Leading and managing radical change

From late 2019, the world has been thrown into a distressing, destabilizing condition due to the COVID-19 pandemic. This has been exacerbated by localized civil disruptions of various kinds. These conditions are affecting governments, large and small businesses, infrastructure, and nonprofit organizations. Organizational leaders are confronted with the need to plan and implement internal systemic changes in response to these changing external events and circumstances. This chapter extends the earlier Lewinian strategies to situations requiring radical change. It describes -the Phoenix and Swamp models, complex systems change strategies, and phases of change-that can be usefully applied to understand radical organizational change. The chapter also provides a phenomenological view of the process of change-what it feels like to lead or be the object of change as well as key stages in organizational reaction and evolution. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Impact of Food Insecurity on Clinical Outcomes in Newly Diagnosed Pediatric Ibd Patients

Purpose: Inflammatory bowel disease (IBD) is an autoimmune disease that consists of Crohn's Disease (CD) and ulcerative colitis (UC). IBD is thought to result from an environmental trigger, one of which could be diet, in a genetically susceptible host. Food insecurity is defined as limited or uncertain access to enough food. It is estimated that 1 in 7 children in the United States experience food insecurity which is estimated to be about 13 million children. This number has increased since the COVID pandemic to 1 in 4. Louisiana has one of the higher rates of food insecurity in the country with an estimate of over 249,000 children affected. Food insecurity is higher in African American and Hispanic households. Despite nutrition playing a significant role in IBD, there is limited data on food insecurity and IBD. Only one adult study identified that adult IBD patients had 69% higher odds of being food insecure compared to peers without IBD. The purpose of this study is to evaluate if pediatric patients with IBD are food insecure. Our hypothesis is that newly diagnosed pediatric IBD patients who are food insecure have worse clinical outcomes than those who are food secure 6 months after diagnosis. The primary aim will be to assess if food insecurity is associated with escalations in therapy within the first 6 months of diagnosis. Secondary aim of the study is to determine if food insecurity is associated with other clinical outcomes. Food access will also be evaluated to see if patients who are food insecure live in areas defined as a food desert, decrease access to nearby grocery stores, or food swamps, defined as adequate access to food but mostly higher calorie food options over healthy food options. Method(s): This is a prospective study of newly diagnosed pediatric IBD patients seen in the Louisiana State University Health Science Center Pediatric Gastroenterology Division at Children's Hospital New Orleans. Patients were screened for food insecurity using the United States Department of Agriculture's food insecurity screening and the American Academy of Pediatrics' Food Insecurity 2-Question Screen. Data was collected including escalations in medication, hospitalizations, surgeries, emergency room visits and nutritional data over the first 6 months of diagnosis. To determine diet quality, food journals were completed, or comprehensive diet recalls were performed then analyzed by a licensed dietitian. Result(s): There are currently 13 patients enrolled in this ongoing study. All patients have Crohn's Disease and receive maintenance therapy with TNF alpha antagonist (infliximab or biosimilar). Most patients are female (69%), Medicaid insurer (54%), with approximately half identifying as white race (46%) and half identifying as African American (46%). The average age at diagnosis was 14.4 years (+/- 2.7 years). Nine of the patients (69%) have no grocery stores within 1 mile of their home. Three patients lived in a food swamp (23%), 1 of which also had low food security. There was one patient who did not live in a food desert or food swamp but identified as having low food security. The average BMI was 19.4 and 3 had a BMI z-score less than -1 at diagnosis. Two parents were identified as having low food security and 2 patients screened positive for low food security. Only one survey matched low food security for both parent and child. For transportation, many traveled to appointments by automobile but were not owners of the automobile. At one month after diagnosis, there was 1 medication change due to the development of antibodies, 2 courses of oral steroids, 2 patients had an additional medication added (methotrexate for both), 3 hospitalizations, 1 surgery;however, none of the patients fit criteria for low food security. There were 2 emergency room visits, 1 of 2 were food insecure. Weight gain in one month ranged from 0.3 to 10.4 kilograms. One food insecure patient lost 0.8 kilograms at 1 month. Conclusion(s): While there were few patients identified as food insecure, each patient had relatively poor access to healthy food options. Every patient in the study either fell into the category of having no grocery stores within a mile of their home, living in a food swamp or having low food security. Establishment of additional surrogates for food insecurity may be warranted to better assess the association of food insecurity with IBD. The significance of food insecurity in pediatric IBD remains unclear. However, longer follow-up is planned to further assess the relationship between food insecurity and clinical and nutritional outcomes. Additional studies are forthcoming to evaluate the impact food quality within the diet of pediatric IBD patients has on short-term and long-term health outcomes.

SEVERE ACUTE VULVAL ULCERATION ASSOCIATED WITH COVID-19 INFECTION IN A SEXUALLY ACTIVE DUAL COVID-VACCINATED YOUNG PERSON: A CASE REPORT

Case A 20-year old was seen at the height of the Omicron wave of the COVID-19 pandemic with a two day history of a first episode of painful genital ulceration. Her last sexual contact was one week previously. She had no other symptoms and no medical or drug history. There was bilateral inguinal lymphadenopathy and a unilateral 1cm slightly indurated shallow vulval ulcer with slough. She was treated empirically for secondarily infected primary herpes. Three days later she presented with increased pain and negative HSV PCR and STI/ BBV tests. She had large bilateral genital ulcers (figure 1) and was admitted. Repeat swabs for HSV, VZV and syphilis were negative. She had a neutrophilia, raised CRP and negative EBV and CMV IgM. A routine nasopharyngeal swab identified SARS-CoV-2 and a full respiratory virus PCR panel was otherwise negative. She disclosed a sore throat and fevers the week before the onset of her vulval symptoms but was reassured by negative home antigen tests. She had received the second dose of an mRNA COVID-19 vaccine four months previously but no booster. She was discharged after five days and treated with a reducing course of oral steroids. At four weeks her ulcers were healing well. Discussion There are few published cases of Lipschütz ulcers associated with COVID-19 and this case adds to the burgeoning evidence of the possible dermatological manifestations of the disease and crucially it illustrates the value of prompt access to sexual health services during the pandemic. (Figure Presented).

Cholera

Cholera, a diarrheal infection caused by the gram-negative bacillus Vibrio cholerae, belongs to the Vibrionaceae family. According to the who in 2017, 34 countries reported a total of 1 227 391 cases of cholera and 5 654 deaths, with a fatality rate of 0.5%. The Asian continent is responsible for 84% and Africa for 14% of all cholera cases worldwide, and in America, Haiti reported 13 681 cases (1%). Practically, most of the cases correspond to developing countries, which translates to us a health problem and/or infrastructure (access to safe water), conditions for outbreaks and epidemics. In Mexico, in 2018 a case was reported in an adult, being the human intestine is not the only reservoir of V. cholerae 01, since it survives and multiplies in estuaries, swamps, rivers and in the sea. Some fish and various shellfish, especially bivalve molluscs from contaminated waters, are a potential source of transmission if eaten raw or undercooked. It can also be spread through other types of food such as rice, coconut water, undercooked pork, and vegetables irrigated with black water. The route of transmission is fecal-oral. Outbreaks associated with the ingestion of contaminated water appear explosively and are generally related to a common source. Cholera occurs mainly in low socioeconomic environments with poor sanitation conditions, it is frequent in people who are exposed to consumption of river water and/or street foods and in food handlers. Given all these aspects, we must always think about this pathology, given the sanitary conditions that are currently distracting from the current coronavirus pandemic, coupled with many regions with floods and the consumption of contaminated water.

Post covid pulmonary mucormycosis, early interventions surgical complications and outcome

Background: Invasive fungal infections are an important cause of morbidity and mortality in immunocompromised patients. These infections remain difficult to diagnose and their management is complicated by their aggressive course of disease. Discussion: A 50yrs old female, case of rheumatoid arthritis on treatment, post covid presented in a state of DKA with complaints of fever, cough, breathlessness and right sided pleuritic chest pain for >1 month with 2-3 episodes of minimal hemoptysis. CXR s/o Right middle lobe cavity lesion. Bronchoscopy: Right UL bronchial segments inflamed, irregular sloughed mucosa with endobronchial narrowing, biopsy obtained. HPE s/o mucormycosis Patient started on IV antibiotics & antifungals. Thoracotomy- Right upper and middle lobectomy done on day 8 of hospitalization. Right upper lobe had two large necrotic thick walled cavities with blackish slough. On post-op day 4 patient developed large air leak in ICD s/o BPF. Second thoracotomy for BPF repair done after 7weeks of 1stsurgery. Patient had respiratory distress after extubation. CXR showed right opaque hemithorax with pull of mediastinum. Required urgent bronchoscopy to remove endobronchial mucus plug. Conclusion: Prognosis and outcome have improved as a result of early diagnosis, newer antifungals agents & surgical debridement. Antifungal treatment, surgical interventions & high risk of post surgical complications in an immunocompromised elderly host is grave challenge. But our case had a positive clinical outcome.

Accidental ingestion of swamp stone: A new and hazardous source of lead poisoning.

It is important to find sources for lead poisoning and educate the population about the danger of this heavy metal. The epidemiologic studies for evaluating BLL can help develop a guideline for screening endangered populations and providing treatment.