Inpatient education reduces length of outpatient oxygen therapy in bronchopulmonary dysplasia: A quality improvement project.

BACKGROUND: Patients discharged on home oxygen therapy (HOT) for bronchopulmonary dysplasia (BPD) often receive months of this therapy. A previous trial comparing two methods of HOT weaning showed that increased parent involvement in HOT weaning decreased HOT duration. Our outpatient team uses a standard protocol for outpatient HOT weaning, starting at the first clinic visit 4-6 weeks after discharge. AIM: To shorten HOT duration by teaching parents the outpatient HOT weaning process before neonatal intensive care unit (NICU) discharge. METHODS: We launched a quality improvement program in April 2021 for preterm infants with BPD without significant comorbidities who were stable on ≤0.5 L nasal cannula. Eligible infants started the outpatient HOT weaning protocol while inpatient, with education for parents and nurses. The outcome measure was the duration of HOT after discharge. Process measures focused on protocol adherence. Balancing measures included NICU length of stay and appropriateness of parent-directed HOT weaning. RESULTS: During the study period, there were a total of 133 eligible patients discharged on home oxygen, with 75 in the baseline group and 58 in the intervention group. Forty-five (78%) participated in the HOT weaning protocol while inpatient. HOT was reduced from an average of 27 to 12 weeks after May 2021. We observed no change in NICU length of stay or inappropriate HOT weaning. CONCLUSION: Early introduction of HOT weaning with a focus on caregiver education is associated with a decreased duration of HOT.

Health-Related Quality of Life for Parents of Infants with Bronchopulmonary Dysplasia.

OBJECTIVE: To determine how bronchopulmonary dysplasia (BPD) affects health-related quality of life (HRQL) among infants from NICU hospitalization through 1-year postdischarge. STUDY DESIGN: This was a prospective cohort study of infants with BPD and their parents. Parent HRQL was measured with the PedsQL Family Impact Module before NICU discharge and 3- and 12-months post-discharge. At 12 months, parent-reported child health outcomes included questions from the Test of Respiratory and Asthma Control in Kids, Warner Initial Developmental Evaluation of Adaptive and Functional Skills, and National Survey of Children with Special Health Care Needs. HRQL change over time was assessed by multivariable linear regression. RESULTS: Of 145 dyads, 129 (89%) completed 3-month follow-up, and 113 (78%) completed 12-month follow-up. In the NICU, lower HRQL was associated with earlier gestational age, postnatal corticosteroids, outborn status, and gastrostomy tubes. At 3 months, lower HRQL was associated with readmissions and home oxygen use. At 12 months, lower HRQL was associated with parent-reported difficulty breathing, lower developmental scores, and not playing with other children. At 3 and 12 months, 81% of parents reported similar or improved HRQL compared with the NICU period. Parents reporting infant respiratory symptoms experienced less improvement. CONCLUSIONS: BPD affects parent HRQL over the first year. Most parents report similar or better HRQL after discharge compared with the NICU stay. Less improvement is reported by parents of infants experiencing respiratory symptoms at 12 months. Efforts to improve parent HRQL should target respiratory symptoms and social isolation.

A new era of assessment for neonatal-perinatal medicine trainees: milestones 2.0.

To optimize post-graduate competency-based assessment for medical trainees, the Accreditation Council for Graduate Medical Education initiated a sub-specialty-specific revision of the existing Milestones 1.0 assessment framework in 2016. This effort was intended to increase both the effectiveness and accessibility of the assessment tools by incorporating specialty-specific performance expectations for medical knowledge and patient care competencies; decreasing item length and complexity; minimizing inconsistencies across specialties through the development of common "harmonized" milestones; and providing supplemental materials, including examples of expected behaviors at each developmental level, suggested assessment strategies, and relevant resources. This manuscript describes the efforts of the Neonatal-Perinatal Medicine Milestones 2.0 Working Group, outlines the overall intent of Milestones 2.0, compares the novel Milestones to the original version, and details the materials contained in the novel supplemental guide. This new tool should enhance NPM fellow assessment and professional development while maintaining consistent performance expectations across specialties.

A Proposed Systematic Approach to the Cognitive Autopsy for Internists.

The cognitive autopsy has been a proposed tool for physicians to evaluate misdiagnosis. However, prior iterations of this tool are cumbersome, not designed for the internist, and may cause users to isolate cognition from systems issues. A 10-point tool was created to be utilized individually or by a group when evaluating an adverse event. This could be used with Croskerry's 2020 "cognitive autopsy" or as a standalone tool for internists. We trialed this tool in large group formats and with individual residents; all reported an improved appreciation of the factors leading to poor outcomes and medical errors.

Vitamin K Status in Women of Childbearing Years Before or After Bariatric Surgery.

BACKGROUND: Vitamin K adequacy has not been widely studied before or after bariatric surgery. Reports of babies born with intracranial bleeds to women after bariatric surgery make this an important vitamin to study in women of childbearing years. OBJECTIVES: The aim of this study was to assess the functional vitamin K status in 2 groups of women of childbearing age, 1 group seeking bariatric surgery and 1 group post Roux-en-Y gastric bypass (RYGB). METHODS: In a cross-sectional design, 40 women [19 presurgical and 21 post-RYGB (6-18 mo following surgery)], aged 18-40 y, completed the study. Participants provided a 3-d food intake record and a list of dietary supplements routinely taken. Participants then underwent a commercially available test to measure des-γ-carboxyprothrombin (DCP) concentration as a measure of functional vitamin K status. RESULTS: Independent-samples t tests (P < 0.05) indicated that there was no significant difference [Sig (2-tailed) 0.821] between the DCP concentrations of the presurgical group and those of the post-RYGB group (mean ± SD DCP: 0.3 ± 0.1 and 0.4 ± 0.2 ng/mL, respectively). Vitamin K intake from food (248 ± 227 and 210 ± 239 µg) and supplements (13 ± 31 and 750 ± 271 µg) showed no linear correlation to DCP (presurgical group: 0.25 and -0.15, respectively; post-RYGB group: 0.13 and 0.05, respectively). Vitamin K intakes for both groups were above the current Institute of Medicine's recommended 90 µg/d for women. Bivariate correlation was conducted on other independent variables with only current BMI for the post-RYGB group having a moderate negative correlation to DCP (-0.54, P < 0.05). No correlation with statistical significance was found between other variables and DCP. CONCLUSIONS: Although the American Society for Metabolic and Bariatric Surgery recommends DCP as a test to determine vitamin K adequacy, no published studies in pre- or post-RYGB patients have been performed with the current commercially available test, which is not FDA approved as a vitamin K biomarker. Previous studies reporting vitamin K inadequacies based on DCP utilized a different assay than the one currently available. Due to the importance of ensuring adequate maternal concentrations of vitamin K after bariatric surgery in order to prevent intracranial bleeding in babies, more research is needed to determine suitable vitamin K measures.

A mixed-methods investigation of successful aging among older women engaged in sports-based versus exercise-based leisure time physical activities.

This mixed-methods study compares active older women in different physically based leisure activities and explores the difference in subjective ratings of successful aging and quantifiable predictors of success. A survey was administered to 256 women, 60-92 years of age, engaged in a sports- or exercise-based activity. Quantitative data were analyzed through ANOVA and multiple regression. Qualitative data (n = 79) was analyzed using the approach associated with means-end theory. While participants quantitatively appeared similar in terms of successful aging, qualitative interviews revealed differences in activity motivation. Women involved in sports highlighted social/psychological benefits, while those involved in exercise-based activities stressed fitness outcomes.

Early career reflections of three female gerontologists: Motivations, perceptions, and the life course.

As the number of individuals age 65 and older increases, so does the need for those prepared to work with this population. Doctoral-level preparation in the field of gerontology creates a uniquely prepared contingent who advocate, conduct research, instruct future generations, and serve the older adult population directly. Women are especially likely to pursue gerontology doctoral degrees, yet little is understood about the unique challenges and opportunities they face. The purpose of this reflection was to examine the experiences of three women who pursued doctoral-level gerontology education and faculty positions at different life stages to explore their challenges and opportunities through their educational process and early career experiences.

Perception, Interpretation, and Impact of Health Risk Appraisal Feedback: Pilot Studies of an Assessment Tool.

One mandate of the Affordable Care Act is continued support of workplace wellness programs. A tool used to encourage behavior change is a health risk appraisal (HRA). However, research indicates there is limited benefit to HRAs unless supported by additional health interventions. The purpose of these two pilot studies was to examine effects of the individual HRA personalized feedback, including the perceived value of the feedback and its influence on behavior change. Six months after completing and receiving HRA personalized feedback, participants in two separate Indiana organizations answered survey questions about the HRA value, motivational influence, and ability to prompt behavior change. Descriptive statistics, chi-square tests, analyses of variance, and factor analysis were used to analyze the influence of various factors and test the relationship between HRA generated feedback and these characteristics. The majority of respondents indicated the HRA was helpful with 69% (Study 1, n = 51) and 63% (Study 2, n = 116) of the respondents reporting an attempted behavior change. Preliminary results indicate that completion of an HRA with feedback alone may be beneficial in prompting behavior change.

Perceptions of Nutrition Education in the Current Medical School Curriculum.

BACKGROUND AND OBJECTIVES: Although the National Academy of Sciences has recommended a minimum of 25 hours of nutrition education, the majority of medical schools offer very little to no training or education in nutrition to medical students during their tenure in medical school. In order to assess the relevance and efficacy of current levels of nutrition training as viewed by students, residents, and physicians, as well as possible areas for further improvement, the authors conducted a qualitative study exploring students' experiences. METHODS: Medical students, residents, and physicians at a Midwestern medical school were interviewed during a series of eight focus groups and one-on-one interviews. Results were coded and analyzed using NVivo qualitative software for emerging themes. RESULTS: Medical students felt nutrition was poorly integrated into the curriculum. They witnessed little nutrition counseling during shadowing experiences, and the nutrition information that was imparted was often outdated or incorrect. Residents stated they felt ill-prepared to offer nutrition counseling and desired further education in this area. CONCLUSIONS: Overall, medical students and physicians agreed that the nutrition education currently provided in medical school is inadequate. Residents stated they would benefit from further training in behavioral counseling in order to increase their confidence in educating patients about nutrition. Increasing training in these areas could translate into improved health outcomes.