Reducing the Time to Action on Bilirubin Results Overnight in a Newborn Nursery.

Introduction: Infants commonly require phototherapy in the nursery to prevent kernicterus, but it can interfere with parent-infant bonding. Minimizing unnecessary phototherapy is important. We noticed frequent delays in initiating and discontinuing phototherapy at our hospital. Our primary aim was to start or stop phototherapy within 3 hours of the intended blood draw time for more than 80% of patients by August 2022. Our secondary aims were to have the bilirubin result available within two hours of the intended draw time and for the result to be actioned upon within 1 hour of becoming available. Methods: We audited all patients requiring phototherapy, from January 2021 to December 2021 (n = 250). In PDSA cycle 1, we used electronic medical record result alerts. In cycle 2, we educated residents on the importance of acting promptly on results. In cycle 3, we asked residents to message the nurse to alert them to any laboratory draws for that shift. In cycle 4, we implemented a standardized laboratory draw policy. Results: We increased the percentage of results acted upon within 3 hours from 56% to more than 80%. We also reduced the mean time from blood draw to action from 184 minutes to 134 minutes. The time from intended draw to result availability decreased from 115 minutes to 95 minutes, and the time to action decreased from 67 minutes to 42 minutes. Conclusions: Combining resident education, electronic medical record result alerts, and policy standardization allowed us to achieve our stated aim and improved care for our neonates.

Interventions to increase colorectal cancer screening adherence in low-income settings within the United States: A systematic review and meta-analysis.

The USPS Task Force recommends screening for colorectal cancer (CRC) in adults aged 45-75. Screening rates are low in underserved populations. We conducted a systematic review of interventions to increase CRC screening adherence in low-income settings in US. We included randomized control trials of CRC screening interventions conducted in low-income settings in the US. Outcome was CRC screening adherence. Random-effects meta-analysis of relative risks was conducted for the effectiveness of CRC screening interventions. We identified 46 studies that met inclusion criteria. Interventions were grouped into four categories: mailed outreach, patient navigation, patient education, and types of reminders. Mailed outreach with enclosed fecal immunohistochemical test (FIT) (RR 2.20, 95% CI 1.74, 2.78), guaiac based fecal occult blood test (gFOBT) (RR 4.34, 95% CI 1.29, 14.67), and without FIT/gFOBT (RR 1.80, 95% CI 1.15, 2.82) all significantly increased CRC screening, as did non-individualized education (RR 1.44, 95% CI 1.07, 1.94) and patient navigation (RR 1.62, 95% CI 1.29, 2.02). Mailed outreach with an incentive (RR 0.97, 95% CI 0.81, 1.16) and individualized education (RR 1.07, 95% CI 0.83, 1.38) did not significantly improve screening adherence. Telephone reminders are slightly more effective than reminder letters (RR 1.16, 95% CI 1.02, 1.33), but there is no difference between personal or automated phone calls (RR 1.17, 95% CI 0.74, 1.84). Mailed outreach and patient navigation are the most effective strategies to improve colorectal cancer screening in low-income populations. There was significant heterogeneity between studies, likely due to differences in intervention design, screening tests, and follow-up.

Multivalvular Endocarditis With Abscess: A Wild Goose Chase.

We report a case of Streptococcus mutans multivalvular infective endocarditis complicated by aortic root abscess and septic emboli in a 19-year-old male with a bicuspid aortic valve. This case illustrates the progression of untreated subacute bacterial endocarditis and highlights the importance of ongoing clinical suspicion for infective endocarditis in patients with underlying valvular defects.

Disrupting Bordetella Immunosuppression Reveals a Role for Eosinophils in Coordinating the Adaptive Immune Response in the Respiratory Tract.

Recent findings revealed pivotal roles for eosinophils in protection against parasitic and viral infections, as well as modulation of adaptive immune responses in the gastric mucosa. However, the known effects of eosinophils within the respiratory tract remain predominantly pathological, associated with allergy and asthma. Simulating natural respiratory infections in mice, we examined how efficient and well-adapted pathogens can block eosinophil functions that contribute to the immune response. Bordetella bronchiseptica, a natural pathogen of the mouse, uses the sigma factor btrS to regulate expression of mechanisms that interfere with eosinophil recruitment and function. When btrS is disrupted, immunomodulators are dysregulated, and eosinophils are recruited to the lungs, suggesting they may contribute to much more efficient generation of adaptive immunity induced by this mutant. Eosinophil-deficient mice failed to produce pro-inflammatory cytokines, to recruit lymphocytes, to organize lymphoid aggregates that resemble Bronchus Associated Lymphoid Tissue (BALT), to generate an effective antibody response, and to clear bacterial infection from the respiratory tract. Importantly, the failure of eosinophil-deficient mice to produce these lymphoid aggregates indicates that eosinophils can mediate the generation of an effective lymphoid response in the lungs. These data demonstrate that efficient respiratory pathogens can block eosinophil recruitment, to inhibit the generation of robust adaptive immune responses. They also suggest that some post-infection sequelae involving eosinophils, such as allergy and asthma, might be a consequence of bacterial mechanisms that manipulate their accumulation and/or function within the respiratory tract.