Validation of hospital discharge coding for neonatal abstinence syndrome.

AIM: To validate the diagnostic discharge coding of neonatal abstinence syndrome (NAS) (International Classification of Diseases [ICD]-10-AM, P96.1). METHODS: Retrospective record review of infants diagnosed with NAS (P96.1) in a non-tertiary Australian hospital between 2000 and 2016. NAS criteria were predetermined to include the following: (i) maternal opioid use; (ii) infant requiring NAS medication and (iii) at least one score of ≥8 on the Finnegan Neonatal Abstinence Scoring Tool (FNAST). RESULTS: Of the 253 infants coded with P96.1, 82/146 (56%) opioid-exposed infants and 9/107(18%) infants exposed to non-opioid drugs only received withdrawal medication: sensitivity 56.2 (95% confidence interval: 47.7-64.3), specificity 91.6 (84.2-95.8%), positive predictive value (PPV) 90.1 (81.6-95.1%) and negative predictive value (NPV) 60.5 (52.5-68.0%) for all three criteria. Using the criterion of ≥1 FNAST score ≥8 resulted in 58.0 (51.3-64.4%) sensitivity, 63.6 (40.8-82.0%) specificity, 94.4 (88.8-97.4%) PPV and 12.6 (7.3-20.6%) NPV for identifying need for NAS medications. CONCLUSION: A diagnosis of P96.1 is highly specific and predictive but poorly sensitive for identifying opioid-exposed infants requiring medications for withdrawal.

Findings from a pragmatic cluster randomised controlled feasibility trial of a music and dance programme for community dwelling older adults.

INTRODUCTION: Functional decline, chronic illness, reduced quality of life and increased healthcare utilisation are common in older adults. Evidence suggests music and dance can support healthy ageing in older adults. This study explored the feasibility, potential for effect and cost effectiveness of the Music and Movement for Health (MMH) programme among community-dwelling older adults using a pragmatic cluster-randomised, controlled feasibility trial design. METHODS: Community-dwelling adults aged 65 years or older were recruited to seven clusters in the Mid-West region of Ireland. Clusters were block randomised to either the MMH intervention or control. Primary feasibility outcomes included recruitment, retention, adherence, fidelity, and safety. Secondary outcomes measured physical activity, physical and cognitive performance, and psychosocial well-being, along with healthcare utilisation were assessed at baseline and after 12 weeks. RESULTS: The study successfully met feasibility targets, with recruitment (n = 100), retention (91 %), adherence (71 %), data completeness (92 %) and intervention fidelity (21 out of 24) all meeting predetermined criteria. Both groups exhibited an increase in self-reported physical activity and improved physical function. Participants in the intervention group scored consistently better in psychosocial measures compared to the control group at follow-up. The health economic analysis confirmed the feasibility of the methodology employed and points to the potential cost-effectiveness of the MMH relative to the control or no organised programme. DISCUSSION AND IMPLICATIONS: The MMH intervention and study design were found to be feasible and acceptable with important findings to inform future evaluation of the clinical and cost-effectiveness of a definitive randomised controlled trial.

Music and Movement for Health: Protocol for a pragmatic cluster-randomised feasibility pilot trial of an arts-based programme for the health and wellbeing of older adults.

Background: Arts-based health programmes (ABHP) can enhance the physical and psychosocial health and wellbeing of older people. However, the feasibility and usefulness of such programmes in Ireland are currently unknown. The primary aim of this study is to examine the feasibility of the study design, its application to a music and movement for health programme and associated costs. The secondary aim is to obtain preliminary effect estimates of an ABHP on health and wellbeing in older adults. Methods: This study is a pragmatic cluster-randomised controlled feasibility trial. Community-dwelling adults, aged 65 years or older will be recruited in the mid-west region of Ireland via methods including social prescription, traditional and social media. The clusters, based on geographical region, will be block randomised to either the ABHP or control using 1:1 allocation ratio. The programme will comprise a 1.5-hour music and dance session each week for 12-weeks together with a 1-hour home-based music and movement programme for 12-weeks. A qualitative and quantitative process evaluation of the arts-based health programme will be performed. Outcomes: Primary outcomes for feasibility include recruitment rates (the number of participants recruited per cluster per month); retention rate (the number of participants who complete measures at baseline and at follow up post intervention, and minimum average attendance. Secondary outcomes will include physical function, balance, physical activity, loneliness, social isolation, cognition, mood, as well as quality of life and cost. Conclusions: If this pioneering study finds evidence to support feasibility and acceptability, a future larger-scale definitive trial will be conducted to examine the effectiveness of an arts-based health programme for older adults. This research aims to strengthen collaborative efforts to implement effective, sustainable and cost-effective programmes for older adults to support community connection, enhancing health and wellbeing, in turn reducing demands on the healthcare system. ISRCTN registration: ISRCTN35313497 (18/02/2022).

A Structured Immersion Approach to Approaching Interprofessional Education.

BACKGROUND: Interprofessional education (IPE) must explore the interdependency between healthcare professionals and ensure that IPE learning experiences are rooted in sound teaching and learning theories. Embedding IPE experiences into curricula using an incremental progression rather than "add-on" or "one-and-done" experience provides for continuous development of interprofessional competence by students as part of the learning process. Employing a school-wide structured immersion approach, over a 2-year period, incorporating five core IPE experiences designed to incrementally engage students in deeper, community-rich, person-centered learning experiences that are meaningful and sustainable. METHODS: An exploratory mixed-methods approach to collected data during the 2018-2019 academic year of the Core Signature IPE Experiences was employed (I-V). As part of the program review process, students were asked to voluntarily provide anonymous feedback after completion of each Core. Quantitative data was collected using Interdisciplinary Education Perception Scale (IEPS). Qualitative data were obtained from responses to open-ended questions added to the demographic component of the survey. The open-ended questions were designed to support, explain, and provide depth to the quantitative section. An elemental coding method was used to preliminarily review the corpus and generate descriptive codes and themes. Descriptive codes summarize in a word or short phrase the basic topic of a qualitative passage. RESULTS: Quantitative data of IEPS scores demonstrated students' mean scores in high range for each subscale at Core II (5.15) and slightly positive trend observed across three remaining Cores with Core V displaying highest mean score (5.44). From the qualitative survey, descriptive codes were agreed upon by two reviewers as providing the essence of response topic. Qualitative themes support and provide insight into quantitative data. CONCLUSIONS: Recognizing the interdependency which exits between professionals and developing trust and mutual respect among disciplines is paramount to ensuring evidence-based, person-centered healthcare. Infusing IPE learning experiences in the academy can play an important role in student development; however, IPE experiences must be rooted in learning theory. Program review findings from the Core Signature structured immersion experiences used across six health professions offers insight and a sound direction for health profession programs seeking to design IPE experiences that will aid in elevating the standard of healthcare and improving patient outcomes, by creating a collaborative ready workforce.

Evaluation of the risk factors for venous thromboembolism post splenectomy - A ten year retrospective cohort study in St James's hospital.

BACKGROUND: Splenectomy is a surgical intervention for a variety of indications; benign and malignant. Complications of this procedure include Venous thromboembolism (VTE) and infection. The incidence of VTE post-surgery has been reported between 0.8%-3% depending on the type of surgery. A higher incidence of abdominal VTE was reported post splenectomy (6-11%). However, there is limited literature regarding the risk factors for post splenectomy VTE and the optimal strategy for thromboprophylaxis. OBJECTIVE: The primary objective of the study was to evaluate the incidence of VTE post splenectomy and to identify the pre-operative, intra-operative and post-operative risk factors. The secondary objective was to assess the local compliance with post-splenectomy prophylactic antibiotics and vaccination protocols. METHODS: We conducted a retrospective observational study. All patients who had a splenectomy in St James's Hospital between January 2007 and June 2017 were included and reviewed. Statistical analysis was carried out using SPSS statistical package. RESULTS: 85 patients were involved in the study. The main indications for splenectomy were benign haematology, malignant haematology, solid tumours, traumatic and spontaneous rupture. 6/85 patients developed VTE (7.06%).High BMI ≥ 30 was associated with increased risk of VTE (p = 0.007), while the use of post-operative prophylactic anticoagulation was associated with reduced risk (p = 0.005). Other factors including age >50 years, female gender, presence of active malignancy and splenomegaly were associated with increased VTE risk with no statistical significance. All VTE's occurred in elective versus emergency splenectomy. Laparoscopic splenectomy was associated with higher risk of VTE than open splenectomy. 97% of patients were prescribed prophylactic antibiotics on discharge, but only 88% had received recommended vaccinations. CONCLUSION: Venous thromboembolism is common post splenectomy. Our data showed that BMI ≥30 was associated with a statistically significant increased risk of VTE, while the use of prophylactic anticoagulation was associated with reduced risk. Further prospective studies with larger samples are warranted and a splenectomy care plan may be helpful.

Academicians and Neurologic Physical Therapy Residents Partner to Expand Clinical Reflection Using the SOLO Taxonomy: A Novel Approach.

Creating curriculums that develop physical therapy (PT) students into evidenced-based, critically reflective, entry-level practitioners is one of the primary goals for PT programs. Academic faculty partnering with neurologic residency programs to design learning environments that capitalize upon the strengths of both can create insightful educational experiences for students during their didactic training. These partnerships support the development of critical thinking skills and provide mentorship for residents transitioning from their role as a clinician to that of an educator. Using the SOLO (structure of observed learning outcomes) taxonomy as a framework for developing learning experiences, Seton Hall University neurologic academic faculty and program directors from the Kessler Institute for Rehabilitation Residency in Neurologic Physical Therapy have built a partnership that seeks to develop critical reflection skills in both the neurologic resident and entry-level PT students. While integration of residents into entry-level PT curriculum may not be novel, we believe that utilizing the SOLO model within this partnership is unique. This paper describes the partnership and learning experiences rooted in the SOLO taxonomy theoretical framework and discusses perceived benefits of this learning experience across professional health science programs.

Mechanisms of mu opioid receptor/G-protein desensitization in brain by chronic heroin administration.

Previous studies have shown that chronic opiate treatment decreases mu opioid-stimulated [35S]GTPgammaS binding in specific brain regions. To extend these findings, the present study investigated DAMGO-stimulated [35S]GTPgammaS binding in membrane homogenates and coronal sections from rats non-contingently administered heroin. Rats were administered saline or increasing doses of heroin i.v. hourly up to 288 mg/kg/day over 40 days. In brain sections, chronic heroin administration decreased DAMGO-stimulated [35S]GTPgammaS binding in medial thalamus and amygdala, with no effect in cingulate cortex or nucleus accumbens. Chronic heroin administration also reduced [35S]GTPgammaS binding stimulated by the principal metabolite of heroin, 6-monoacetylmorphine. In contrast, no significant changes in mu opioid receptor binding were observed in amygdala or thalamus using [3H]DAMGO autoradiography. In membranes from amygdala and thalamus, chronic heroin treatment decreased the maximal effect of DAMGO in stimulating [35S]GTPgammaS binding, with no effect on DAMGO potency. GTPgammaS saturation analysis showed that chronic heroin treatment decreased the Bmax, and increased the K(D), of DAMGO-stimulated [35S]GTPgammaS binding. These data suggest potential mechanisms by which chronic agonist treatment produces opioid receptor/G-protein desensitization in brain.

An observational study exploring academic mentorship in physical therapy.

BACKGROUND: Health professions faculty members often come to the academy without formal training as a professor. A challenge that exists for many new professors is the expectation that they will effectively balance their tripartite roles, which include ensuring teaching excellence, research rigor, and service to the university community. Mentoring has been suggested to be a way that new faculty can be supported as they seek to meet these expectations. Currently, there is limited information on faculty mentoring for physical therapy (PT) faculty. OBJECTIVE: The purpose of this study was to discover if and to what extent mentoring is occurring in entry-level PT education for new full-time PT faculty. DESIGN: Exploratory, cross-sectional survey research design. METHODS: Using the Health Sciences Faculty Mentoring Survey, the authors gathered descriptive data regarding faculty mentoring across entry-level PT education. RESULTS: Of the 66 respondents in this study, only 15 faculty members (22.7%) reported having a faculty mentor, with only 10 of these receiving mentorship from within their own PT department. While the sample size was small, the data provide specific information on current mentorship practices in the PT academic community. CONCLUSION: The findings indicate that the presence of academic mentorship in PT is limited. In light of this finding, the authors sought to provide insight on PT faculty perceptions regarding mentorship in the academy and discuss possible frameworks that can be used to develop and support the tripartite roles of novice faculty as they transition into the academy.

Creating an IPE infusion plan: from foundation to implementation.

Today's health care system has embraced the model of collaborative interprofessional efforts among health care professionals to achieve desired patient health outcomes. The Academy can offer the foundational experiences needed to support and develop interprofessional patient-centered plans of care for health professional students. This paper explores one institution's approach to the creation of an infusion plan which the authors have termed a "structured immersion approach" (SIA) to interprofessional education (IPE). The SIA supports "Core Signature IPE" experiences within existing silo-based curriculums that allow for interprofessional education experiences and the appreciation of the importance of interprofessional practice in today's health care.

Myophosphorylase deficiency (McArdle disease) in a patient with normal pregnancy and normal pregnancy outcome.

McArdle disease is a rare, mostly autosomal recessive disorder of deficient myophosphorylation of glycogen in skeletal muscles. Recent knowledge regarding this condition means that women of childbearing age with McArdle disease can expect to labour normally without ill effect. We report a case of a 30-year-old woman in her first pregnancy who had an episode of exercise-induced myoglobinuria with a significant rise in serum creatine kinase (CK) levels in early pregnancy who then laboured normally but did require a caesarean section for a malposition of the fetal head.