Reducing Tracheostomy-Related Acquired Pressure Injury by Flipping the Ventilator Circuit Position Study.

BACKGROUND: Tracheostomy-related acquired pressure injuries (TRPIs) are one of the hospital-acquired conditions. We hypothesize that an uneven ventilator circuit load, leading to non-neutral tracheostomy tube positioning in the immediate post-tracheostomy period, leads to an increased incidence of TRPIs. Does switching the ventilator circuit load daily, in addition to standard post-tracheostomy care, lead to a decreased incidence of TRPIs? METHODS: This is a prospective quality improvement study. Study was conducted at two academic hospital sites within tertiary care hospitals at Emory University in different ICUs. Consecutive patients undergoing bedside percutaneous tracheostomy by the interventional pulmonary service were included. The flip the ventilator circuit (FLIC) protocol was designed and implemented in selected ICUs, with other ICUs as controls. RESULTS: Incidence of TRPI in intervention and control group were recorded at post-tracheostomy day 5. A total of 99 patients were included from October 22, 2019, to May 22, 2020. Overall, the total incidence of any TRPI was 23% at post-tracheostomy day 5. Incidence of stage I, stage II, and stages III-IV TRPIs at postoperative day 5 was 11%, 12%, and 0%, respectively. There was a decrease in the rate of skin breakdown in patients following the FLIC protocol when compared with standard of care (13% vs. 36%; p = 0.01). In a multivariable analysis, interventional group had decreased odds of developing TRPI (odds ratio, 0.32; 95% CI, 0.11-0.92; p = 0.03) after adjusting for age, albumin, body mass index, diabetes mellitus, and days in hospital before tracheostomy. CONCLUSIONS: The incidence of TRPIs within the first week following percutaneous tracheostomy is high. Switching the side of the ventilator circuit to evenly distribute load, in addition to standard bundled tracheostomy care, may decrease the overall incidence of TRPIs.

Household Decision-Making: Implications for Production, Consumption, and Sale of Nutrient-Rich Foods.

Household decision-making influences choices related to the production, sale, purchase, and consumption of nutrient-rich foods. The present study assessed the effect of household decision-making in 2 regions of Ethiopia within 2 groups of households, most vulnerable households and model farmer households. The study focused on identifying barriers and facilitators relating to decisions about nutrient-rich foods-in this case fruits, vegetables, and animal source foods. The results provide insights into how future agricultural programs can affect key aspects of decision-making to maximize the positive impacts on diet and food security.

Universal Precautions Plus: Physician-Directed Strategies for Improving Patient Health Literacy in the Emergency Department.

Working on the frontlines with safety-net populations, emergency physicians are uniquely positioned to take on a greater role in addressing the current health literacy crisis and specific barriers that may exist. Here, we review the concept of universal health literacy precautions and explore the application of these universal precautions in conjunction with other patient-centered strategies. More specifically, to improve patient understanding and outcomes, emergency physicians can pair universal health literacy precautions with strategies including multiple learning techniques, dual-code theory, empowerment counseling, family buy-in, and hands-on practice. We provide two examples of emergency department encounters where this combined approach was used differently yet successfully and efficiently. Ultimately, we aim to highlight the value of emergency physicians being equipped with basic skills in health literacy educational strategies.

Social and behaviour change communication to improve child feeding practices in Ethiopia.

Social and behaviour change communication (SBCC) interventions can positively affect optimal nutritional practices. This study evaluated the added value of a virtual facilitator tool to an enhanced community conversation (ECC) programme to improve infant and young child feeding (IYCF) practice among children under the Growth through Nutrition Activity programme in Ethiopia. The study used a quasi-experimental design with a control group. Pregnant and/or lactating women were the study population for both study groups. The intervention (ECC + VF) group received all the same components as the control group but had the addition of in-person ECC meetings supplemented with audio-recorded virtual facilitators (VF) sessions designed to complement the monthly meeting lesson or topic. A difference in difference analysis was employed using generalized linear mixed model (GLMM) in Stata version 15.0 (Stata Corporation, College Station, TX). A p-value of less than or equal to 0.05 was considered significant for all tests. Accordingly, a 13.6% change in iron folic acid (IFA) intake for 3 months and above was observed in the intervention group. Even though not statistically significant, large to moderate positive changes in child minimum diet diversity (20%), minimum acceptable diet (18%) and women diet diversity (7.9%) were observed in the intervention group. This study identified the use of virtual facilitators as a modality to transmit standard nutrition messages during ECC programmes for optimal IYCF practices. The findings strengthen the notion that using a combination of SBCC approaches has advantage over a single method in improving important nutritional practices.

Nutrition Policy and Governance in Ethiopia: What Difference Does 5 Years Make?

Two studies, ENGINE (Empowering New Generations to Improve Nutrition and Economic opportunities) and Growth through Nutrition, were conducted in the same 4 regions of Ethiopia approximately 5 years apart. A similar protocol using a quantitative and qualitative survey of key informants at the subnational level was used to explore barriers and facilitators for implementation of the country's national multisector nutrition plan. Noticeable differences were observed, including a change in the perception of the nutrition problems in pregnant women and preschool aged children and greater awareness of the multisector plan. Poor coordination and collaboration were still noted in both time periods. A key issue highlighted was the need to keep up the momentum for multisector approaches to improve nutrition in the policy agenda.

Acceptance of HIV Counseling and Testing among Antenatal Clinic Attendees in Southern Ethiopia.

BACKGROUND: Counseling and testing for Human Immunodeficiency Virus (HIV) (HCT) during antenatal care (ANC) is a critical entry point for the prevention of mother-to-child transmission (PMTCT) of HIV. However, in Ethiopia limited evidence exists regarding the extent of acceptance of the service. The study aimed to assess the level and factors associated with acceptance of HCT in Hawassa city, Southern Ethiopia. METHODS: Cross-sectional study was conducted in four public health facilities found in the city. Five hundred and four ANC clients were selected using multistage sampling technique. Data were collected via interviewer administered questionnaire and analyzed using multivariable binary logistic regression analysis. The outputs are presented using adjusted odds ratio (AOR) with 95% confidence interval (CI). RESULTS: The vast majority, 84.1% (95% CI: 80.6-87.2%), of the respondents accepted the HCT. Acceptance was positively associated with being married [AOR=5.60 (95% CI: 1.87-16.50)], having two or more ANC visits [4.93 (95% CI: 2.40-10.07)], history of prior HIV testing [4.23 (95% CI: 1.90-9.74)], having good knowledge about MTCT [4.91 (95% CI: 2.07-11.6)] and PMTCT [6.22 (95% CI: 2.87-13.50)] and having no fear of stigma and discrimination [3.32 (95% CI: 1.57-7.02)]. CONCLUSION: Acceptance of HCT can be further improved by enhancing the knowledge of mother about PMTCT and combating stigma and discrimination.

Phosphorylation of the nicotinic acetylcholine receptor in myotube-cholinergic neuron cocultures.

Acetylcholine receptor (AChR) stability in the postsynaptic membrane is affected by serine kinases. AChR are phosphorylated by protein kinase C (PKC) and PKA, and we have shown that activation of PKA and PKC have opposite effects on AChR stability and that this may play some role in the selective, activity-dependent synapse loss that occurs during development of the neuromuscular junction. Myotube cultures with and without added spinal motor neurons were probed with immunoaffinity-purified antibodies prepared against phosphorylated peptides with amino acid sequences from different AChR subunits. Different treatments activating PKC (phorbol 12-myristate 13-acetate; PMA) or PKA (dibutyryl cyclic adenosine monophosphate; cAMP) or blocking electrical activity (tetrodotoxin; TTX) of the cocultures were chosen because of their known effects, direct or indirect, on receptor stability. We asked whether the phospho-specific antibody staining in conjunction with alpha-bungarotoxin (BTX) identification of AChR aggregates could provide a direct demonstration of changes in receptor phosphorylation produced by the treatments. We found that PMA treatment did increase phosphorylation of the delta subunit and cAMP increased phosphorylation of the epsilon subunit relative to total BTX labeling in muscle-nerve cocultures, but not in muscle-only cultures. Blockade of electrical activity with TTX increased the incidence of aggregates that showed no phospho-epsilon staining. Myotube cultures grown in the absence of neurons did not show the responses of myotubes in cocultures. The results show that manipulations that alter receptor stability also produce changes in receptor phosphorylation. We suggest that phosphorylation may be a mechanism mediating the changes in receptor stability.