Stopping routine urine screening studies for stroke rehabilitation inpatient admissions.

Urine testing on asymptomatic patients is not aligned with guidelines; however, stroke survivors have trouble communicating symptoms, and urinary tract infections (UTIs) are a recognised poststroke complication. All stroke inpatients at a tertiary rehabilitation hospital underwent urine testing on admission. We led a quality improvement (QI) project on one stroke rehabilitation unit aimed to reduce admission urine testing from 100% to 0%. Baseline audit representing 2 weeks of admissions identified 27 of 28 patients had urine tests; however, none required UTI treatment despite 3 positive culture results. Estimated cost of testing was $C675. QI tools identified that a standardised paper-based admission form facilitated automatic urine testing. Project intervention strategies included education, clinicians crossing off urine orders and unit clerks flagging unaddressed orders for reassessment. A chart audit after 4 weeks and prescriber survey after 6 months assessed impact. Postintervention audit (n=23) revealed 1 patient had admission urine tests, 22 orders were crossed out, 1 chart was flagged and estimated testing cost declined from $C675 to $C25. Six urine tests were completed after admission and two patients required UTI treatment. Post 6 months, unit clerks assumed the role to cross out the order on the standardised form, and no patient had routine admission urine testing. There was no clinical benefit in screening for UTIs prior to stroke rehabilitation. This project is a practical example of deadopting a practice promoted by standardised order forms.

Prospective Investigation of Glutamate Levels and Percentage Gray Matter in the Medial Prefrontal Cortex in Females at Risk for Postpartum Depression.

BACKGROUND: The substantial female hormone fluctuations associated with pregnancy and postpartum have been linked to a greater risk of developing depressive symptoms, particularly in high-risk women (HRW), i.e. those with histories of mood sensitivity to female hormone fluctuations. We have shown that glutamate (Glu) levels in the medial prefrontal cortex (MPFC) decrease during perimenopause, a period of increased risk of developing a major depressive episode. Our team has also demonstrated that percentage gray matter (%GM), another neural correlate of maternal brain health, decreases in the MPFC during pregnancy. OBJECTIVE: To investigate MPFC Glu levels and %GM from late pregnancy up to 7 weeks postpartum in HRW and healthy pregnant women (HPW). METHODS: Single-voxel spectra were acquired from the MPFC of 41 HPW and 22 HRW using 3- Tesla in vivo proton magnetic resonance spectroscopy at five different time points. RESULTS: We observed a statistically significant interaction between time and group for the metabolite Glu, with Glu levels being lower for HRW during pregnancy and early postpartum (p<0.05). MPFC %GM was initially lower during pregnancy and then significantly increased over time in both groups (p<0.01). CONCLUSION: This investigation suggests that the vulnerability towards PPD is associated with unique fluctuations of MPFC Glu levels during pregnancy and early postpartum period. Our results also suggest that the decline in MPFC %GM associated with pregnancy seems to progressively recover over time. Further investigations are needed to determine the specific role that female hormones play on the physiological changes in %GM during pregnancy and postpartum.