Rabies post-exposure prophylaxis in the emergency department.

STUDY OBJECTIVES: Rabies is a zoonotic single-stranded RNA lyssavirus that can cause acute infections of the central nervous system (CNS) including encephalomyelitis, encephalitis, and meningoencephalitis that is progressively fatal. Rabies is more common in developing countries, but approximately 23,000 people in the United States (US) are estimated to have been exposed or to have received post exposure prophylaxis (PEP) yearly. Nebraska Medicine follows the Advisory Committee on Immunization Practices (ACIP) guidelines for the vaccination series, as well as the 20 units/kg administration of immunoglobulin (RIG). Nebraska Medicine Medical Center (NMC) and Bellevue Medical Center (BMC) treat the scheduling of the complete rabies vaccine series differently. At both campuses, patients receive their immunoglobulin and first vaccine in the Emergency Department (ED). At NMC, patients are scheduled to receive the remainder of their vaccination series at the outpatient infusion center by the ED pharmacist. At BMC, the subsequent vaccinations are given as "Nurse Only" return visits to the ED. The objective of this study was to compare patient compliance of two different processes for follow-up rabies vaccine series completion. This project's primary aim was to determine the rate of patient compliance for follow up rabies vaccine doses. The secondary aims of this project were to determine if there was a difference in patient follow-up compliance between the two campuses, patient specific factors that impact compliance, and potential cost savings if a dose rounding protocol for RIG was utilized. METHODS: This retrospective chart review was completed as a quality improvement project. Data from patients who had received either rabies immunoglobulin and/or a rabies vaccine, were >18 years of age, and were not admitted were collected for a 3-year period from July 1, 2019, to June 30, 2022. Data were abstracted from the patient's EMR (electronic medical records) using a SQL (Structured query language) query of pre-identified data elements. When unable to abstract with SQL query, data elements were manually abstracted. All data abstracted was collated and descriptive analysis performed. RESULTS: A total of 723 individual encounters were identified during the study period. After combining rabies series for each individual patient, 173 unique patients remained. After exclusions were applied, 143 patients were included: 104 patients from NMC, and 39 from BMC. For the primary outcome, appropriate completion between the two campuses was 78.3%. When comparing the two campuses, completion rates were higher at NMC (82% vs. 69%), although not statistically significant (p = 0.12). Appropriate completion of vaccine series was statistically significant for both payor and exposure type. Application of a dose rounding policy with those >45 kg, rounding to the nearest vial, as well as rounding down if at the midpoint interval, 56 fewer vials would have been used between the two campuses. This would have resulted in a potential cost savings of $57,928.64 over the study period.

Implementing services for pediatric cystic fibrosis treatment in a community hospital.

PURPOSE: Our community hospital was recently charged with providing care for pediatric people with cystic fibrosis (PwCF). Pediatric PwCF generally need a higher level of care than is required by other pediatric patients cared for at our institution. This project aimed to prepare the pharmacy department to care for this specialized population safely and efficiently. SUMMARY: The implementation process was divided into 3 phases to accomplish the larger purpose. These phases were as follows: (1) creating order sets and protocols; (2) providing staff and clinical pharmacists with training and resources; and (3) creating and managing clinical decision support. The central aspect of preparing inpatient pharmacy staff to care for PwCF was the development of antibiotic dosing protocols and order sets comprised of intravenous and oral antibiotics as well as aminoglycoside and vancomycin pharmacokinetic guides. A pharmacokinetic calculator was created to assist with aminoglycoside dosing and monitoring. During phase 2, pharmacist education modules were created to provide guidance on cystic fibrosis and medications commonly used to treat it. As the newly designed protocols were enacted, education was provided on how to use them. Phase 3 occurred concurrently, as clinical decision support was vital to completing phases 1 and 2. CONCLUSION: The phased approach was imperative to the project's success and kept individual components on track. All parts were completed in just over one year.

Feasibility of Telehealth Occupational Therapy for Behavioral Symptoms of Adults With Dementia: Randomized Controlled Trial.

IMPORTANCE: Supporting community residency of adults with Alzheimer's disease (AD) is a critical public health initiative. Occupational therapy can contribute to this goal. OBJECTIVE: To assess the feasibility of a novel telehealth intervention to support occupational engagement in community-residing people with AD. DESIGN: Single-blind, three-arm, parallel, randomized controlled trial. SETTING: Occupational therapy delivered through telehealth in participants' homes. PARTICIPANTS: People with AD who reside in the community with behavioral symptoms and their care partners (dyads). INTERVENTIONS: (1) HARMONY (Helping older Adults cReate & Manage OccupatioNs successfully), a telehealth intervention that applies principles of individualized guided discovery with environmental cueing for caregivers of persons with AD to promote activity participation and manage behavioral symptoms; (2) standardized training regarding the use of a sensory-based approach in dementia care; and (3) a control, including home safety education and weekly monitoring of behaviors. OUTCOMES AND MEASURES: Feasibility was assessed as the primary outcome measured by completion of at least 75% of the telehealth sessions. Secondary outcomes included change in functional activity performance and neuropsychiatric behavioral symptoms. RESULTS: Twenty-eight dyads participated. The intervention was feasible, with high adherence to weekly visits (M number of visits = 5.4 for HARMONY, 4.9 for standardized training, and 4.6 for control), with high participant retention in the intervention arms. HARMONY demonstrated promise in improving patient performance and behavioral symptoms. CONCLUSIONS AND RELEVANCE: HARMONY is feasibly delivered through telehealth service and has a positive effect on occupational performance and behavioral symptoms of AD. Additional studies are needed to explore effectiveness in a broader population. What This Article Adds: Use of HARMONY for community-residing adults with AD is feasible and has promise for improving functional activity performance and behavioral symptoms, as well as caregiver satisfaction.

What referring clinicians value most: Accuracy of radiology results and personal interactions with radiologists.

PURPOSE: We sought to identify which aspects of the referring clinician experience are most strongly correlated with overall satisfaction, and hence of greatest relevant importance to referring clinicians. METHODS: A survey instrument assessing referring clinician satisfaction throughout 11 domains of the radiology process map was distributed 2720 clinicians. The survey contained sections assessing each process map domain, with each section including a question about satisfaction overall in that domain and multiple more granular questions. The final question on the survey was overall satisfaction with the department. Univariate logistic regression and multivariate logistic regression were performed to assess the association between individual survey questions and overall satisfaction with the department. RESULTS: 729 referring clinicians (27%) completed the survey. Using univariate logistic regression nearly every question was associated with overall satisfaction. Amongst the 11 domains of the radiology process map multivariate logistic regression identified the following as mostly strongly associated with overall satisfaction: results/reporting overall (odds ratio 4.71; 95% confidence interval 2.15-10.23), section with which work most closely overall (3.39; 1.28-8.64), and inpatient radiology overall (2.39; 1.08-5.08). Other survey questions associated with overall satisfaction on multivariate logistic regression were attending radiologist interactions (odds ratio 3.71; 95% confidence interval 1.54-8.69), timeliness of inpatient radiology results (2.91; 1.01-8.09), technologist interactions (2.15; 0.99-4.40), appointment availability for urgent outpatient studies (2.01; 1.08-3.64), and guidance for selecting correct imaging study (1.88; 1.04-3.34). CONCLUSION: Referring clinicians value most the accuracy of the radiology report and their interactions with attending radiologists, particularly within the section they work most closely.

The Effectiveness of Small-group Community-based Information Sessions on Clinical Trial Recruitment for Secondary Prevention of Alzheimer's Disease.

Effective and practical recruitment strategies are needed to ensure successful recruitment into the Alzheimer disease clinical trials. To facilitate successful recruitment for the NIH-sponsored A4 (Anti-Amyloid treatment in Asymptomatic Alzheimer's disease, NCT02008357) trial for the secondary prevention of Alzheimer disease, we developed a small-group community information session to attract and recruit potential research participants. After a successful media campaign, 213 participants were screened through telephone for eligibility, identifying 127 potential participants. Participants were given the option of a traditional one-on-one recruitment session or a small-group session. One-on-one recruitment was performed for 15 participants requesting this procedure, and yielded an overall recruitment rate of 67% (n=10). Substantially more individuals (n=112, 88%) requested small-group sessions to learn about the study. After attending the small-group informational sessions, 98% of potential participants self-reported a greater understanding of the study; and the recruitment rate from these sessions was 90%. Small-group sessions not only improved recruitment success rates, but also contributed to significantly shorter median time for consent processes (20 vs. 60 min) and reduced staff time spent on persons not recruited. Small-group education programs are an effective strategy for enhancing recruitment success and facilitating practical recruitment into clinical trials with high recruitment demands.

Overweight and obesity among children with Down syndrome: a descriptive study of children attending a Down syndrome clinic in South Carolina.

Throughout their lifespan, children with DS have unique issues related to weight management. We must remember that as children with DS grow older, they typically increase their BMI and deviate from the norms of their peers. Thus, from infancy through adolescents primary care physicians must continue to incorporate core principals concerning healthy lifestyles and weight management. In addition, they need to be aware of other health care concerns in these special children.

Coating nanothickness degradable films on nanocrystalline hydroxyapatite particles to improve the bonding strength between nanohydroxyapatite and degradable polymer matrix.

Hydroxyapatite (HA) nanoparticles are similar to bone apatite in size, phase composition, and crystal structure. When compared with micron-size HA particles, nano-HA possesses improved mechanical properties and superior bioactivity for promoting bone growth and regeneration. However, scaffolds fabricated from nano-HA alone cannot meet the mechanical requirements for direct-loading applications. A number of studies suggest that nanostructured composites may offer surface and/or chemical properties of native bone, and therefore represent ideal substrates to support bone regeneration. However, a common problem with nanohydroxyapatite (nano-HA)-polymer composites is the weak binding strength between the nano-HA filler and the polymer matrix since they are two different categories of materials and cannot form covalent bonds between them during the mixing process. Often, the mechanical strength of the composite is compromised due to the phase separation of the HA filler from the polymer matrix during the tissue repair process. To overcome this problem, an ultrathin degradable polymer film was grafted onto the surface of nano-HA using a radio-frequency plasma polymerization technology from acrylic acid monomers. The treated nano-HA powders are expected to bind to the polymer matrix via covalent bonds, thus enhancing the mechanical properties of the resultant composites. High-resolution transmission electron microscopy (HRTEM) experiments showed that an extremely thin polymer film (2 nm) was uniformly deposited on the surfaces of the nanoparticles. The HRTEM results were confirmed by X-ray photoelectron spectroscopy (XPS) and time-of-flight secondary ion mass spectroscopy (TOFSIMS). Tensile tests performed on the specimens revealed that the degradable coating had improved elastic and strength properties when compared with the nondegradable and uncoated controls. XPS and TOSIMS data revealed that more functional carboxyl groups were formed on degradable coatings than cross-linked nondegradable coatings. Cytocompatibility assay demonstrated that both the degradable and nondegradable coatings are cytocompatible.

Proteomics and genomics of microgravity.

Many serious adverse physiological changes occur during spaceflight. In the search for underlying mechanisms and possible new countermeasures, many experimental tools and methods have been developed to study microgravity caused physiological changes, ranging from in vitro bioreactor studies to spaceflight investigations. Recently, genomic and proteomic approaches have gained a lot of attention; after major scientific breakthroughs in the fields of genomics and proteomics, they are now widely accepted and used to understand biological processes. Understanding gene and/or protein expression is the key to unfolding the mechanisms behind microgravity-induced problems and, ultimately, finding effective countermeasures to spaceflight-induced alterations. Significant progress has been made in identifying the genes/proteins responsible for these changes. Although many of these genes and/or proteins were observed to be either upregulated or downregulated, however, no large-scale genomics and proteomics studies have been published so far. This review aims at summarizing the current status of microgravity-related genomics and proteomics studies and stimulating large-scale proteomics and genomics research activities.