Integration of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Primary Care Settings.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been shown to improve food and economic security, advance health and educational outcomes, and reduce health costs. Despite proven benefits, 54% of those eligible for WIC in Denver County are not enrolled, likely due to documented barriers including stigma, psychological costs, administrative resources, and physical access. In partnership with Denver County WIC, Denver Health's Federally Qualified Health Centers collaborated to create a Specialized WIC Co-Enrollment program to integrate WIC services into pediatric well-child and obstetric visits. WIC Co-Enrollment programmatic data were collected using a REDCap database. Program participant feedback and experiences were gathered through a bilingual survey after visits were completed. Program staff feedback and experiences were collected through third-party interviews and anonymous surveys. Data were analyzed using descriptive statistics and inductive thematic analysis. Between March 2021 and December 2022, 1,870 families were served in Specialized WIC Co-Enrollment appointments, serving a total of 3,347 individuals. Participants noted positive experiences and that receiving WIC services during healthcare visits saved them time, money, childcare, and transportation. Staff and providers noted the program was convenient for families and offered system-level benefits such as improved interprofessional collaboration and clinic efficiency. Specialized WIC Co-Enrollment has been popular among participants, providers, and staff. Integrating WIC services in a health system leverages existing touchpoints with Medicaid beneficiaries and eliminates barriers to accessing the WIC program, which could be beneficial in other communities where assistance program enrollment gaps exist.

Case Report: De Novo and Persistent Psychosis After Withdrawal From Chronic Opioid Therapy.

Psychiatric illness is associated with both chronic pain syndromes and opioid use disorder, further complicating how we care for patients with psychiatric issues. We report a unique case of a de novo and persistent psychotic disorder after complicated opioid withdrawal in a patient without any psychiatric history. The patient developed persistent auditory hallucinations after discontinuation of chronic opioid therapy that responded only to atypical antipsychotic (olanzapine) treatment. This case illustrates the neuropsychiatric effects of chronic opioid exposure, as well as layered clinical management dimensions related to opioid detoxification and psychosis treatment. Long-term opioid therapy may have lasting neuropsychiatric effects, including playing a role in the development and/or expression of psychotic disorders. Here we review the limited literature on the effects of opioids on psychosis. This complex case also demonstrates a clinical approach for effectively co-managing psychiatric symptoms in the context of chronic pain and chronic opioid therapy.

A Structured Peer Assessment Method with Regular Reinforcement Promotes Longitudinal Self-Perceived Development of Medical Students' Feedback Skills.

BACKGROUND: Given that training is integral to providing constructive peer feedback, we examined the impact of a regularly reinforced, structured peer assessment method on student-reported feedback abilities throughout a two-year preclinical Communication Skills course. METHODS: Three consecutive 32-student medical school classes were introduced to the Observation-Reaction-Feedback method for providing verbal assessment during Year 1 Communication Skills orientation. In biweekly small-group sessions, students received worksheets reiterating the method and practiced giving verbal feedback to peers. Periodic questionnaires evaluated student perceptions of feedback delivery and the Observation-Reaction-Feedback method. RESULTS: Biweekly reinforcement of the Observation-Reaction-Feedback method encouraged its uptake, which correlated with reports of more constructive, specific feedback. Compared to non-users, students who used the method noted greater improvement in comfort with assessing peers in Year 1 and continued growth of feedback abilities in Year 2. Comfort with providing modifying feedback and verbal feedback increased over the two-year course, while comfort with providing reinforcing feedback and written feedback remained similarly high. Concurrently, student preference for feedback anonymity decreased. CONCLUSIONS: Regular reinforcement of a peer assessment framework can increase student usage of the method, which promotes the expansion of self-reported peer feedback skills over time. These findings support investigation of analogous strategies in other medical education settings. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01242-w.

Investigations of blood ammonia analysis: Test matrices, storage, and stability.

An assessment of blood ammonia concentration is common medical practice in the evaluation of an individual with an unexplained mental status change or coma. The determination of a blood ammonia level is most commonly done using a glutamate dehydrogenase (GLDH)-based assay, although there are many potential sources of artifact and the literature is inconsistent regarding key preanalytic issues. Using a GLDH-based assay, we first investigated matrix effects using three anticoagulants: heparin, EDTA and oxalate. Heparin-anticoagulated plasma was substantially less precise than EDTA- and oxalate-anticoagulated plasma. Oxalate-anticoagulated plasma showed a greater baseline of apparent ammonia than either heparin- or EDTA-derived plasma, presumably due to interferants. We then evaluated the stability of EDTA-anticoagulated plasma for assessment of ammonia when stored at 4°C,-14°C or -70°C. There was a linear increase of ammonia with storage at both 4°C and -14°C. Plasma kept at -70°C for up to three weeks showed no change in measured ammonia relative to the baseline determination. This work clarifies preanalytic conditions for which a precise determination of ammonia can be accomplished using a GLDH-based assay.

Associations Between Posttraumatic Stress Disorder, Emotion Dysregulation, and Alcohol Dependence Symptoms Among Inner City Females.

OBJECTIVE: The purpose of this study was to examine how emotion dysregulation (ED) might help explain the relationship between posttraumatic stress disorder (PTSD) and alcohol dependence (AD) symptoms in females. METHOD: Participants included 260 women from primary, diabetes, and gynecological clinics of an urban public hospital. This is a primarily African American sample (96.9%), including individuals reporting exposure to at least 1 traumatic event. We examined the associations and predictability patterns between severity of PTSD symptoms, ED, and AD symptoms. RESULTS: Using linear regression analyses, PTSD avoidance and numbing symptoms and ED were significant predictors of AD symptoms. When looking at specific dimensions of ED, one's inability to engage in goal-directed behavior under strong emotional influences showed a full indirect effect on the relationship between PTSD avoidance and numbing symptoms and AD symptoms. CONCLUSION: Our findings suggest that having poor emotion regulation skills may help explain why females with PTSD become dependent on alcohol.