased self-efficacy in palliative care delivery. Thematic analysis revealed increased understanding of core palliative care concepts, greater confidence in team- based care delivery, and enthusiasm for continued education. Key competencies improved included symptom management, communication, and goals of care discussions.
Conclusions: Primary palliative care training enhances interprofessional staff knowledge, confidence, and collaboration in home health settings. The findings support the integration of structured, interprofessional education into ongoing staff development and annual competencies. Continued expansion of training access and support for interprofessional learning is essential to fostering a sustainable, evidence-based palliative care culture in home health
Daybreak
No full textPhotographhttps://hsrc.himmelfarb.gwu.edu/artshow_gallery_2025/1038/thumbnail.jp
Remembering Vermeer
No full textPhotograph (AI)https://hsrc.himmelfarb.gwu.edu/artshow_gallery_2025/1036/thumbnail.jp
Satellite data to support air quality assessment and management
No full textSatellite data have long been recognized as valuable for air quality applications. These applications are in a stage of rapid growth: new geostationary satellites provide hourly or sub-hourly data; improvements in algorithms convert measured wavelengths into retrievals of atmospheric constituents; advances in machine learning support improved estimates of near-surface pollution; and growing interest among air quality managers has led to a range of new satellite data applications. Considering mainly activities in the United States under the Clean Air Act, we discuss proven applications relevant to air quality management, including: informing epidemiological studies and health risk assessments for setting regulatory standards; evaluating regulatory models; constraining emissions inventories; supporting Exceptional Event Demonstrations through tracking wildfire plumes and other sources; characterizing emission patterns and ozone-forming chemistry for State Implementation Plans; improving air quality forecasting; and tracking long-term trends to evaluate regulatory impact. Air quality professionals are increasingly using satellite data for these and related analyses, but barriers remain. This review provides a summary of satellite products used in applications for air quality and related health assessments; progress in using satellite observations for deriving surface-level air quality information across scales; and their use in air quality management.Implications: The review covers advancements in satellite data for air quality applications over the last 15 years. Success with satellite applications, especially for PM and NO, include use in health risk assessment, constraining emissions inventories, and supporting tracking short- and long-term trends with regulatory relevance. Solutions co-developed between researchers and practitioners show promise for continued improvements in the use and value of satellite data for air quality applications
Nutritional priorities to support GLP-1 therapy for obesity: a joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society
No full textBACKGROUND: Glucagon-like peptide 1 receptor agonists and combination medications (hereafter collectively referred to as GLP-1s) are shifting the treatment landscape for obesity. However, real-world challenges and limited clinician and public knowledge on nutritional and lifestyle interventions can limit GLP-1 efficacy, equitable results, and cost-effectiveness. OBJECTIVES: We aimed to identify pragmatic priorities for nutrition and other lifestyle interventions relevant to GLP-1 treatment of obesity for the practicing clinician. METHODS: An expert group comprising multiple clinical and research disciplines appraised the scientific literature, informed by expert knowledge and clinical experience, to identify and summarize relevant topics, priorities, and emerging directions. RESULTS: GLP-1s reduce body weight by 5% to 18% in trials, with modestly lower effects in real-world analyses, and multiple demonstrated clinical benefits. Challenges include side effects, especially gastrointestinal; nutritional deficiencies due to calorie reduction; muscle and bone loss; low long-term adherence with subsequent weight regain; and high costs with resulting low cost-effectiveness. Numerous practice guidelines recommend multicomponent, evidence-based nutritional and behavioral therapy for adults with obesity, but use of such therapies with GLP-1s is not widespread. Priorities to address this include: (a) patient-centered initiation of GLP-1s, including goals for weight reduction and health; (b) baseline screening, including usual dietary habits, emotional triggers, disordered eating, and relevant medical conditions; (c) comprehensive exam including muscle strength, function, and body composition assessment; (d) social determinants of health screening; (e) and lifestyle assessment including aerobic activity, strength training, sleep, mental stress, substance use, and social connections. During GLP-1 use, nutritional and medical management of gastrointestinal side effects is critical, as is navigating altered dietary preferences and intakes, preventing nutrient deficiencies, preserving muscle and bone mass through resistance training and appropriate diet, and complementary lifestyle interventions. Supportive strategies include group-based visits, registered dietitian nutritionist counseling, telehealth and digital platforms, and Food is Medicine interventions. Drug access, food and nutrition insecurity, and nutrition and culinary knowledge influence equitable obesity management with GLP-1s. Emerging areas for more study include dietary modulation of endogenous GLP-1, strategies to improve compliance, nutritional priorities for weight maintenance post-cessation, combination or staged intensive lifestyle management, and diagnostic criteria for clinical obesity. CONCLUSIONS: Evidence-based nutritional and lifestyle strategies play a pivotal role to address key challenges around GLP-1 treatment of obesity, making clinicians more effective in advancing their patients\u27 health
A rare case of BK cystitis in an immunocompetent patient
No full textHemorrhagic cystitis secondary to BK virus is often seen in immunocompromised patients, but it is a rare cause of hematuria or hemorrhagic cystitis in immunocompetent children. We report a case of an otherwise healthy 4-year-old female who presented to urgent care for urinary frequency, dysuria, and gross hematuria. The initial hematuria workup, including complements, anti-nuclear antibody, anti-streptolysin O titer, and urine culture, was all negative. However, hematuria persisted for 14 days and further work up showed viral PCRs that were positive for BK virus both in blood and urine
Antenatal corticosteroids for pregnant women at risk of preterm labour in low- and middle-income countries: utilisation and facility readiness
No full textBACKGROUND: Administering antenatal corticosteroids (ACS) to pregnant women at risk of imminent preterm labour improves newborn survival. However, ACS remains substantially underused in low- and middle-income countries (LMICs), where most preterm births occur globally. Providing ACS in inadequately equipped settings can be harmful. Health facilities must demonstrate readiness to ensure safe and effective ACS use. We aimed to assess ACS utilisation and facility readiness to administer ACS based on the World Health Organization (WHO) recommendations. METHODS: We used data from Service Provision Assessments in nine LMICs. The primary outcome was ACS utilisation, which was defined as having ever provided ACS in a health facility. We assessed the availability of injectable corticosteroids (dexamethasone or betamethasone) and facility readiness to administer ACS appropriately. To measure readiness, we developed an overall readiness index based on 35 indicators, grouped into four categories based on WHO recommendations. The results were stratified by facility level. RESULTS: Across eight countries with comparable sampling strategies, only a median of 10.7% (range = 6.7-35.2%) of facilities had provided ACS, one-fourth (median = 25.3%; range = 4.6-61.5%) had injectable corticosteroids available at the time of the survey. Significant gaps were observed between corticosteroid availability and ACS use. We found low overall readiness indices, ranging from 8.1% for Bangladesh to 32.9% for Senegal. Across four readiness categories, the readiness index was the lowest for criterion one (i.e. ability to assess gestational age accurately) (7.3%), followed by criterion two (i.e. ability to identify maternal infections) (24.8%), criterion four (i.e. ability to provide adequate preterm newborn care) (31.3%), and criterion three (i.e. ability to provide adequate childbirth care) (32.9%). CONCLUSIONS: We proposed a strategy for measuring facility readiness to implement one of the most effective interventions to improve neonatal survival. Countries should operationalise readiness measurement, improve facility readiness to provide ACS appropriately, and encourage ACS uptake in well-equipped facilities
Norepinephrine versus epinephrine after cardiac arrest: A systematic review and meta-analysis
No full textOBJECTIVES: Patients who obtain return of spontaneous circulation (ROSC) after cardiac arrest often experience post-resuscitation hypotension, typically managed with epinephrine (EPI). However, recent research suggests that norepinephrine (NE) may improve patient outcomes. This systematic review and meta-analysis evaluates the effectiveness of EPI versus NE in managing post-resuscitative shock in patients who achieve ROSC. METHODS: A systematic literature search in PubMed, Medline, Scopus, EMBASE, and Cochrane CENTRAL was performed. Observational or randomized studies on adults comparing EPI to NE after cardiac arrest were included in analysis. Outcomes were analyzed via random-effects meta-analysis and included rate of re-arrest during hospital stay, survival to discharge, and functional neurological outcome at discharge. RESULTS: After screening 1217 studies, we analyzed 6 studies, which involved 3458 patients, with mean (+/- SD) age of 64 (+/- 3) years, and 2188 (63 %) were male. The NE group consisted of 1833 (53 %) patients and 287 (41 %) of the total 703 re-arrest. Patients receiving NE were associated with 63 % lower odds of having recurrent arrest (OR 0.47, 95 % CI 0.24-0.92, P = 0.03, I = 89 %). There was no statistical difference for rates of hospital survival (OR 2.04, 95 % 0.93-4.47) or discharge with unfavorable neurological outcome (OR 1.72, 95 % CI 0.92-3.22). CONCLUSIONS: Among a small number of studies, norepinephrine use in post-cardiac arrest patients was associated with lower odds of recurrent cardiac arrest. However, high study heterogeneity highlights the need for well-designed future research to validate these findings
