A novel behavioral health program for family caregivers of children admitted to a transitional chronic ventilator unit.

BACKGROUND: The care of mechanically ventilated pediatric patients is complex and burdensome. It is essential to adequately support the family caregivers of these children to optimize outcomes; however, there is no literature describing interventions for caregivers in this population. RESEARCH QUESTION: This study described a novel behavioral health program and examined its impact on family caregiver engagement and psychological distress on a pediatric inpatient chronic ventilator unit. STUDY DESIGN AND METHODS: Electronic chart review was completed with retrospective and prospective participant enrollment for the purposes of longitudinal evaluation of caregiver engagement. For analytic purposes, participants were grouped into three categories: (1) preprogram, (2) postprogram, and (3) postprogram with completion of psychotherapy. RESULTS: The behavioral health program was associated with increased caregiver participation in rounds, t = 7.76, p = < .001. Parents who completed a course of psychotherapy within the behavioral health program demonstrated reduced time to training completion (F = 5.89; p < .01), higher staff-rated caregiver engagement (F = 3.69; p < .05), and significantly reduced levels of caregiver distress (t = 2.09; p < .05).

Are We Speaking the Same Language? Communicating Diagnostic Probability in the Radiology Report.

OBJECTIVE. The purpose of this study was to evaluate the level of agreement in diagnostic probability for selected phrases among radiologists and emergency medicine (EM) physicians. MATERIALS AND METHODS. A survey was distributed to the radiologists and EM physicians at our academic institution. Respondents selected the degree of diagnostic probability they believe was conveyed by 18 commonly used phrases chosen from studies in the radiology literature. Potential responses for the degree of diagnostic probability were < 10%, ≈ 25%, ≈ 50%, ≈ 75%, and > 90%. RESULTS. Seventy-eight percent (28/36) of EM residents and 56% (14/25) of EM attending physicians (combined fellows and attending physicians) completed the survey; 83% (15/18) of radiology residents and 81% (17/21) of radiology attending physicians completed the survey. There was a high degree of shared understanding for most phrases between the departments except for the phrase "compatible with," which was associated with a higher degree of diagnostic probability by radiologists than by EM physicians (p = .02). Although no term was significantly more specific than any other within the ≈ 50% category or below, "most likely" and "diagnostic of" were significantly more specific than other terms in the ≈ 75% and > 90% categories, respectively. CONCLUSION. The results of this study show a high degree of shared understanding between radiologists and EM physicians for most of the phrases (17/18) in the survey. The only phrase that showed a significant difference was "compatible with." These results can be used to generate diagnostic probability groups with suggested phrases that can be used when creating radiology reports, thereby improving communication with the emergency department.

FAST Performance in a Stationary versus In-Motion Military Ambulance Utilizing Handheld Ultrasound: A Randomized Controlled Study.

OBJECTIVE: On-scene prehospital conditions and patient instability may warrant a during-transport ultrasound (US) exam. The objective of this study was to assess the effect of ambulance turbulence on the performance of the Focused Assessment with Sonography in Trauma (FAST) with a handheld US device. METHODS: This was a randomized controlled trial in which participants were randomized to perform a FAST in either a stationary or an in-motion military ambulance. Participants were physicians and physician assistants (PAs) with previous FAST training. All exams were performed on an US phantom model. The primary outcome was FAST completion time, reported as a mean, in seconds. Secondary outcomes included image acquisition score (range of 0-24, reported as a mean), diagnostic accuracy (reported as sensitivity and specificity), and a post-participation survey with five-item Likert-type scales. RESULTS: Twenty-seven participants performed 27 FASTs, 14 in the stationary ambulance and 13 in the in-motion ambulance. All participants obtained the four requisite views of the FAST. A significant difference was detected in image acquisition scores in favor of the stationary ambulance group (19.4 versus 16.7 [95% CI for difference, 0.9-4.4]; P <.01). Significant differences in survey items between groups were related to obtaining and maintaining US images and the exam conditions. There was not a difference in FAST completion time between groups (98.5 seconds versus 78.7 seconds [95% CI for difference, -13.5 seconds to 53.1 seconds]; P = .23). Sensitivity and specificity of FAST in the stationary ambulance was 85.7% (95% CI, 67.3%-96.0%) and 96.4% (95% CI, 81.7%-99.9%) versus 96.2% (95% CI, 80.4%-99.9%) and 100.0% (95% CI, 86.8%-100.0%) in the in-motion ambulance group (P = .21). CONCLUSION: Vehicular motion did not affect FAST completion time and diagnostic accuracy; however, it did reduce FAST image acquisition scores. The results suggest timely and diagnostically accurate FASTs may be completed by experienced sonographers during moderate levels of ambulance turbulence. Further investigation assessing the utility and limitations of newer handheld US devices in various prehospital conditions is warranted.

Hospital-based, Multidisciplinary, youth mentoring and medical exposure program positively influences and reinforces health care career choice: "The Reach One Each One Program early Experience".

BACKGROUND: According to the National Center for Educational Statistics, underrepresented minorities (URMs) are more likely to leave science, technology, engineering and mathematics (STEM) fields at higher rates than their peers during undergraduate studies. Many institutions of higher learning have implemented pipeline programs aimed at preparing and inspiring high school and college aged students in select careers in health sciences with varying levels of success. Research has shown that a health care workforce that mirrors the community they serve is more effective in reducing health disparities and increasing positive health outcomes. We hypothesize that a hospital-based, multidisciplinary youth mentoring and medical exposure program will enhance the decision of URM high school students to choose healthcare careers. MATERIALS AND METHOD: A retrospective analysis of the Reach One Each One Program (ROEO) was performed. ROEO is a hospital based, 11-week multidisciplinary youth mentoring and medical exposure program for inner-city high school students. The analysis was based on a phone survey of the twenty-six (26) seniors who completed the program and subsequently graduated from high school between May 2013 and May 2015 to assess the following: 1) College enrollment/attendance, 2) Health profession majors, and 3) Pre-med status. The study was approved by the Morehouse School of Medicine Institutional Review Board. RESULTS: Of the twenty-six students, 23 were female and 3 were male; 25 (96%) of the students were African American and one student was a Caucasian female. Twenty-four (92.3%) of the students were enrolled in college and 2 (7.7%) were scheduled to begin in the spring semester of 2016. Twenty-one of the 24 attending college at the time of the survey (87.5%) were enrolled in a health science degree program and 16 (66.7%) confirmed that they were enrolled in pre-medical (Pre-med) curriculum. CONCLUSION: Hospital-based, multidisciplinary medical mentoring programs can have a positive impact on the lives and health care career decisions of aspiring URM high school students. Further study will be necessary to validate the most influential components needed for the success of such programs.

No evidence for genetic association of interferon regulatory factor 1 in juvenile idiopathic arthritis.

OBJECTIVE: Juvenile idiopathic arthritis (JIA) comprises several clinically distinct subgroups and is the most widespread cause of chronic childhood disability. A significant association between JIA and a polymorphism in the interferon regulatory factor 1 (IRF-1) gene has previously been reported, implicating IRF1 in disease susceptibility. The aim of this study was to replicate the IRF1 association in JIA using single-marker and haplotype analyses in a case-control study, using control subjects different from those in the previous study and a larger cohort of patients (n = 765). METHODS: DNA from 765 patients with JIA and 508 unaffected control subjects was genotyped for 4 single-nucleotide polymorphisms in the IRF-1 gene. Association of genotypes at the IRF1 loci was assessed using single-marker and haplotype analyses. RESULTS: No significant differences in genotype frequency or allele frequency were observed between patients and control subjects. CONCLUSION: This replication study used a much larger patient cohort to examine the association of IRF1 in JIA. However, despite the increased statistical power, we observed no significant association for IRF1 markers, either individually or as haplotypes. It is therefore unlikely that this gene is involved in JIA susceptibility.

Novel IL10 gene family associations with systemic juvenile idiopathic arthritis.

Juvenile idiopathic arthritis (JIA) is the most common cause of chronic childhood disability and encompasses a number of disease subgroups. In this study we have focused on systemic JIA (sJIA), which accounts for approximately 11% of UK JIA cases. This study reports the investigation of three members of the IL10 gene family as candidate susceptibility loci in children with sJIA. DNA from 473 unaffected controls and 172 patients with sJIA was genotyped for a single nucleotide polymorphism (SNP) in IL19 and IL20 and two SNPs in IL10. We examined evidence for association of the four SNPs by single marker and haplotype analysis. Significant differences in allele frequency were observed between cases and controls, for both IL10-1082 (p = 0.031) and IL20-468 (p = 0.028). Furthermore, examination of the haplotypes of IL10-1082 and IL20-468 revealed greater evidence for association (global p = 0.0006). This study demonstrates a significant increased prevalence of the low expressing IL10-1082 genotype in patients with sJIA. In addition, we show a separate association with an IL20 polymorphism, and the IL10-1082A/IL20-468T haplotype. The two marker 'A-T' haplotype confers an odds ratio of 2.24 for sJIA. This positive association suggests an important role for these cytokines in sJIA pathogenesis.

Explaining comfort with homosexuality in rural america.

While recent research has explored the determinants of homophobia in urban settings, few have looked at the perception of homosexuals in rural communities. This research fills this gap by exploring the ways in which Central Appalachians feel about homosexuality. In doing so, the impact of interpersonal contact with a homosexual as well as the factors of gender, age, religious beliefs, gender role prescriptions and fear of AIDS are identified through a multivariate analysis of 123 college students. In the end, the role of homosexual peers is emphasized, as are the effects of the perceived cause of homosexuality, and the anxieties over AIDS. Finally after some stipulations about methodological limitations, this work offers some suggestions as to how practitioners and social work educators can use this study to counter the homophobic ideas that are prevalent in rural Americans.

The use of head computed tomography in elderly patients sustaining minor head trauma.

The study objectives were to ascertain historical and clinical criteria differentiating intracranial injury (ICI) in elderly patients with minor head trauma (MHT), and determine applicability of current head computed tomography (CT) scan indications in this population. A 12-month retrospective chart review was performed at a community teaching hospital with 34,000 annual Emergency Department (ED) visits. Included were patients > or = 65 years old sustaining MHT with a Glasgow Coma Scale (GCS) score of 13-15 who had a CT scan performed during their hospital stay. Data included: injury mechanism, symptoms, signs, GCS, anticoagulation use or studies, presence of alcohol or drug, CT scan result, diagnosis, and outcome and intervention(s). There were 133 patients, with 19 (14.3%) suffering ICI. Four ICI patients required neurosurgical intervention. The mean age was 80.4 years and 66% were female. Four of 19 ICI patients (21%) had a GCS of 15, no neurologic symptoms, alcohol use or anticoagulation. Only 1 of 13 signs and symptoms correlated with ICI. In this study, no useful clinical predictors of intracranial injury in elderly patients with MHT were found. Current protocols based on clinical findings may miss 30% of elderly ICI patients. Head CT scan is recommended on all elderly patients with MHT.