The biphasic cuirass ventilation (BCV) device is an alternative respiratory support device for patients with chronic respiratory failure. Considered by some a “forgotten” mode of supportive ...ventilation, the device is portable, lightweight, and easy to operate. Biphasic cuirass ventilation can also be used to rapidly resuscitate patients in acute respiratory distress and requires minimal technical skill to operate. Biphasic cuirass ventilation can be employed by the patient’s caregiver in the home setting, making it a viable alternative to other forms of mechanical ventilation (e.g., BiPAP) for patients enrolled in home hospice or palliative care. The article reviews current knowledge and aims to enhance awareness and encourage further study about cuirass ventilation, particularly with regard to its use in treating patients in the palliative care setting and in the home.
Oral food challenges (OFCs) are routinely used to confirm ongoing food allergy. Serum-specific IgE (sIgE) and skin prick testing (SPT) are imperfect predictors of which patients will pass OFCs.
The ...objective of this study was to describe the design and implementation of a Standardized Clinical Assessment and Management Plan (SCAMP) to study and iteratively improve sIgE and SPT thresholds to determine when and where to conduct OFCs for patients.
Allergists consulted recommended sIgE and SPT thresholds when ordering challenges although diversions were permitted. Criteria were iteratively improved after periodic analyses of challenge outcome and diversions.
Over 3 years, allergists ordered 2368 food challenges for 1580 patients with histories of IgE-mediated reactions to food: 1386 in an outpatient clinic and 945 in a higher resource infusion center. Reactions to challenge were observed in 13% of clinic and 23% of infusion center challenges. Six patients challenged in clinic required treatment with epinephrine compared with 22 in the infusion center. The need for epinephrine was more common in patients with asthma-5% of asthmatic patients required epinephrine compared with 1% of nonasthmatic patients (P < .01). Recommended sIgE and SPT thresholds were incrementally changed and, using the control chart methodology, a significant decrease was noted in the proportion of challenges ordered in the higher resource location.
By setting and continually refining sIgE and SPT recommendations using the SCAMP method, allergists can better determine the risk of severe reaction and triage patients to the appropriate setting for an OFC.
1. Participants will self-report the ability to define concurrent care in Veterans admitted to hospice with a diagnosis of heart failure.
2. Participants will better understand the prevalence of ...advanced heart failure therapies utilized by Veterans admitted to hospice with heart failure.
We aim to explore the utilization and prevalence of concurrent hospice care in VA patients with heart failure to create a standardized definition of concurrent care in this hospice population.
Concurrent hospice care may one day become an option for all Medicare-eligible citizens, however it has been available to VA patients since 2009. Prior studies in the VA population have shown that concurrent care in hospice patients with cancer has allowed for Veterans to continue active, disease-modifying cancer treatment (radiation, chemotherapy) and have also shown a reduction in aggressive medical treatments, ICU stays, and costs. Limited data exist regarding the use of concurrent care in heart failure patients.
Using a national VA data set, we will identify Veteran patients admitted to the hospital with complications of severe heart failure between 2010 and 2020. Patients will be excluded if they were previously on hospice prior to the index hospital admission. For the purposes of this study, concurrent care will be defined as a patient who was enrolled in hospice (VA or Medicare) following a random hospital admission and later received advanced heart failure therapies. Receipt of concurrent care will be determined by confirmation of receipt of advanced heart failure therapies via specific CPT codes following enrollment in hospice. Additionally we plan to collect data regarding burdensome transitions to analyze whether there are differences between hospice patients who did and did not receive concurrent care.
1) Define concurrent care in Veterans admitted to hospice with a diagnosis of heart failure. 2) Determine the prevalence of advanced heart failure therapies in Veterans admitted to hospice with heart failure. 3) Explore whether heart failure patients receiving concurrent hospice care experience fewer burdensome transitions.
Disease specific management; Patient Outcomes
Conclusions By setting and continually refining ssIgE and skin prick test recommendations using the SCAMP method, allergists can better determine the risk of severe reactions and triage patients to ...the appropriate resource setting for an OFC.
Title: MENTAL HEALTH INTERVENTION STRATEGIES FOR YOUTH IN RURAL NORTHEAST TN
Introduction: A major need in Hawkins County entails lack of access to mental health resources. As a rural Appalachian ...county, this scarcity is especially felt by the area’s youth, who are subject to peer pressure, higher ACE scores, and may lack the autonomy to seek out professional help.
Methods: The community-based intervention spanned in three consecutive weekly small-group sessions. Eligible participants were recruited from the afterschool program at the Boys and Girls Club of Hawkins County and must have been in the 5th to 8th grade (middle school) during the course of the study (n=13). Each participant completed a pre-intervention assessment, a series of short weekly surveys (one per session) and a post-intervention assessment to determine effectiveness and retention of the material presented. Statistical significance was determined using a paired T-Test.
Results: Results did not provide any statistically significant relationships but trends were observed in perceived stress which decreased overall from pre-survey to post-survey (p=0.716), as did the self-reported use of negative coping strategies in the group (p=0.193). There was also a slight increase (p=0.653) in self-reported use of positive coping skills. A trend for greater change in the male participants was also observed. The mindfulness activity was perceived with a higher affinity than the baseline knowledge (Unpacking Mental Health) session (p=0.017).
Conclusions: The results of this study suggest that short 1-hour interventions per week, especially those incorporating mindfulness strategies, can influence attitudes and coping strategies in rural adolescent children compared to mental health knowledge sessions alone (p=0.017). Trends in gender differences could underlie cultural and societal norms. Due to the limited number of mental health providers, evaluating behaviors were considered but not utilized. These trends, especially in mindfulness activities, could help further guide community partner mental health strategies for youth in rural Appalachia. Overall, these initial trends warrant further work in a much larger sample size and power of the study to draw definitive results.
The biphasic cuirass ventilation (BCV) device is an alternative respiratory support device for patients with chronic respiratory failure. Considered by some a “forgotten” mode of supportive ...ventilation, the device is portable, lightweight, and easy to operate. Biphasic cuirass ventilation can also be used to rapidly resuscitate patients in acute respiratory distress and requires minimal technical skill to operate. Biphasic cuirass ventilation can be employed by the patient’s caregiver in the home setting, making it a viable alternative to other forms of mechanical ventilation (e.g., BiPAP) for patients enrolled in home hospice or palliative care. The article reviews current knowledge and aims to enhance awareness and encourage further study about cuirass ventilation, particularly with regard to its use in treating patients in the palliative care setting and in the home.
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