Perspectives on Implementing a Communication Facilitator Intervention From a Critical Care Setting.

Context: Critically-ill patients and their families often experience communication challenges during their ICU stay and across care transitions. An intervention using communication facilitators may help address these challenges.

Objectives: Using clinicians' perspectives, we identified facilitators and barriers to implementing a communication intervention.

Interprofessional Collaboration and Patient/Family Engagement on Rounds in a Comprehensive Stroke Center: A Mixed-Methods Study.

Background And Objectives: Daily rounds provide an opportunity for interprofessional collaboration and patient/family engagement, which are critical to stroke care. As part of a quality improvement program, we conducted a baseline assessment to examine interprofessional collaboration and patient/family engagement during the current rounding process in a 12-bed comprehensive stroke center. Findings from the baseline assessment will be used to inform the development, implementation, and evaluation of a new rounding model.

Innovations in Remote Teaching of Engineering Design Teams.

The University of Washington's Engineering Innovation in Health program is a yearlong engineering design course sequence where senior undergraduate and graduate engineering students across different disciplines work in teams with health professionals to address their unmet needs. With the onset of the COVID-19 pandemic, these team- and project-based courses shifted from an in-person to remote course environment. Here, we share innovative teaching strategies for a team-based, remote course environment.

Definitions of resilience and resilience resource use as described by adults with congenital heart disease.

Background: Adult congenital heart disease (ACHD) is a lifelong illness that presents ongoing challenges to quality of life. Fostering personal resilience resources to sustain well-being can enhance patients' psychosocial health.

Objective: We aimed to describe patients' resilience experiences: how they understand, develop, and utilize resilience resources in managing ACHD.

Beyond shadowing: Active involvement of pre-health undergraduate students in patient- and family-centered rounds.

An early introduction to interprofessional collaborative practice (IPCP) has many benefits for students. However, pre-health undergraduate (PHU) students have limited exposure to IPCP. Observing patient- and family-centered rounds (PFCR) offer a potential avenue for PHU students to learn about IPCP.

Characterization of Antibodies against Receptor Activity-Modifying Protein 1 (RAMP1): A Cautionary Tale.

Calcitonin gene-related peptide (CGRP) is a key component of migraine pathophysiology, yielding effective migraine therapeutics. CGRP receptors contain a core accessory protein subunit: receptor activity-modifying protein 1 (RAMP1). Understanding of RAMP1 expression is incomplete, partly due to the challenges in identifying specific and validated antibody tools.

Development and Usability Testing of a System to Detect Adverse Events and Medical Mistakes.

Many inpatient hospital visits result in adverse events, and a disproportionate number of adverse events are thought to occur among vulnerable populations. The personal and financial costs of these events are significant at the individual, care team, and system levels. Existing methods for identifying adverse events, such as the Institute for Healthcare Improvement Global Trigger Tool, typically involve retroactive chart review to identify risks or triggers and then detailed review to determine whether and what type of harm occurred.

Can relational coordination theory be used to understand and improve interprofessional care coordination in schools? A pilot study.

Attending to the health needs of students with chronic conditions requires a fluid exchange of information and coordination between parents, educators, administrators, and school healthcare professionals. Previous research often omits school nurses in this exchange, although their role is key to successful outcomes. Relational Coordination (RC) theory posits that cohesive relationships help support communication, enabling stakeholders to coordinate their work.

Measuring the Impact of the National Train-the-Trainer Interprofessional Team Development Program (T3-ITDP) on the Implementation of Interprofessional Education and Interprofessional Collaborative Practice.

Background: In order to prepare current and future educators and clinicians to lead interprofessional education (IPE) and interprofessional collaborative practice (IPCP), faculty and staff need training in collaborative approaches to developing, implementing, assessing, and sustaining high quality IPE across the interprofessional learning continuum. The Train-the-Trainer Interprofessional Team Development Program (T3-ITDP) is a 3.5-day program designed to develop expert IPE teams through interactive workshops, coaching, and the development and implementation of an IPE or IPCP (IPECP) project for their home institutions.

A scoping review of new implementations of interprofessional bedside rounding models to improve teamwork, care, and outcomes in hospitals.

Poor communication within healthcare teams occurs commonly, contributing to inefficiency, medical errors, conflict, and other adverse outcomes. Interprofessional bedside rounds (IBR) are a promising model that brings two or more health professions together with patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. The purpose of this systematic scoping review was to investigate the breadth and quality of IBR literature to identify and describe gaps and opportunities for future research.

Adrenomedullin: new inhibitory regulator for cortisol synthesis and secretion.

Preterm birth is associated with immaturity of several crucial physiological functions notably those prevailing in the lung and kidney. Recently, a steroid secretion deficiency was identified in very preterm neonates, associated with a partial yet transient deficiency in 11β-hydroxylase activity, sustaining cortisol synthesis. However, the P450c11β enzyme is expressed in preterm adrenal glands, we hypothesized an inhibition of cortisol production by adrenomedullin (ADM), a peptide highly produced in neonates and whose effect on steroidogenesis remains poorly known.

Team interventions in acute hospital contexts: protocol for the evaluation of an initial programme theory using realist methods.

: Literature on multi-disciplinary healthcare team interventions to improve quality and safety of care in acute hospital contexts tends to focus on evaluating the success of the intervention by assessing patient outcomes. In contrast, there is little focus on the team who delivered the intervention, how the team worked to deliver the intervention or the context in which it was delivered. In practice, there is therefore a poor understanding of why some interventions work and are sustained and why others fail.

Relationships Between the Great Recession and Widening Maternal and Child Health Disparities: Findings From Washington and Florida.

The purpose of this study was to explore relationships between the Great Recession in the United States and maternal and child health (MCH) disparities in prenatal care, birth weight, gestational age, and infant mortality. Using annual, 2005-2011 individual-level Washington (WA) and Florida (FL) birth certificate data, we analyzed MCH outcome rates and disparities among subpopulation component groups (e.g.

Sustaining improvements in relational coordination following team training and practice change: A longitudinal analysis.

Background: Poor communication is a leading cause of errors in health care. Structured interprofessional bedside rounds are a promising model to improve communication.

Purpose: The aim of the study was to test if an intervention to improve communication and coordination in an inpatient heart failure care unit would result in lasting change.

The effect of women, infant, and children (WIC) services on birth weight before and during the 2007-2009 great recession in Washington state and Florida: a pooled cross-sectional time series analysis.

Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been shown to have positive effects in promoting healthy birth outcomes in the United States. We explored whether such effects held prior to and during the most recent Great Recession to improve birth outcomes and reduce differences among key socio-demographic groups.

Methods: We used a pooled cross-sectional time series design to study pregnant women and their infants with birth certificate data.

Engaging patients and families to transform heart failure care.

For patients with advanced heart failure involvement as a member of the healthcare team is critical to safe, high-quality and goal-directed care. While recognized as an important aspect of care, patient engagement is not yet a standard practice. This presents an opportunity for professional education and development in team-based care.

Social determinants of health and disparities in prenatal care utilization during the Great Recession period 2005-2010.

Background: Early, regular prenatal care utilization is an important strategy for improving maternal and infant health outcomes. The purpose of this study is to better understand contributing factors to disparate prenatal care utilization outcomes among women of different racial/ethnic and social status groups before, during, and after the Great Recession (December 2007-June 2009).

Methods: Data from 678,235 Washington (WA) and Florida (FL) birth certificates were linked to community and state characteristic data to carry out cross-sectional pooled time series analyses with institutional review board approval for human subjects' research.

Calcitonin-Receptor-Like Receptor Signaling Governs Intestinal Lymphatic Innervation and Lipid Uptake.

The absorption of dietary fat requires complex neuroendocrine-mediated regulation of chylomicron trafficking through enterocytes and intestinal lymphatic vessels. Calcitonin-receptor-like receptor () is a G protein-coupled receptor that can bind either a lymphangiogenic ligand adrenomedullin, with coreceptor RAMP2, or the neuropeptide CGRP, with coreceptor RAMP1. The extent to which this common GPCR controls lipid absorption via lymphatics or enteric innervation remains unclear.

Genetic loss of proadrenomedullin N-terminal 20 peptide (PAMP) in mice is compatible with survival.

Adrenomedullin (AM) and proadrenomedullin N-terminal 20 peptide (PAMP) are small peptides derived from a common precursor, pre-proadrenomedullin. Although AM and PAMP share hypotensive effects in the cardiovascular system, the peptides also exert diverse and distinct effects on endocrine physiology, innate immunity, cytoskeletal biology and receptor signaling pathways. Tremendous knowledge has been gleaned from the study of several genetic animal models of AM deletion or overexpression, some of which also simultaneously delete the coding region for PAMP peptide.

Lymphatic deletion of calcitonin receptor-like receptor exacerbates intestinal inflammation.

Lymphatics play a critical role in maintaining gastrointestinal homeostasis and in the absorption of dietary lipids, yet their roles in intestinal inflammation remain elusive. Given the increasing prevalence of inflammatory bowel disease, we investigated whether lymphatic vessels contribute to, or may be causative of, disease progression. We generated a mouse model with temporal and spatial deletion of the key lymphangiogenic receptor for the adrenomedullin peptide, calcitonin receptor-like receptor (), and found that the loss of lymphatic was sufficient to induce intestinal lymphangiectasia, characterized by dilated lacteals and protein-losing enteropathy.

Estimating the Burden of Pandemic Infectious Disease: The Case of the Second Wave of Pandemic Influenza H1N1 in Forsyth County, North Carolina.

Background: Understanding the burden of influenza A(H1N1)pdm09 virus during the second wave of 2009-2010 is important for future pandemic planning.

Methods: Persons who presented to the emergency department (ED) or were hospitalized with fever and/or acute respiratory symptoms at the academic medical center in Forsyth County, North Carolina were prospectively enrolled and underwent nasal/throat swab testing for influenza A(H1N1)pdm09. Laboratory-confirmed cases of influenza A(H1N1)pdm09 virus identified through active surveillance were compared by capture-recapture analysis to those identified through independent, passive surveillance (physician-ordered influenza testing).

Relative timing of influenza disease by age group.

A detailed understanding of influenza movement in communities during yearly epidemics is needed to inform improved influenza control programs. We sought to determine the relative timing of influenza presentation and symptom onset by age group and influenza strain. Prospective, laboratory-confirmed surveillance was performed over three moderate influenza seasons in emergency departments and inpatient settings of both medical centers in Winston-Salem, NC.

Evaluation of the limit of detection of the BD Veritor™ system flu A+B test and two rapid influenza detection tests for influenza virus.

We evaluated the limits of detection of 3 rapid influenza diagnostic tests-BD Veritor™ System for Flu A+B, Binax NOW® Influenza A+B, and QuickVue® Influenza-for influenza strains circulating in 2010-2012. Limits of detection varied by influenza strain, with Veritor™ Flu A+B test showing the lowest limit of detection for all strains.

Characterization of biliary conjugates of 4,4'-methylenedianiline in male versus female rats.

4,4'-Methylenedianiline (4,4'-diaminodiphenylmethane; DAPM) is an aromatic diamine used in the production of numerous polyurethane foams and epoxy resins. Previous studies in rats revealed that DAPM initially injures biliary epithelial cells of the liver, that the toxicity is greater in female than in male rats, and that the toxic metabolites of DAPM are excreted into bile. Since male and female rats exhibit differences in the expression of both phase I and phase II enzymes, our hypothesis was that female rats either metabolize DAPM to more toxic metabolites or have a decreased capacity to conjugate metabolites to less toxic intermediates.