Assessment of pre-operative psychosocial function among people receiving left ventricular assist devices: A national survey of US LVAD programs.

BACKGROUND: The International Society for Heart & Lung Transplantation (ISHLT) guidelines for Mechanical Circulatory Support (MCS) includes assessment of four elements of psychosocial functioning prior to Left Ventricular Assist Device (LVAD) implantation. Information about the practices and impact of assessments of psychosocial functioning are limited. OBJECTIVE: To describe the psychosocial function assessment practices used within US LVAD programs and the influence of psychosocial assessment results on clinical decisions for LVAD patient selection. METHODS: In 2017, a cross-sectional survey of LVAD programs listed in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) (N = 164) was conducted to understand practices used for and the influence of psychosocial assessments for post-operative care planning decisions. RESULTS: Respondents included representatives of 69 LVAD programs from throughout the U.S. that implanted 64.8% of all U.S LVADs in 2016. More than 39 psychosocial screening instruments were used. Assessment of family, social and emotional support occurred most frequently (84.1% (n = 58) of programs assessed 100% of patients), but assessment was least likely to be conducted with standardized instruments (36.2%). Cognitive dysfunction was the least likely characteristic to be assessed (26.1% (n = 18) of programs assessed 100% of patients), but was most often conducted with standardized instruments (53.8% of programs). Twenty seven percent of programs used non-standardized instruments or patient observation. The influence of assessments on clinical decisions to implant an LVAD was most influential in the bridge to transplant pathway with 60% (n = 39) of respondents rating it very influential and least influential for patients in the destination therapy pathway with 39.4% (n = 26) of respondents. CONCLUSIONS: Current psychosocial assessment practices in LVAD programs vary widely and often yield non-standardized, non-comparable data that may lead to variations in care and limit generation of an evidence base for decision making regarding psychosocial eligibility for LVAD implantation.

Variation in the Viral Hepatitis and HIV Policies and Practices of Methadone Maintenance Programs.

OBJECTIVE: Patients prescribed methadone maintenance treatment (MMT) demonstrate elevated prevalence of hepatitis B virus (HBV), hepatitis C virus, and HIV. Government agencies recommend testing for these infections in MMT programs, but uptake is limited. METHODS: We audited infection-related policies and practices of all 14 MMT programs in Philadelphia, Pennsylvania, in 2015. Results were tabulated and compared with the results from a 2010 audit of 10 of 12 MMT programs. The audit focused on which patients are tested, timing and frequency, specific tests ordered, vaccination, and communication of test results. RESULTS: Written policies were nonspecific, offering little guidance on appropriate testing. The principal change in policy between 2010 and 2015 involved adding clearer guidance for communication of results to patients. In 2010 and 2015, all MMT programs tested new patients for hepatitis C virus antibodies, although retesting of existing patients varied. HBV testing increased from 2010 to 2015, though it was not uniform, with 5 programs testing for HBV surface antibodies and 10 programs testing for HBV surface antigens. Six programs assessed hepatitis vaccination status, but only 1 administered vaccines. In 2010, city-sponsored HIV antibody testing was available at all MMT programs. Without this program in 2015, few MMT programs conducted HIV testing. CONCLUSIONS: Despite limited hepatitis and HIV screening in MMT programs nationally, this study shows that testing can be incorporated into routine procedures. MMT programs are positioned to play an integral role in the identification of patients with chronic infections, but additional guidance and resources are required to maximize their impact.

Life Course Factors Associated with Initiation and Continuation of Exclusive Breastfeeding.

INTRODUCTION: Exclusive breastfeeding (EBF) benefits the life course health development of infants, families, and society. Professional health associations recommend EBF for 4 months, and many now recommend EBF for 6 months. Yet only 18.8 % of US infants born in 2011 were exclusively breastfed. Numerous studies on breastfeeding are published, but few describe EBF. This study describes characteristics of women who initiated EBF and examines the associations of those factors with EBF lasting ≥4 months. The Life Course Health Development (LCHD)framework was used to structure the analysis and interpret results. METHODS: Data collected through the Infant Feeding Practices Study II survey (2005-2007) were used to identify a cohort of women (n = 1226) practicing EBF at the time of hospital discharge and their sociodemographic, health, work, and child care characteristics. Associations of these characteristics with EBF lasting ≥4 months were studied by bivariate and logistic regression analyses. RESULTS: College education [odds ratio (OR) 2.14, 95 %confidence interval (CI) 1.58-2.89] and marriage (OR2.19, 95 % CI 1.43-3.37) were associated with greater odds of EBF lasting ≥4 months, whereas the plan to return to work after birth (OR 0.57, 95 % CI 0.43-0.74), living in the south (OR 0.67, 95 % CI 0.47-0.95), and postpartum depression risk (OR 0.43, 95 % CI 0.28­0.66)were associated with lower odds of EBF lasting ≥ 4 months. DISCUSSION: Several factors associated with disparities in continued EBF were identified. The application of the LCHD framework furthers understanding of the multiple and interacting risks associated with early discontinuation of EBF.

An education in contrast: state-by-state assessment of school immunization records requirements.

OBJECTIVES: We reviewed the complexities of school-related immunization policies, their relation to immunization information systems (IIS) and immunization registries, and the historical context to better understand this convoluted policy system. METHODS: We used legal databases (Lexis-Nexis and Westlaw) to identify school immunization records policies for 50 states, 5 cities, and the District of Columbia (Centers for Disease Control and Prevention "grantees"). The original search took place from May to September 2010 (cross-referenced in July 2013 with the list on http://www.immunize.org/laws ). We describe the requirements, agreement with IIS policies, and penalties for policy violations. RESULTS: We found a complex web of public health, medical, and education-directed policies, which complicates immunization data sharing. Most (79%) require records of immunizations for children to attend school or for a child-care institution licensure, but only a few (11%) require coordination between IIS and schools or child-care facilities. CONCLUSIONS: To realize the full benefit of IIS investment, including improved immunization and school health program efficiencies, IIS and school immunization records policies must be better coordinated. States with well-integrated policies may serve as models for effective harmonization.

Assessment of screening, treatment, and prevention of perinatal infections in the Philadelphia birth cohort.

Certain population groups are at risk for inadequate prenatal care and transmission of perinatal infections. Philadelphia's birth cohort comprises largely at-risk groups and its infant mortality rate is among the nation's highest. This study identifies factors associated with infectious disease screening, treatment, and prevention in Philadelphia. Delivery charts for a probability sample of 550 patients were reviewed. Demographic factors associated with prenatal and delivery care were identified through Pearson chi-square, analysis of variance, and stepwise logistic regression analysis. Nonstandard and incomplete documentation complicated abstraction. Some prenatal care was noted in 95% of the records and screening varied by disease. Factors independently associated with care include maternal race, insurance status, and maternal age. Screening for infections with well-established recommendations (hepatitis B virus, rubella, syphilis) occurred more often than for group B streptococcus, HIV, hepatitis C virus, and varicella. Adoption of standard reporting forms and processes could improve practice and aid in quality improvement efforts and patient communication.

Hepatitis support groups: meeting the information and support needs of hepatitis patients.

An estimated 5 million Americans are chronically infected with hepatitis B or C. They face socially and clinically significant reductions in mental and physical health. Improved coping and compliance with clinical therapies and harm-reducing behaviors can improve quality of life and, potentially, treatment outcomes. Motivation to join, participation, use, and usefulness of online and in-person hepatitis support groups was examined through observation and survey of group members and group leaders. Members joined primarily to get information particularly about treatments, diet, and treatment side effects. They also joined to get support. All received support that was often hard to get elsewhere. Healthcare providers were generally the most used source of information, yet support groups were the most useful source of information. Members used the information and support obtained to make treatment and lifestyle changes such as initiating or ceasing treatment, eliminating alcohol consumption, increasing openness with family and friends, and discussing side effects with healthcare providers. Providers caring for hepatitis patients should consider recommending support groups to their patients and also participate in the groups to ensure that valid and reliable information is provided.