Search

Women are a growing portion of the U.S. veteran population, and every year the Veterans Health Administration (VHA) serves an increasing number of women seeking obstetrics services. Women veterans experience elevated rates of anxiety, depression, posttraumatic stress disorder (PTSD), and traumatic events, including military sexual trauma, as compared with women in the general population. It is possible that mental health disorders may be associated with birth experiences. We investigated the link between anxiety, depression, PTSD, and military sexual trauma (MST; i.e., rape and sexual harassment) with perceived birth experience (i.e., Negative or Neutral vs. Positive). Participants included 1,005 veterans who had recently given birth and were enrolled in the multisite, mixed methods study known as the Center for Maternal and Infant Outcomes Research in Translation study (COMFORT). Using χ2 tests, we investigated the relationship between mental health conditions including anxiety, depression, and PTSD and MST with birth experience (coded as Negative/Neutral vs. Positive). Findings indicated that participants who endorsed PTSD (39.5%), MST-rape (32.1%), or MST-harassment (51.4%; all p <.05) were significantly more likely to report a Negative/Neutral birth experience (14.7%) versus a Positive birth experience (85.3%). Anxiety and depression were not associated with birth experience. Veterans with PTSD and/or who experienced MST were more likely to report a negative or neutral birth experience. Thus, screening for PTSD and MST during obstetrics services as well as providing trauma-informed obstetrics care during pregnancy, labor, birth, and recovery may be important among veterans seeking obstetric services. [ABSTRACT FROM AUTHOR]

The recognition of social determinants as major drivers of health outcomes has important implications for health care providers, including pharmacists. It is therefore imperative that providers have the requisite knowledge, skills, and attitudes to adequately address the contributions of social determinants of health (SDOH) alongside the impact of medical care on health and treatment outcomes. Case-based learning is a common practice in pharmacy education. Patient cases used in pharmacotherapy courses typically highlight clinical parameters and quantitative indices, often to the exclusion of sociocultural contexts. In actual practice, pharmacists (and other health care providers) must consider both clinical information and the context of SDOH in order to deliver responsive and effective patient care. The aim of the project was to build patient cases that reflect both aspects. The intent is to use these cases in the core pharmacy curriculum to teach students how to concurrently consider both clinical and social elements in patient care. Eleven pharmacists and educators participated in three work groups to develop 10 cases for pharmacotherapy courses in cardiovascular disease, diabetes management, and mental health. Two of the cases were facilitated with fourth year students on advanced pharmacy practice experiences. Feedback from case developers and students highlights features of the cases that lend them to utility in the pharmacy curriculum. The integration of SDOH in patient cases provides opportunity for students to build the relevant competencies that will enable them to provide holistic patient care. [ABSTRACT FROM AUTHOR]

A pediatric ED program sought to promote injury prevention through distribution of child restraint systems. Program funds are paid for child passenger safety technician certification of all personnel. Pediatric emergency nurses distributed child restraint systems at hospital discharge and dedicated technicians at fitting stations. Researchers described program characteristics, developed a baseline understanding of program outreach using geographic information systems, and evaluated adherence to manufacturer guidelines with a sensitivity analysis. This retrospective cross-sectional study used distribution forms linked to hospital records from 2013 to 2016. Testing for differences used nonparametric methods. Median values and interquartile ranges for weight and height of children were compared with manufacturer guidelines. Geographic information systems visualized recipients' street addresses and motor vehicle crashes on an underlying base map. There were 312 child restraint systems distributed: of which 179 (57.4%) at the hospital, 126 (40.4%) at fitting stations, and 7 (2.2%) missing a location. Among those on Medicaid, 64.4% received a child restraint system at the hospital compared with 35.6% at fitting stations (χ2 = 5.40, P <.02). Fitting stations had limited outreach to rural residents. Finally, results from the sensitivity analysis showed that devices were issued according to manufacturer guidelines. Despite the workplace pressures of clinical care, pediatric emergency nurses delivered educational information and demonstrated hands-on installation at similar rates to dedicated technicians. Distribution of child restraint systems through the hospital reached a uniquely underserved population. Further research should investigate methods to improve fitting station outreach among Medicaid recipients. [Display omitted] [ABSTRACT FROM AUTHOR]

• Simulation increased clinician support for family presence during resuscitation. • Simulation increased clinician knowledge about family presence during resuscitation. • Unclear how simulated family presence impacts technical performance of resuscitation. • Simulation can be used to evaluate outcomes of family presence during resuscitation. Family presence during resuscitation (FPDR) remains recommended, yet controversial, clinical practice. Simulation-based experiences (SBEs) may offer a strategy to address barriers to offering FPDR and to improve outcomes. This systematic review aimed to describe outcomes of SBEs related to FPDR and to provide recommendations for future work. Following PRISMA guidelines, 17 articles were evaluated for both simulation and methodologic rigor. Modalities included high-fidelity manikins, simulated participants, and case-based learning. Outcomes examined were: (a) clinician competencies, (b) practice changes, and (c) strategic resource development. Study limitations included bias due to small samples, short-term evaluation, inconsistent simulation rigor, and minimal stakeholder (family) involvement. Evidence suggests positive effects of SBEs on clinicians' knowledge and affective competencies, practice changes, and resource development. Inconsistent effects on clinicians' technical performance competencies were noted. Increased simulation rigor is needed to replicate this phenomenon. Further, increased study rigor is needed to determine long-term effects on clinician competencies and practice changes. Well-designed SBEs may be strategically used in practice, education, and research settings to address barriers to offering FPDR and to improve outcomes. [ABSTRACT FROM AUTHOR]

COVID-19 emerged in 2019 and has since killed more than two and a half million people worldwide. Several studies have investigated the role of COVID-19 on the prevalence of mental health outcomes, with general findings indicating elevated rates of mental health issues as compared to the pre-COVID-19 era. However, the effect of specific demographic features is less clear. As such, we investigated whether anxiety, depressive, and eating pathology symptoms varied by gender, age, status as a medical provider (compared to the general public), race, or region of origin. Forty-three effect sizes from 36 studies indicated that all three symptoms increased from pre- to peri‑COVID-19-eras across all regions. No symptom varied by age, status as a medical provider, or race, though females were significantly more likely to experience eating pathology than males. Findings from our study indicate that worldwide, regardless of age, status as a medical provider, race, or region of origin, respondents experienced significantly elevated rates of psychopathology symptoms during the onset of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Recommendations on clinic-administered medications to stock in an urban family medicine clinic and how to manage an outpatient formulary are not well defined in the literature. Although there are numerous hypothesized incentives for a standardized medication inventory, the financial impact at the level of a single clinic is unknown.Objectives: The purpose of this project was to develop clinic-administered medication inventory recommendations for urban family medicine clinics and to determine the financial impact of standardization at a single clinic.Methods: The current clinic-administered medication inventory was assessed using the following prespecified criteria: (1) clinic administration is required for successful patient outcomes, (2) use of the medication for intended indication is evidence-based, (3) appropriately trained staff and equipment are available to administer and monitor the medication, (4) most cost-effective dosage form of the medication is stocked in the clinic, and (5) quantity and location of medication stocked in the clinic match need. Changes to the medication inventory were made effective on August 1, 2018, based on physician group consensus. Monthly clinic medication cost during the study period was analyzed before and after intervention.Results: A total of 80 medications were identified; 45 medications remained after changes according to the prespecified criteria. The monthly cost of maintaining the inventory during the study period was $1947 preintervention compared with $1048 postintervention. The estimated average monthly cost savings of a standardized inventory in a single, urban family medicine clinic is $900, or $10,800 annually.Conclusion: Standardizing a clinic-administered medication inventory in an urban family medicine clinic can help reduce unnecessary cost. [ABSTRACT FROM AUTHOR]

Objective: The objective of this quality improvement project was to design and implement a systematic team-based care approach to medication reconciliation, with a goal of physician-documented medication reconciliation at 70% of all patient office visits.Setting: Ambulatory clinics located in urban, underserved communities in Minneapolis and St. Paul, MN.Practice Description: Four family medicine residency clinics, with pharmacists integrated at each site. All clinics use the Epic electronic medical record (Epic Systems Corporation).Practice Innovation: A team-based care approach to medication reconciliation was designed and implemented involving medical assistants (MAs), physicians, and pharmacists. The MAs did an initial review with patients, the physicians addressed discrepancies, and difficult situations were escalated to the pharmacist for a detailed assessment.Evaluation: The percentage of visits with physician-documented medication reconciliation was measured preintervention and then for 18 months postintervention in 6-month intervals involving more than 118,000 patient visits. Satisfaction surveys of team members were done pre- and postintervention.Results: The percentage of visits with physician-documented medication reconciliation improved significantly from 6.5% preintervention to 58.7% (P < 0.001) postintervention, and was sustained and further improved to 70.3% (P < 0.001) 1 year later. The team members had a statistically significant improvement in their ability to articulate the medication reconciliation process. Satisfaction improved significantly for physicians, but MAs did not experience a statistically significant change.Conclusion: A team-based care approach to medication reconciliation was successfully implemented and sustained at 4 family medicine clinics. There was significant improvement in physician-documented medication reconciliation. Future studies need to address whether this process improves medication-list discrepancies, completeness, and accuracy. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the preliminary efficacy, feasibility, and acceptability of a template-based intervention to facilitate shared decision making (SDM) in medication therapy management (MTM) consultations; and to examine the type and number of drug therapy problems (DTPs) discussed and how resolution was communicated to patients' primary care providers (PCPs).Setting: An internal medicine clinic at a large safety-net hospital.Practice Description: Hennepin County Medical Center is an urban safety net hospital serving an ethnically-diverse population with about 50 percent of patients enrolled in Medicaid. Within its internal medicine clinic, the study setting, over 100 clinicians participate in the primary care of approximately 25,000 discrete patients.Practice Innovation: This is the first study to use a template format to facilitate SDM with pharmacists in MTM consultations. The template approach is more flexible than the use of decision aids, facilitating discussion around various issues.Interventions: Patients completed template-guided interventions with pharmacists trained in SDM.Evaluation: We analyzed the electronic health record used during the intervention, as well as post-appointment surveys administered to patients and pharmacists, for indications of SDM efficacy, feasibility, and acceptability.Results: Twenty patients and four pharmacists participated in the study. Free-text comments demonstrated that both patients and pharmacists appreciated the intervention, although some pharmacists had concerns including consultation length and SDM applicability. On average, two DTPs were identified per consultation and were most commonly related to appropriate compliance (30% of DTPs), appropriate indication (26%), medication effectiveness (23%), and safety (21%).Conclusion: Using a template to facilitate SDM within MTM consultations appears to be effective, feasible, and acceptable. DTP identification exemplifies a potential application of template-guided SDM. These results will be used to inform future work refining the intervention and developing robust comparative analyses. [ABSTRACT FROM AUTHOR]

Suicide is the second leading cause of death in adolescents; a frequent precursor of suicide is suicidal ideation (SI). Literature indicates that Post-Traumatic Stress Disorder (PTSD) and SI are robust cross-sectional correlates of one another, with PTSD often being conceptualized as a risk factor (i.e., conferring risk) for SI. Indeed, PTSD is a well-established risk factor for SI; however, SI is an understudied risk factor for PTSD. It is possible that, yet unknown if, PTSD and SI promote each other over time in a bidirectional fashion. We investigated the bidirectional longitudinal associations between PTSD and SI in a large, diverse sample, who at baseline were adolescents. Participants were interviewed between 1995 and 1998 and again between 2004 and 2008. We hypothesized that PTSD and SI would be cross-sectionally, longitudinally, and bidirectionally related and that the number of traumas endorsed at baseline would be positively associated with PTSD and SI at baseline and follow-up. Indeed, PTSD and SI were cross-sectionally correlated at baseline, but not follow-up. PTSD predicted SI over nine years; however, SI during adolescence did not predict PTSD in adulthood. Finally, poly-trauma endorsed at baseline was associated with increased risk of SI, but not PTSD, over nine years. • PTSD and suicidal ideation were cross-sectionally related during adolescence. • PTSD and suicidal ideation were not cross-sectionally related during adulthood. • PTSD predicted suicidal ideation over the nine year follow-up period. • Suicidal ideation did not predict suicidal ideation over the nine-year follow-up. [ABSTRACT FROM AUTHOR]