Cognitive Symptom Awareness Among Patients With Multiple Sclerosis Using a Mobile Application.

PURPOSE: Cognitive impairment is a common complication in persons with multiple sclerosis (MS). Using a mobile application has been shown to improve patient's awareness of cognitive symptoms. The purpose of this quality improvement project was to improve awareness of cognitive symptoms in adult patients with MS using a mobile application. DESIGN: A pre/post-implementation quality improvement design was used. METHODS: Patients were instructed to download the application MS Care Connect. Patients completed a pre/post-questionnaire regarding their awareness of cognitive symptoms and if they were likely to discuss symptoms with providers. They were instructed to use the application to rate the severity of their cognitive symptoms at least weekly. RESULTS: Thirty-two patients completed both pre- and post-implementation questionnaires. No significant change in awareness of cognitive symptoms was found; however, patients were more likely to discuss cognitive changes with their healthcare team. In the 18 patients who used the application, a total of 60 cognitive symptom ratings were reported. CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING: Nurses may recommend use of a mobile application for patients to track their cognitive symptoms; however, further research is needed. CONCLUSION: This project showed that adding a mobile application did not change awareness of patients' cognitive symptoms.

Supplementation-based hypoglycemia guidelines including donor breast milk reduce NICU admission.

OBJECTIVE: To study the effects of a supplementation-based hypoglycemia guideline including donor (DM) on NICU admission, exclusive breastfeeding, and blood glucose concentrations in infants at-risk for neonatal hypoglycemia (NH). PROJECT DESIGN: We integrated DM, feeding supplementation, and reduced frequency of blood glucose testing into an NH bundle for term and late-preterm newborns. We then examined NICU admission rates and rates of exclusive breastfeeding at discharge. RESULTS: NICU admission rates were reduced to 6% (-10%). Exclusive breastfeeding rates increased to 55% (+22%). Median cost of DM utilization was $13.73 per patient with an average volume of 50.8 ml/infant. DM supplementation resulted in similar times to last hypoglycemic episode and greater increases in blood glucose compared to expressed breast milk or breastfeeding alone (+9.6 mg/dL, p < 0.05). CONCLUSIONS: A supplementation-based hypoglycemia guideline including donor milk may be an effective way to reduce NICU admissions for asymptomatic hypoglycemia and support mothers in achieving breastfeeding goals.

Using Skin-to-Skin Contact to Increase Exclusive Breastfeeding at a Military Medical Center.

Evidence shows that early formula supplementation leads to early weaning from exclusive breastfeeding. We implemented an evidence-based practice project on skin-to-skin contact (SSC) for healthy term newborns at a large military treatment facility in an effort to decrease formula supplementation in the early postpartum period. Military women face unique challenges when it comes to breastfeeding. SSC in the early postpartum period is an effective intervention to increase exclusive breastfeeding during the hospital stay and foster future positive breastfeeding outcomes. Through this project, staff knowledge of the benefits of SSC to women and newborns improved and the hospital's exclusive breastfeeding rate increased by 20 percent.