Specimen contamination generates unreliable results, leading to potential misdiagnosis and improper treatments. The purpose of this multidisciplinary continuous quality improvement project was to ...implement an evidence-based diagnostic stewardship program to reduce urine specimen contamination rates. We conducted educational in-service sessions introducing a 3-step preanalytical protocol within the emergency department. Pre- and postintervention chart review was used to evaluate the impact on urine contamination. Urine culture contamination rates were significantly reduced between the pre- and postintervention phases (χ2 = 3.78, P = .05). An evidence-based preanalytical protocol supplemented with an educational intervention reduced the contamination of urine specimens.
•Contaminated specimens can lead to misdiagnosis and unnecessary antibiotic use.•Multidisciplinary diagnostic stewardship programs can reduce contamination rates.•Focusing on the initial pre-analytic phase of specimen origination is recommended.•Projects that mandate protocol steps are recommended for greater clinical impact.
Our goal is to evaluate the current dietary offerings available for residents, survey how this food selection impacts their overall wellness, and measure any effect gained from broadening the current ...nutritional choices available.
An anonymous, paper survey about GME nutrition selection was distributed to residents during a dedicated wellness hour. The surveys were collected and analyzed as follows. The z-test for proportions was performed to determine the proportion of residents who answered yes or no to the resident lounge snack survey questionnaires. The first question was on snack satisfaction was a response on a scale of 1–10 and is presented as means with confidence interval. A chi-squared test was performed to see if there is a correlation between resident snack satisfaction and yes or no responses to survey questions on dietary restriction, limited choices, nutritional needs, sugar crash, patient advice, home food quality and nutritional for wellness. The last two questions were written responses and were tabulated and enumerated for responses falling into respective food categories.
All residents’ (100%) surveyed responded, “yes” to the nutritional wellness. While the “Yes” responses to home food quality, diet restriction, limited choices, and sugar crash were 8.3%, 20.8%, 25% and 58.3%, respectively. All residents surveyed (100%) responded “No” to the nutritional needs and patient advice. The mean snack satisfaction score was 4, 95% CI 3.32–4.68. Only home food quality was found to be significantly related to resident satisfaction (P < 0.05). The most popular response to the suggestion list for GME snacks were fruit (n = 6) and jerky (n = 5). The most popular response to the Do Not Need List for GME Snack Area were no response (n = 9), cookies (n = 6) and chips (n = 6).
Residents prefer healthy snacks such as fruit and do not want unhealthy snacks like cookies and chips. There is an association between resident’s snack satisfaction on the current snack choices and the home food quality.
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Abstract
Objective
We sought to support public health surveillance and response to coronavirus disease 2019 (COVID-19) through rapid development and implementation of novel visualization applications ...for data amalgamated across sectors.
Materials and Methods
We developed and implemented population-level dashboards that collate information on individuals tested for and infected with COVID-19, in partnership with state and local public health agencies as well as health systems. The dashboards are deployed on top of a statewide health information exchange. One dashboard enables authorized users working in public health agencies to surveil populations in detail, and a public version provides higher-level situational awareness to inform ongoing pandemic response efforts in communities.
Results
Both dashboards have proved useful informatics resources. For example, the private dashboard enabled detection of a local community outbreak associated with a meat packing plant. The public dashboard provides recent trend analysis to track disease spread and community-level hospitalizations. Combined, the tools were utilized 133 637 times by 74 317 distinct users between June 21 and August 22, 2020. The tools are frequently cited by journalists and featured on social media.
Discussion
Capitalizing on a statewide health information exchange, in partnership with health system and public health leaders, Regenstrief biomedical informatics experts rapidly developed and deployed informatics tools to support surveillance and response to COVID-19.
Conclusions
The application of public health informatics methods and tools in Indiana holds promise for other states and nations. Yet, development of infrastructure and partnerships will require effort and investment after the current pandemic in preparation for the next public health emergency.
Appropriate use of language in the field of addiction is important. Inappropriate use of language can negatively impact the way society perceives substance use and the people who are affected by it. ...Language frames what the public thinks about substance use and recovery, and it can also affect how individuals think about themselves and their own ability to change. But most importantly, language intentionally and unintentionally propagates stigma: the mark of dishonor, disgrace, and difference that depersonalizes people, depriving them of individual or personal qualities and personal identity. Stigma is harmful, distressing, and marginalizing to the individuals, groups, and populations who bear it. For these reasons, the Editorial Team of Substance Abuse seeks to formally operationalize respect for personhood in our mission, our public relations, and our instructions to authors. We ask authors, reviewers, and readers to carefully and intentionally consider the language used to describe alcohol and other drug use and disorders, the individuals affected by these conditions, and their related behaviors, comorbidities, treatment, and recovery in our publication. Specifically, we make an appeal for the use of language that (1) respects the worth and dignity of all persons ("people-first language"); (2) focuses on the medical nature of substance use disorders and treatment; (3) promotes the recovery process; and (4) avoids perpetuating negative stereotypes and biases through the use of slang and idioms. In this paper, we provide a brief overview of each of the above principles, along with examples, as well as some of the nuances and tensions that inherently arise as we give greater attention to the issue of how we talk and write about substance use and addiction.
Triple elimination is an initiative supporting the elimination of mother-to-child transmission of three diseases - human immunodeficiency virus (HIV) infection, syphilis and hepatitis B. Significant ...progress towards triple elimination has been made in some regions, but progress has been slow in sub-Saharan Africa, the region with the highest burden of these diseases. The shared features of the three diseases, including their epidemiology, disease interactions and core interventions for tackling them, enable an integrated health-systems approach for elimination of mother-to-child transmission. Current barriers to triple elimination in sub-Saharan Africa include a lack of policies, strategies and resources to support the uptake of well established preventive and treatment interventions. While much can be achieved with existing tools, the development of new products and models of care, as well as a prioritized research agenda, are needed to accelerate progress on triple elimination in sub-Saharan Africa. In this paper we aim to show that health systems working together with communities in sub-Saharan Africa could deliver rapid and sustainable results towards the elimination of mother-to-child transmission of all three diseases. However, stronger political support, expansion of evidence-based interventions and better use of funding streams are needed to improve efficiency and build on the successes in prevention of mother-to-child transmission of HIV. Triple elimination is a strategic opportunity to reduce the morbidity and mortality from HIV infection, syphilis and hepatitis B for mothers and their infants within the context of universal health coverage.
Introduction: HIV‐infected pregnant and breastfeeding adolescents are a particularly vulnerable group that require special attention and enhanced support to achieve optimal maternal and infant ...outcomes. The objective of this paper is to review published evidence about antenatal care (ANC) service delivery and outcomes for HIV‐infected pregnant adolescents in low‐income country settings, identify gaps in knowledge and programme services and highlight the way forward to improve clinical outcomes of this vulnerable group.
Discussion: Emerging data from programmes in sub‐Saharan Africa highlight that HIV‐infected pregnant adolescents have poorer prevention of mother‐to‐child HIV transmission (PMTCT) service outcomes, including lower PMTCT service uptake, compared to HIV‐infected pregnant adults. In addition, the limited evidence available suggests that there may be higher rates of mother‐to‐child HIV transmission among infants of HIV‐infected pregnant adolescents.
Conclusions: While the reasons for the inferior outcomes among adolescents in ANC need to be further explored and addressed, there is sufficient evidence that immediate operational changes are needed to address the unique needs of this population. Such changes could include integration of adolescent‐friendly services into PMTCT settings or targeting HIV‐infected pregnant adolescents with enhanced retention and follow‐up activities.
This study explored psychological predictors that may impact viewers’ decision to watch television shows on the basis of perceived racial or ethnic representation. 1998 undergraduate students ...selected from a list of motivations for watching television that included race-specific motivations such as “a character is of my race/ethnicity.” Participants also completed attitudinal measures of colorblind racial ideology, social dominance orientation, ethnic identity, and ethnic stigma consciousness. Analysis revealed that prejudicial beliefs predicted less salience for racial representation when making choices about television watching, while deeper connection to one’s ethnic group predicted greater salience for representation when making these choices.
Background Procalcitonin (PCT)-guided antibiotic stewardship (ABS) has been shown to reduce antibiotics (ABxs), with lower side-effects and an improvement in clinical outcomes. The aim of this ...experts workshop was to derive a PCT algorithm ABS for easier implementation into clinical routine across different clinical settings. Methods Clinical evidence and practical experience with PCT-guided ABS was analyzed and discussed, with a focus on optimal PCT use in the clinical context and increased adherence to PCT protocols. Using a Delphi process, the experts group reached consensus on different PCT algorithms based on clinical severity of the patient and probability of bacterial infection. Results The group agreed that there is strong evidence that PCT-guided ABS supports individual decisions on initiation and duration of ABx treatment in patients with acute respiratory infections and sepsis from any source, thereby reducing overall ABx exposure and associated side effects, and improving clinical outcomes. To simplify practical application, the expert group refined the established PCT algorithms by incorporating severity of illness and probability of bacterial infection and reducing the fixed cut-offs to only one for mild to moderate and one for severe disease (0.25 μg/L and 0.5 μg/L, respectively). Further, guidance on interpretation of PCT results to initiate, withhold or discontinue ABx treatment was included. Conclusions A combination of clinical patient assessment with PCT levels in well-defined ABS algorithms, in context with continuous education and regular feedback to all ABS stakeholders, has the potential to improve the diagnostic and therapeutic management of patients suspected of bacterial infection, thereby improving ABS effectiveness.
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