An innovative approach for coordinating multiple sedated procedures in medically complex pediatric patients.

Children and youth with special health care needs often undergo a higher frequency of sedated procedures, increasing their risk for complications, prolonged hospitalizations, as well as increased time and cost burdens. By consolidating multiple procedures requiring anesthetic sedation, the risk and cost can be reduced for both families and health care systems. In this paper, we discuss an innovative model to coordinate procedures across internal and external providers to improve quality of care for this vulnerable patient population.

Implementing a social work care coordination model for children and youth with special health care needs in a rural-urban health system.

This retrospective chart review examined care coordination among pediatric patients with varying levels of medical complexity who received care in a rural-urban health system. Care coordination utilization across patient acuity levels was examined for meaningful differences in frequency and duration of care coordination services. Results indicated that patients with more severe medical complexity had increased frequency and duration of care coordination services, as well as different patterns of care coordination activity utilization.

Masked pregnancy-associated hypertension as a predictor of adverse outcomes.

Background: Masked hypertension has been described in nonpregnant populations as elevated blood pressure in the home setting that is not reproduced on clinical assessment. Patients with masked hypertension have a greater risk of cardiovascular morbidity than patients who have blood pressures within normal range or those with white coat hypertension.

Objective: This study aimed to determine whether masked pregnancy-associated hypertension detected on Connected Maternity Online Monitoring, a remote home blood pressure monitoring system, is associated with higher rates of hypertensive disorders of pregnancy during delivery admission and maternal and neonatal morbidities.

Health-care utilization for sinusitis after pneumococcal vaccination in patients with low antibody titers.

Background: Pneumococcal antibody deficiency has been the subject of limited study in chronic rhinosinusitis (CRS) and has not been studied in recurrent acute rhinosinusitis (RARS). The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is considered for patients with nonprotective Streptococcus pneumoniae titers. We hypothesized that both RARS and CRS patients with deficient S pneumoniae titers and subsequent PPSV23 vaccination would have reduced health-care encounters for sinusitis and fewer prescriptions for antibiotics or steroids.

Interprofessional grant writing seminar for early career faculty in a small, isolated teaching center.

Small, isolated teaching centers have difficulty mentoring interprofessional junior faculty in research methods and grant writing. Peer mentoring programs for grant writing at larger institutions have been successful. In this short report, we describe our program that leveraged mentor experience using four framing seminars followed by project refinement in three-person peer groups and monthly mentored works in progress meetings.

The Lunch Conference Diet: Fostering Resident Engagement in Culinary Medicine Through a Curriculum Centered on Changes to Provided Conference Food.

Background: Despite the burden of chronic disease attributable to lifestyle, most internal medicine residents do not receive adequate training in nutrition and nutrition counseling.

Methods: We held a culinary medicine workshop in September 2018, followed by didactic sessions throughout the academic year. Changes were made to lunch conference food to more closely follow the Mediterranean diet and to encourage healthy eating.

Pediatric care coordination and risk tiering: Moving beyond claims data.

Purpose: The goal of this study was to evaluate the performance of a pediatric stratification tool that incorporates health and non-medical determinants to identify children and youth with special health care needs (CYSHCN) patients according to increasing levels of complexity and compare this method to existing tools for pediatric populations.

Methods: This retrospective cohort study examined pediatric patients aged 0 to 21 years who received care at our institution between 2012 and 2015. We used the St.

Development and Psychometric Testing of the Nurses' Confidence Scale: Unique Families.

Objective: To develop and evaluate an instrument designed to measure the confidence of nurses in their ability to provide neutral, compassionate care to unique families in perinatal settings: the Nurses' Confidence Scale: Unique Families.

Design: Prospective instrument development and psychometric study.

Setting: Health system in the U.

Clinical Care Coordination in Medically Complex Pediatric Cases: Results From the National Survey of Children With Special Health Care Needs.

This study uses a secondary analysis of the 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) to describe care coordination (CC) for children with medical complexity (CMC). Chi-square test, test, and multivariate logistic regression statistical tests are used to determine the relationships and differences between sources of CC and factors associated with receiving clinic-based CC for CMC and their family. Among CMC, 66.

Evaluation of Food Insecurity in Adults and Children With Cystic Fibrosis: Community Case Study.

Advances in the care and treatment of cystic fibrosis (CF) have led to improved mortality rates; therefore, considerably more individuals with CF are living into adulthood. With an increased number of CF patients advancing into adulthood, there is the need for more research that surrounds the aging adult CF patient. It is important to conduct research and collect results on the aging CF population to help better prepare the CF patient, who is dealing with the heavy treatment and financial burden of their disease, build autonomy and increase their quality of life.

NO SToPS: Assessment of a Supportive Care Program to Reduce Treatment Breaks in Patients With Head and Neck Cancer.

NO SToPS is an interprofessional supportive care program implemented in 2008 for patients with head and neck cancer undergoing chemoradiation. The goals of the program are to reduce radiation treatment breaks and hospitalizations related to toxicity from this difficult treatment. Breaks lead to lower locoregional control and survival rates in this population.

Successful adherence and retention to daily monitoring of physical activity: Lessons learned.

Research utilizing repeated-measures such as daily assessments with self-report and/or objective measures [e.g., physical activity (PA) monitors] are important in understanding health behaviors and informing practice and policy.

Evaluation of a Designated Family Bonding Time to Decrease Interruptions and Increase Exclusive Breastfeeding.

Objective: The purpose of this quality improvement project was to plan and implement a daily family bonding time on our mother/baby care unit and evaluate its effect on interruptions, mothers' perceptions of interruptions, and exclusive breastfeeding rates.

Design: A separate sample pre-/postintervention design conducted in three phases.

Setting/local Problem: Healthy breastfeeding newborns had double the odds of receiving supplementation before discharge if they stayed more than 1 night or were born at night.

Impact of a complex chronic care patient case conference on quality and utilization.

There is need for effective venues to allow teams to coordinate care for high-risk or high-need patients. In addition, health systems need to assess the impact of such approaches on outcomes related to chronic health conditions and patient utilization. We evaluate the clinical impact of a novel case conference involving colocated trainees and supervisors in an interprofessional academic primary care clinic.

Interprofessional case conference: impact on learner outcomes.

Transition to interprofessional team-based care is a quickly progressing healthcare model and requires changes in medical training approaches. The Department of Veteran Affairs (VA) has taken a lead role in creating such training experiences, one of which is the establishment of multiple Centers of Excellence in Primary Care Education (CoEPCE). These sites are tasked with developing teaching innovations to better facilitate interprofessional team-based care.

Interprofessional Care Conferences for High-Risk Primary Care Patients.

Problem: As health care systems convert to team-based care, the need to improve interprofessional education is tremendous. In addition to formal instruction, trainees need authentic team-based workplace learning experiences.

Approach: The authors designed the PACT-ICU (Patient-Aligned Care Team Interprofessional Care Update) conference to provide team-based care to high-risk patients while teaching trainees principles of interprofessionalism and modeling relevant behaviors.

The value of a genetic counselor: improving identification of cancer genetic counseling patients with chart review.

Advances in genetics are changing cancer care and requiring institutions to maximize the unique skills of genetics professionals. The identification of genetic syndromes is vital for prevention and management of families with high cancer risks. Despite this, high risk individuals who qualify are often not referred.

A multisite, multistakeholder validation of the Accreditation Council for Graduate Medical Education competencies.

Purpose: The Accreditation Council for Graduate Medical Education's (ACGME's) six-competency framework has not been validated across multiple stakeholders and sites. The objective of this study was to perform a multisite validation with five stakeholder groups.

Method: This was a cross-sectional, observational study carried out from October to December, 2011, in the internal medicine residency continuity clinics of eight internal medicine residency programs in the Pacific Northwest, including a VA, two academic medical centers, a military medical center, and four private hospitals.

Cancer deaths and occupational exposure in a group of plutonium workers.

An exploratory epidemiological study was conducted for 319 deceased nuclear workers who had intakes of transuranic radionuclides and histories of employment during the time period from 1943 to 1995. The workers were employed at various facilities throughout the United States, including the Department of Energy defense facilities and uranium mining and milling sites. The majority of individuals were involved in documented radiological incidents during their careers.

Assessing change in health professions volunteers' perceptions after participating in Special Olympics healthy athlete events.

This study assessed perceptions of health professions student and faculty volunteers who participated with athletes at the 2009 Special Olympics World Winter Games in Healthy Athlete venues. The volunteers' perceptions and expectations of the abilities of intellectually disabled athletes were measured by administering pre-event and post-event questionnaires consisting of demographic questions and the Prognostic Belief Scale (PBS). Invitations to participate in the study were sent to 165 students and faculty members; of those, eighty (48.

Are medical offices prepared for the next disaster?

Disasters have an enormous economic impact on the United States as well as short- and long-term healthcare implications. Federal and state governments are providing billions of dollars to communities across the nation for emergency preparedness activities. An online poll conducted in July 2008 indicated that most medical practices in the United States, even though they believe they will be impacted by a disaster within the next five years, re port themselves to be inadequately prepared.

Alcohol and estrogen replacement therapy in postmenopausal women. Direct and mediated effects on cognitive component processes.

The literature remains contentious regarding the separate and combined effects of moderate drinking and estrogen replacement therapy (ERT) on cognition. In the current study, the authors sought to disentangle the predictive utility of alcohol use, ERT and their interaction on the episodic and semantic memory stores of postmenopausal women. It was predicted that relationships between moderate drinking, ERT and cognition would be attenuated by demographic and health-related factors.

One-per-occasion or less: are moderate-drinking postmenopausal women really healthier than their nondrinking and heavier-drinking peers?

Background: While some reported benefits of moderate drinking are thought to be the direct results of physiological mechanisms associated with consumption, other effects may be attributable to mediating factors. Both explanations suggest that moderate drinkers may be healthier than nondrinking and heavier-drinking peers. The purpose of this study was to determine whether moderate-drinking postmenopausal women report healthier dietary and exercise patterns, and whether they demonstrate better physiological functioning compared with peers.

Transdermal nicotine administration and the electroencephalographic activity of substance abusers in treatment.

Objectives: It is widely recognized that individuals with alcohol or illicit substance abuse disorders often smoke cigarettes. However, few studies have examined the direct effects of nicotine among substance abuse subgroups. The current study examined patterns of electroencephalographic (EEG) activity in alcohol-dependent (AD), stimulant-dependent (StimD), alcohol- and stimulant-dependent (ASD) participants, as well as community controls (CC).