Parkview Health Research Repository
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Vancomycin Dosing: Bayesian derived AUC/MIC vs. trough only monitoring
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Evaluation of a pharmacist direct oral anticoagulant (DOAC) monitoring service
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Impact of restriction criteria on optimal ertapenem use in a community health system
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Adult experts\u27 perceptions of telemental health for youth: A Delphi study.
Get PDFOBJECTIVES: Our objectives were to measure experts\u27 opinions and develop consensus via the Delphi process on the barriers, applications, and concerns associated with telemental health (TMH) for youth.
MATERIALS AND METHODS: We delivered 3 online surveys over 2 months in Summer, 2016-2025 adult experts, including adults who experienced youth depression or suicidality, parents of youth with lived experience, and professionals (ie youth mental health researchers, clinicians/staff, or educators). We used the Delphi method to construct Likert and open-ended questions, developing expert consensus over 3 iterative surveys on the barriers and benefits of TMH for youth.
RESULTS: Adult experts identified stigma and knowledge barriers to youth mental health care. Although TMH is perceived as beneficial for screening, education, follow-up, and emotional support, no single delivery method (eg websites or instant messaging) was deemed universally beneficial.
DISCUSSION: Adults are the developers, administrators, and gatekeepers of youth mental health care. Although adult experts see potential for TMH to supplement traditional therapy via familiar technologies, there is no consensus on the technologies by which TMH should be delivered. However, there is consensus that family members and friends provide potential pathways to care; thus, an online TMH toolkit for youth would be beneficial for both caretakers and practitioners.
CONCLUSION: Telemental health may not overcome barriers for crisis management but adult experts agreed that TMH had potential benefits for youth. Health care organizations should conduct research and provide training and education to youth caretakers and practitioners on potential barriers and benefits of TMH technologies for youth
Breastfeeding in the Community: Sharing Stories on Implementations That Work.
Get PDFTo improve equity in breastfeeding rates and eliminate breastfeeding disparities, the Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity in 2014 funded the National Association of County and City Health Officials (NACCHO) through a cooperative agreement to implement the Reducing Disparities in Breast-feeding through Peer and Professional (Lactation) Support project (Breastfeeding Project). The purpose was to increase the implementation of evidence-based and innovative breastfeeding programs, practices, and services, specifically focusing on peer and professional lactation support for pregnant and postpartum women in predominantly African American and underserved communities with low breastfeeding rates. Between January 2015 and June 2016, NACCHO provided $2.9 million in funding through reimbursement grants and more than 1,500 hours of training and technical assistance to 69 organizations to implement 72 breastfeeding demonstration projects in 32 states and U.S. territories. This Breastfeeding Project represents the most extensive U.S.-based implementation of coordinated community-level breastfeeding support projects. This overview of the Breastfeeding Project highlights the work of 19 Breastfeeding Project grantees. The goal of sharing these stories is to increase awareness of the processes, successes, and challenges of implementing and expanding access to lactation support services for families and communities that have been historically marginalized and underserved. These examples can assist other communities to design sustainable breastfeeding support programs that increase availability and accessibility to skilled lactation care to improve equity in breastfeeding care.
Grantee Abstract submitted by Carmen Moore, RN, BSN, CLS (Parkview Health)
Integrating Breastfeeding Support Into Social Services Programs Background: Rates of breastfeeding in the state of Indiana fall short of the Healthy People 2020 goals. There is also a disparity in breastfeeding rates among African Americans and Caucasians in the state. The Indiana Breastfeeding Task Force developed a plan of action that aligns with and supports the goals of the U.S. Breastfeeding Committee, the Indiana Perinatal Network, and the American Academy of Pediatrics. These goals are to (a) assure access to comprehensive, culturally appropriate lactation care for all families, (b) ensure that breastfeeding is recognized as the normal and preferred method of feeding young children, (c) ensure that federal, state, and local child welfare and family laws support the importance of breastfeeding, and (d) increase protection, promotion, and support for breastfeeding mothers in the workforce. Methods: Parkview and its community partner, Stop Child Abuse and Neglect (SCAN) Healthy Families department, provided evidence-based prenatal breastfeeding education and support to pregnant and postpartum mothers, with the goal that more African American mothers initiate and continue breastfeeding in Allen County, Indiana. The targeted area was southeast Fort Wayne, a designated Medically Underserved Area, which includes a large African American population. Professional and peer breastfeeding support were provided through support groups, individual counseling, and home visits. With funds from the National Association of County and City Health Officials (NACCHO), two African American social workers were trained as Certified Lactation Specialists (CLSs). The CLSs were recruited from the SCAN existing staff and were familiar with the community and connected to the families. Experience has shown that new mothers and families are more likely to listen to and heed advice from someone who is perceived as part of the community. Results: As a result of this project, Parkview Health increased the provision of breastfeeding services from one support group per week to nine groups per month within the targeted area. In addition, home visits were provided to mothers who were unable to attend the group session because of medical conditions. Furthermore, Parkview developed several culturally sensitive breastfeeding education and marketing materials. The materials feature photos of families and infants of color, with information on breastfeeding benefits for mother and infant and also contact information for local support and resources, including the CLSs. Over a 12-month period, from March 2015 to February 2016, a total of 97 breastfeeding support groups were hosted, which included a total of 626 face-to-face encounters with mothers engaged in the breastfeeding program. The women who received support were primarily White and African American. Overall demographics were 232 White, 194 African American, 100 Hispanic, 45 Asian, 8 American Indian, and 47 of other races.
Conclusion: The NACCHO funding increased Parkview Health and SCAN’s organizational capacity to provide breastfeeding support. Lactation support has been incorporated into job responsibilities for the program to be sustained. The increase in attendance at the breastfeeding support groups and the additional home visiting requests have led this initiative to develop a new registered nurse position, who will be trained in lactation management. Last, the nine support groups per month have been maintained, with approximately 8 to 10 women in attendance per session. As this program continues, the goal is to close the breastfeeding gap in Allen County
Designing tailored patient education on atrial fibrillation
No full textBackground & Hypothesis: Research has revealed a high prevalence of depression, anxiety, and burnout among medical students accompanied by widespread lack of treatment. We hypothesize that by leveraging our study findings examining the use of telemental health(TMH) among youth (ages 14-24) alongside results from existing research focused on the mental health needs of medical students (median age at start 22-24 years old), we will gain valuable insight into the potential for TMH to address the needs of this high-risk population.
Methods: Using the Delphi method, a sample of 25 experts were surveyed anonymously, thus avoiding group pressure for conformity while also developing a consensus. Three rounds of surveys were completed over two months, including Likert scale and open-ended questions.
Results: Participants agreed that TMH may help overcome highly ranked barriers to getting mental health help: stigma (92% say this is a barrier /64% believe TMH will help), cost (84%/56%), poor availability of mental health services (60%/76%) and transportation (60%/88%). Concerns regarding TMH use expressed by participants included: technology alone is not sufficient to address the mental health care needs of youth (75% of participants), technology may impede development of therapeutic connections (60%), and performing therapy via technology may not be sufficiently personal (50%). Conclusions: Lack of time, stigma, fear of impact on career/academic record, and fear of being recognized by a colleague associated with the mental health center are some of the barriers to mental health treatment experienced by untreated medical students, which overlap considerably with the barriers that our participants agreed could be overcome using TMH. Given the unmet need for mental health care among medical students and prior research, our work suggests more medical schools should consider how to integrate TMH resources into their academic support systems
Andecaliximab/GS-5745 Alone and Combined with mFOLFOX6 in Advanced Gastric and Gastroesophageal Junction Adenocarcinoma: Results from a Phase I Study.
No full textPurpose: Matrix metalloproteinase-9 (MMP9) is implicated in protumorigenic processes. Andecaliximab (GS-5745, a monoclonal antibody targeting MMP9) was evaluated as monotherapy and in combination with mFOLFOX6.
Patients and Methods: Three dosages of andecaliximab monotherapy [200, 600, and 1800 mg i.v. every 2 weeks (q2w)] were investigated in patients with advanced solid tumors (n = 13 in a 3+3 design). After determining a recommended dose, patients with advanced HER2-negative gastric/gastroesophageal junction (GEJ) adenocarcinoma (n = 40) received 800 mg andecaliximab + mFOLFOX6 q2w. Pharmacokinetics, pharmacodynamics, safety, and efficacy were assessed.
Results: Andecaliximab monotherapy demonstrated no dose-limiting toxicity (DLT) in any cohort, displaying target-mediated drug disposition at the lowest dose (200 mg) and linear pharmacokinetics at higher doses. Based on target engagement, recommended doses for further study are 800 mg q2w or 1,200 mg q3w. Maximal andecaliximab target binding, defined as undetectable andecaliximab-free MMP9 in plasma, was observed in the gastric/GEJ adenocarcinoma cohort. We observed no unusual toxicity, although there were four deaths on study not attributed to andecaliximab treatment. In first-line patients (n = 36), median progression-free survival (PFS) was 9.9 months [95% confidence interval (CI), 5-13.9 months], and the overall response rate (ORR) was 50%. Among all patients (n = 40), median PFS was 7.8 (90% CI, 5.5-13.9) months, and ORR was 48%, with a median duration of response of 8.4 months.
Conclusions: Andecaliximab monotherapy achieved target engagement without DLT. Andecaliximab + mFOLFOX6 showed encouraging clinical activity without additional toxicity in patients with HER2-negative gastric/GEJ adenocarcinoma. A phase III study evaluating mFOLFOX6 ± andecaliximab in this setting is ongoing
The Peripheral Vascular Intervention (PVI)-Lower Extremity Structured Report: A Tool for Physician Reporting Data Elements for the National Cardiovascular Data Registry (NCDR ® ) PVI Registry ™
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The American College of Cardiology (ACC)/ National Cardiovascular Data Registry (NCDR®) Peripheral Vascular Intervention (PVI) Registry™ relies on thorough data collection to give registry participants a way to measure and improve the quality of care they provide to their patients. The majority of the data being collected in the PVI lower extremity procedures comes directly from the Interventional Cardiologist’s procedural report. There were three different reports from five physicians. The Interventional Cardiologist Group meets monthly to discuss cases and other pertinent information to the group. The members of this group include the Interventional Cardiologists, Parkview Heart Institute’s Chief Operating Officer, Vice President and Medical Director. The Database Specialist goes quarterly to this meeting to share the quarterly data and any issues with gathering data. At this meeting the group decided to have a structured report built similar to the NCDR Cath Percutaneous Intervention (CathPCI) Registry™ that was developed and utilized at Parkview Health by the Interventional Cardiologists in 2015. The NCDR-CATH PCI Structured Report was presented in poster format at the NCDR 2016 National Conference and was a People’s Choice winner. A structured report is a method of gathering and collecting data using pre-determined data elements and formats. The structured report allows for organized storing and retrieving of information through the record. EPIC© is the name of the company that provides our electronic medical record (EMR) and has developed and defined the structured report. At the Interventional Cardiology meeting, the physicians decided they wanted the data elements requested by the NCDR addressed in their structured report just as they had been doing for NCDR-Cath PCI. The Data Abstractor had difficulty determining the exact percentages of each lesion, which lesion was worked on, presentation of symptoms and procedure indication with the current reports (Fig. 1). The structured report will provide the physician a consistent tool that ensures data elements for the PVI Registry are addresse
Clostridioides Difficile Testing of bedside and shower curtains in C diff-positive patient population rooms
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Research Question: Are curtains in a C diff-positive patient room a potential source of contamination and risk factor of C diff infection for subsequent patients
Impact of customized response options on medication alert salience
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