16 results on '"Don Buckingham"'
Search Results
2. Achieving Equity in Diabetes Research: Borrowing From the Field of Quality Improvement Using a Practical Framework and Improvement Tools
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Osagie Ebekozien, Ann Mungmode, Don Buckingham, Margaret Greenfield, Rashida Talib, Devin Steenkamp, J. Sonya Haw, Ori Odugbesan, Michael Harris, Priyanka Mathias, Jane K. Dickinson, and Shivani Agarwal
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Endocrinology, Diabetes and Metabolism ,Internal Medicine - Abstract
There are limited tools to address equity in diabetes research and clinical trials. The T1D Exchange has established a 10-step equity framework to advance equity in diabetes research. Herein, the authors outline this approach and expand on its practical application.
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- 2022
3. Implementation of a Pharmacist-Led Antimicrobial Time-Out for Medical-Surgery Services in an Academic Pediatric Hospital
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Preeti Jaggi, Kathryn Nuss, Nathaniel Gallup, Katelyn Parson, Jessica Tansmore, Christopher R.T. Stang, R. Zachary Thompson, Don Buckingham, Matthew Sapko, Joshua R. Watson, and Mahmoud Abdel-Rasoul
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medicine.medical_specialty ,Time-out ,Quality management ,business.industry ,Research ,Pharmacist ,Health informatics ,Surgery ,Clinical pharmacy ,Documentation ,Pediatrics, Perinatology and Child Health ,Pediatric surgery ,medicine ,Antimicrobial stewardship ,Pharmacology (medical) ,business - Abstract
OBJECTIVE This report describes a quality improvement initiative to implement a pharmacist-led antimicrobial time-out (ATO) in a large, freestanding pediatric hospital. Our goal was to reach 90% ATO completion and documentation for eligible patients hospitalized on general pediatric medicine or surgery services. METHODS A multidisciplinary quality improvement team developed an ATO process and electronic documentation tool. Clinical pharmacists were responsible to initiate and document an ATO for pediatric medicine or surgery patients on or before the fifth calendar day of therapy. The quality improvement team educated pharmacists and physicians and provided ATO audit and feedback to the pharmacists. We used statistical process control methods to track monthly rates of ATO completion retrospectively from October 2017 through March 2018 and prospectively from April 2018 through April 2019. Additionally, we retrospectively evaluated the completion of 6 data elements in the ATO note over the final 12-month period of the study. RESULTS Among 647 eligible antimicrobial courses over the 19-month study period, the mean monthly documentation rate increased from 54.6% to 83.5% (p < 0.001). The mean ATO documentation rate increased from 32.8% to 74.2% (p < 0.001) for the pediatric medicine service and from 65.0% to 88.1% for the pediatric surgery service (p = 0.006). Among 302 notes assessed for completeness, 35.8% had all the required data fields completed. A tentative antimicrobial stop date was the data element completed least often (49.3%). CONCLUSIONS We implemented a pharmacist-led ATO, highlighting the role pharmacists play in antimicrobial stewardship. Additional efforts are needed to further increase ATO completion rates and to define treatment duration.
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- 2021
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4. Improving Hepatitis B Vaccination Rates among At-risk Children and Adolescents with Inflammatory Bowel Disease
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Megan Megan McNicol, Amy Donegan, Kate Hawa, Angelique E. Boutzoukas, Barb Drobnic, Melanie Oates, Maudie Orraca-Tetteh, Hilary K. Michel, Ross M. Maltz, Jennifer L. Dotson, Don Buckingham, Brendan Boyle, and Monica I. Ardura
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Building and Construction - Abstract
Patients with inflammatory bowel disease (IBD) receiving tumor necrosis factor alpha inhibitors (TNFai) may be at higher risk for hepatitis B virus (HBV) infection. We conducted a quality improvement (QI) initiative to improve HBV vaccination rates in seronegative children with IBD.This QI initiative implemented an HBV vaccination strategy from September 2018 to March 2020 in patients with newly diagnosed IBD with hepatitis B surface antibody (HBsAb)10 mIU/mL. The project aimed to (1) increase HBV vaccination rates in seronegative patients and (2) document immunogenicity after completing a three-dose vaccine series. Outcome measures included the percentage of seronegative patients who received HBV vaccines (dose 1 and three-dose series). Interventions included applying a standardized vaccination protocol, and creating a vaccine workflow in two clinical areas, previsit planning and stakeholder engagement.One hundred seventy-four children and adolescents with IBD were evaluated during the study period, and 132 (76%) were HBsAb negative. After plan-do-study-act (PDSA) 1, the proportion of eligible patients who received HBV vaccine dose 1 increased from a baseline of 7% to 100% and was sustained for over 12 months. During PDSA 2, the proportion of patients completing the three-dose vaccine series improved from a baseline of 0% to 82% (n = 100); among 93 children in this subgroup who had repeat serology performed, 86 (92%) demonstrated serologic evidence of HBV protection.A multidisciplinary approach applying QI methodology allowed for improved and sustained HBV vaccination rates in at-risk seronegative children and adolescents with IBD. A three-dose HBV vaccine series proved immunogenic in 92% of eligible patients.
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- 2021
5. Increasing Insulin Pump Use Among 12- to 26-Year-Olds With Type 1 Diabetes: Results From the T1D Exchange Quality Improvement Collaborative
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Joyce M. Lee, Ori Odugbesan, Rona Sonabend, G. Todd Alonso, Ashley Garrity, Kathryn Gallagher, Ilona Lorincz, Nicole Rioles, Osagie Ebekozien, Sarah K. Lyons, Don Buckingham, Sarah L. Thomas, and Manmohan K. Kamboj
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Insulin pump ,medicine.medical_specialty ,Type 1 diabetes ,Quality management ,business.industry ,Endocrinology, Diabetes and Metabolism ,Insulin ,medicine.medical_treatment ,Psychological intervention ,Telehealth ,Onboarding ,medicine.disease ,Special Collection: T1D Exchange Quality Improvement Collaborative ,Emergency medicine ,Internal Medicine ,medicine ,business ,Glycemic - Abstract
Insulin pump therapy in pediatric type 1 diabetes has been associated with better glycemic control than multiple daily injections. However, insulin pump use remains limited. This article describes an initiative from the T1D Exchange Quality Improvement Collaborative aimed at increasing insulin pump use in patients aged 12–26 years with type 1 diabetes from a baseline of 45% in May 2018 to >50% by February 2020. Interventions developed by participating centers included increasing in-person and telehealth education about insulin pump technology, creating and distributing tools to assist in informed decision-making, facilitating insulin pump insurance approval and onboarding processes, and improving clinic staff knowledge about insulin pumps. These efforts yielded a 13% improvement in pump use among the five participating centers, from 45 to 58% over 22 months.
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- 2021
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6. 22 Implementation of a pharmacist-driven antimicrobial time-out for medical-surgery services in an academic pediatric hospital
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Preeti Jaggi, Mahmoud Abdel-Rasoul, Jessica Tansmore, Zachary Thompson, Don Buckingham, Christopher R.T. Stang, Joshua R. Watson, Kathryn Nuss, Matthew Sapko, and Katelyn Parson
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lcsh:R5-920 ,Time-out ,medicine.medical_specialty ,Quality management ,business.industry ,education ,Psychological intervention ,Pharmacist ,Antimicrobial ,Surgery ,Clinical pharmacy ,Documentation ,medicine ,Antimicrobial stewardship ,lcsh:Medicine (General) ,business - Abstract
Background This quality improvement initiative implemented a pharmacist-driven antimicrobial time-out (ATO) in a large, free-standing pediatric hospital. Objectives Our goal was to complete and document an ATO for 90% of eligible patients hospitalized on general pediatric medicine or surgery services within 12 months. Methods A multidisciplinary quality improvement team developed an ATO process and electronic documentation tool. Clinical pharmacists were responsible to initiate and document an ATO for pediatric medicine or surgery patients on or before the 5th calendar day of therapy. Interventions included education of pharmacists and physicians, as well as ATO audit and feedback to the pharmacists. We used statistical process control methods to track monthly rates of ATO completion from October 2017 through April 2019. Results Among 647 eligible antimicrobial courses over the 17-month study period, the mean monthly documentation rate increased from 54.6% to 83.5% (p Conclusions We successfully implemented a pharmacist-driven ATO, highlighting the opportunity for pharmacists to play an active role in antimicrobial stewardship. Defining treatment duration remains an important antimicrobial stewardship target.
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- 2020
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7. The Type 1 Diabetes Composite Score: An Innovative Metric for Measuring Patient Care Outcomes Beyond Hemoglobin A1c
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Manmohan K. Kamboj, Kathryn Obrynba, Don Buckingham, Kajal Gandhi, Chris Servick, Justin A. Indyk, and Alyssa M. Kramer
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medicine.medical_specialty ,education.field_of_study ,Type 1 diabetes ,business.industry ,media_common.quotation_subject ,Population ,Population health ,medicine.disease ,Outcome (game theory) ,Diabetes management ,Family medicine ,Cohort ,medicine ,Quality (business) ,Metric (unit) ,education ,business ,Individual QI Projects From Single Institutions ,media_common - Abstract
Introduction: Patient outcomes resulting from optimal type 1 diabetes (T1D) care have historically focused on driving a single metric, hemoglobin A1c. Our objectives were to design, build, and launch an aggregate clinical indicator that comprehensively reflects patient management status beyond hemoglobin A1c alone. This project aimed to show proof of principle that an aggregate score comprised of T1D outcome metrics could be built to track quality performance. Methods: We established an electronic medical record-based diabetes registry and utilized its population health modules to design and build this diabetes care metric. Elements representing optimal diabetes management, as defined by current guidelines and expert opinion, were identified. Nine elements fall into categories of management tools, care assessments, and complications risk. The Type 1 Diabetes Composite Score (T1DCS) aggregates these outcome measures to reflect the overall diabetes care status for each patient. Higher scores suggest better management and overall improved patient health. Results: We launched this metric build in November 2018 and applied the scoring to our T1D population (≈1,900 patients). The T1DCS quickly provides a summary of current diabetes management status. T1DCS viewed over the registry cohort demonstrates a normal distribution, and scores improved from March to September 2019, reflecting better care and outcomes, and illustrating the potential to track program effectiveness. Conclusions: The T1DCS is a useful metric to evaluate the clinical status of T1D patients, assess the capability of a clinical program to achieve optimal diabetes outcomes, identify patient diversity opportunities, and document outcome improvement as a novel comprehensive quality measure.
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- 2020
8. Optimizing Rapid Sequence Intubation for Medical and Trauma Patients in the Pediatric Emergency Department
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Daniel J. Scherzer, Elaise Hill, Sandra P. Spencer, Delia L. Gold, Andrew McClain, Joseph Christman, Berkeley L. Bennett, Andrew Shonk, Adjoa Andoh, and Don Buckingham
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Pediatric emergency ,medicine.medical_specialty ,Trauma patient ,Oxygen desaturation ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Laryngoscopy ,MEDLINE ,Building and Construction ,Emergency medicine ,Individual QI projects from Single Institutions ,Medicine ,Intubation ,business - Abstract
Introduction: Rapid sequence intubation (RSI) is a critical procedure for severely ill and injured patients presenting to the pediatric emergency department (PED). This procedure has a high risk of complications, and multiple attempts increase this risk. We aimed to increase successful intubation within two attempts, focusing on medical and trauma patients separately to identify improvement barriers for each group. Methods: A multifaceted intervention was implemented using quality improvement methods. The analysis included adherence to the standardized process, successful intubation within two attempts, and frequency of oxygen saturations
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- 2020
9. 1331. Reducing Inpatient Antimicrobial Treatment Duration for Febrile Infants through Implementation of Rapid Diagnostic Testing and Clinical Risk Definition
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Octavio Ramilo, Don Buckingham, Guliz Erdem, Joshua R. Watson, and William J. Barson
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medicine.medical_specialty ,business.industry ,Treatment duration ,Diagnostic test ,Virus diseases ,Antimicrobial ,Rapid screening test ,AcademicSubjects/MED00290 ,Infectious Diseases ,Oncology ,Poster Abstracts ,Medicine ,business ,Intensive care medicine ,Clinical risk factor - Abstract
Background The management approach to febrile infants remain challenging. Despite new advances in rapid diagnostic testing, febrile infants with a viral infection could receive prolonged antimicrobial treatment due to concerns for co-existing serious bacterial infection (SBI). We sought to decrease the duration of antibiotic treatment in febrile infants less than 8 weeks of age hospitalized on inpatient infectious disease service following sepsis evaluation, who have enterovirus, parechovirus, or respiratory viruses detected, from average 30 hours to 24 hours and sustain for six months. Figure 1. Antibiotic Treatment Duration of Infants Underfoing Evaluation for Sepsis Figure 2. Length of Stay in Infants Underfoing Sepsis Evaluation Methods A new management guideline that defined “low-risk” infants, as well as inclusion and exclusion criteria, was created to monitor the accurate duration of parenteral treatment and length of hospitalization. Respiratory viruses were detected by a multiplex PCR assay. We created a QlikSense App for further clinical characterization of patients and follow-up. This management guideline was adapted as a quality improvement division initiative. Control charts were used to assess the impact of the interventions. Figure 3. Readmissions in Infants Underfoing Sepsis Evaluation Results The management guideline was developed and implemented by pediatric infectious disease faculty. Febrile infants < 8 weeks of age were included if they had both documented viral infections and sepsis evaluation. 178 infants were admitted with fevers in 2018 and 148 infants were admitted in 2019. The mean inpatient antibiotic treatment duration decreased from 27.7 hours in 2018 to 24.9 hours in 2019 (P > 0.05) (Figure 1). There was no significant difference in length of hospitalization or 30-day readmission rates (Figure 2 and 3). There was no reported readmission for SBI. Conclusion Antibiotic treatment could be discontinued in clinically stable infants with a documented viral infection after 24 hours of negative blood, CSF, and urine bacterial culture incubation so as not to receive unnecessary prolonged inpatient treatment that may increase side effects. In addition to possible decreased treatment side effects our protocol led to decreased patient care costs with no documented changes in readmission rates. Disclosures Octavio Ramilo, MD, Bill & Melinda Gates Foundation (Grant/Research Support)Janssen (Grant/Research Support, Advisor or Review Panel member)Medimmune (Grant/Research Support)Merck (Advisor or Review Panel member)NIH/NIAID (Grant/Research Support)Pfizer (Consultant, Advisor or Review Panel member)Sanofi/Medimmune (Consultant, Advisor or Review Panel member)
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- 2020
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10. A Quality Improvement Initiative to Increase the Number of Pediatric Resident Laceration Repairs
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Tracey L. Wagner, Maya S Iyer, Michael W Dunn, Sandra P. Spencer, and Don Buckingham
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Pediatric resident ,Quality management ,business.industry ,MEDLINE ,Simple laceration ,Internship and Residency ,030208 emergency & critical care medicine ,General Medicine ,medicine.disease ,Lacerations ,Pediatrics ,Quality Improvement ,Tertiary Care Centers ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,030212 general & internal medicine ,Medical emergency ,business ,Emergency Service, Hospital ,Competence (human resources) ,Medical Informatics ,Original Research - Abstract
Background Pediatric residents must demonstrate competence in several clinical procedures prior to graduation, including simple laceration repair. However, residents may lack opportunities to perform laceration repairs during training, affecting their ability and confidence to perform this procedure. Objective We implemented a quality improvement initiative to increase the number of laceration repairs logged by pediatric residents from a baseline mean of 6.75 per month to more than 30 repairs logged monthly. Methods We followed the Institute for Healthcare Improvement's Model for Improvement with rapid plan-do-study-act cycles. From July 2016 to February 2018, we increased the number of procedure shifts and added an education module on performing laceration repairs for residents in a pediatric emergency department at a large tertiary hospital. We used statistical process control charting to document improvement. Our outcome measure was the number of laceration repairs documented in resident procedure logs. We followed the percentage of lacerations repairs completed by residents as a process measure and length of stay as a balancing measure. Results Following the interventions, logged laceration repairs initially increased from 6.75 to 22.75 per month for the residency program. After the number of procedure shifts decreased, logged repairs decreased to 13.40 per month and the percentage of lacerations repaired by residents also decreased. We noted an increased length of stay for patients whose lacerations were repaired by residents. Conclusions While our objective was not met, our quality improvement initiative resulted in more logged laceration repairs. The most effective intervention was dedicated procedure shifts.
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- 2019
11. Decreasing the Duration of Discharge Antibiotic Treatment Following Inpatient Skin and Soft Tissue Abscess Drainage
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Nathaniel Gallup, Kevin Drewes, Don Buckingham, Brian D. Kenney, William J. Barson, Annika Gibson, and Guliz Erdem
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medicine.medical_specialty ,business.industry ,medicine.drug_class ,medicine.medical_treatment ,Antibiotics ,Soft tissue ,medicine.disease ,Individual QI Projects from Single Institutions ,Surgery ,Inclusion and exclusion criteria ,Incision and drainage ,Etiology ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Medicine ,Medical prescription ,business ,Abscess ,Surgical incision - Abstract
Supplemental Digital Content is available in the text., Introduction: Skin and soft tissue abscesses do not require prolonged systemic antimicrobial treatment following drainage. We aimed to decrease the duration of discharge antibiotic treatment to less than 5 days following inpatient incision and drainage of uncomplicated abscesses. Methods: A new treatment protocol that defined uncomplicated abscesses, as well as inclusion and exclusion criteria, was created to monitor the accurate duration of prescribed therapy at discharge. We implemented a treatment algorithm that takes into account the epidemiologic changes in microbial etiologies and the presence of systemic findings for patients after surgical incision and drainage. We used control charts to assess the impact of the interventions. Results: Four hundred and eighteen patients were discharged following abscess drainage from our inpatient infectious diseases unit in 2016. The patients were 3 months to 21 years of age. Only 72 (17%) patients had prescribed discharge antibiotic treatment courses that were less than 5 days [range 0–31 days, median 8 days (IQR 6, 9)], and the average prescribed course at discharge was 8.6 days. During the study period, we significantly decreased the average duration of discharge antibiotics to 7.3 days in all patients (P = 0.0016, 95% CI: −2.1036 to −0.4964, difference of means −1.3). The discharge treatment duration of patients with uncomplicated abscess was shorter at 4.7 days [range 0–9 days, median 5 days, (IQR 3, 5)]. Prescription compliance to less than 5 days treatment course at discharge increased from the baseline of 17% to 42% overall. Conclusions: Standardizing definitions of uncomplicated skin and soft tissue abscesses was critical to the success of this project. In addition to possible improved treatment adherence and decreased side effects, our protocol led to decreased patient care costs with no documented changes in readmission rates.
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- 2018
12. Increasing Trichomonas vaginalis testing for high-risk adolescents a pediatric emergency department
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Daniel M. Cohen, Kristin Stukus, and Don Buckingham
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Vaginal discharge ,medicine.medical_specialty ,biology ,business.industry ,Pelvic pain ,Trichomonas ,Psychological intervention ,biology.organism_classification ,medicine.disease_cause ,Individual QI Projects from Single Institutions ,Emergency medicine ,Health care ,medicine ,Dysuria ,Trichomonas vaginalis ,medicine.symptom ,business ,Reproductive health - Abstract
Background Trichomonas is a common sexually transmitted infection (STI) among adolescents, causing vaginal discharge, pelvic pain, and dysuria. Affected individuals have increased susceptibility to other STIs and may have pregnancy complications. A quality improvement project was developed to increase trichomonas testing among high-risk adolescent patients from 40% in July 2014 to 100% by December 31, 2014, and sustain over 6 months. Methods An interdisciplinary team (providers and support staff) was assembled to address this objective. We collected 6 months of baseline data. Deploying the Institute for Healthcare Improvement Model for Improvement, we formulated an aim statement and identified key drivers. We used cause analysis to identify interventions for each problem area. Multiple Plan-Do-Study-Act cycles were undertaken, and results were monitored using control charts. Interventions included increasing awareness and education for clinical staff; changing computer order entry for the test; using order sets for STI; and adding a Licensed Professional Initiated Protocol to nurse ordering practice. These interventions were all done in conjunction with feedback to providers for individual missed cases. Results Over 18 months, the trichomonas testing rate rose with each intervention: from 25% (January 2014) to 98% (December 2014), which we have sustained through June 2015. Implications and contributions This article demonstrates the successful use of quality improvement methodology to increase rates of Trichomonas vaginalis testing among at-risk adolescent patients. Increased testing results in increased detection and improved treatment and sexual health for our patients. Conclusion Improving the trichomonas testing process in the pediatric emergency department results in higher screening rates among high-risk adolescent patients.
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- 2019
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13. Urine Culture Follow-up and Antimicrobial Stewardship in a Pediatric Urgent Care Network
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Terry Barber, Dipanwita Saha, Don Buckingham, Jimisha Patel, Joshua R. Watson, and David J. Thornton
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medicine.medical_specialty ,medicine.drug_class ,Urinary system ,Antibiotics ,MEDLINE ,Urine ,Urinalysis ,03 medical and health sciences ,0302 clinical medicine ,Anti-Infective Agents ,030225 pediatrics ,medicine ,Ambulatory Care ,Antimicrobial stewardship ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Child ,business.industry ,Antibiotic exposure ,Electronic medical record ,Hospitals, Pediatric ,Quality Improvement ,Discontinuation ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Urinary Tract Infections ,business ,Follow-Up Studies - Abstract
BACKGROUND AND OBJECTIVES: Empiric antibiotic therapy for presumed urinary tract infection (UTI) leads to unnecessary antibiotic exposure in many children whose urine culture results fail to confirm the diagnosis. The objective of this quality improvement study was to improve follow-up management of negative urine culture results in the off-campus urgent care network of Nationwide Children’s Hospital to reduce inappropriate antibiotic exposure in children. METHODS: A multidisciplinary task force developed and implemented a protocol for routine nurse and clinician follow-up of urine culture results, discontinuation of unnecessary antibiotics, and documentation in the electronic medical record. Monthly antibiotic discontinuation rates were tracked in empirically treated patients with negative urine culture results from July 2013 through December 2015. Statistical process control methods were used to track improvement over time. Fourteen-day return visits for UTIs were monitored as a balancing measure. RESULTS: During the study period, 910 patients received empiric antibiotic therapy for UTIs but had a negative urine culture result. The antibiotic discontinuation rate increased from 4% to 84%, avoiding 3429 (40%) of 8648 antibiotic days prescribed. Among patients with discontinued antibiotics, none was diagnosed with a UTI within 14 days of the initial urgent care encounter. CONCLUSIONS: Implementation of a standard protocol for urine culture follow-up and discontinuation of unnecessary antibiotics was both effective and safe in a high-volume pediatric urgent care network. Urine culture follow-up management is an essential opportunity for improved antimicrobial stewardship in the outpatient setting that will affect many patients by avoiding a substantial number of antibiotic days.
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- 2016
14. Bringing home the right to food in Canada: challenges and possibilities for achieving food security
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Aleck Ostry, Graham Riches, Karen Rideout, Don Buckingham, and Rod MacRae
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Economic growth ,Canada ,Human Rights ,media_common.quotation_subject ,Safety net ,International Cooperation ,Medicine (miscellaneous) ,Food Supply ,Nutrition Policy ,Political science ,Humans ,media_common ,Social Responsibility ,Nutrition and Dietetics ,Food security ,Human rights ,business.industry ,Politics ,Public Health, Environmental and Occupational Health ,Food safety ,Relief Work ,Altruism ,Justiciability ,Right to food ,Accountability ,business ,Social responsibility - Abstract
We offer a critique of Canada's approach to domestic food security with respect to international agreements, justiciability and case law, the breakdown of the public safety net, the institutionalisation of charitable approaches to food insecurity, and the need for ‘joined-up’ food and nutrition policies. We examined Canada's commitments to the right to food, as well as Canadian policies, case law and social trends, in order to assess Canada's performance with respect to the human right to food. We found that while Canada has been a leader in signing international human rights agreements, including those relating to the right to food, domestic action has lagged and food insecurity increased. We provide recommendations for policy changes that could deal with complex issues of state accountability, social safety nets and vulnerable populations, and joined-up policy frameworks that could help realise the right to adequate food in Canada and other developed nations.
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- 2007
15. INCREASING TRICHOMONAS TESTING IN THE PEDIATRIC EMERGENCY DEPARTMENT
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Laura Sawicki, Lindsey Weisbecker, Kristin Stukus, Kelli J. Kurtovic, Daniel M. Cohen, Don Buckingham, Timothy P. Cripe, Jessica Hollar, and Farah Craig
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Pediatric emergency ,Pediatrics ,medicine.medical_specialty ,biology ,business.industry ,Health Policy ,Trichomonas ,Human immunodeficiency virus (HIV) ,Psychological intervention ,biology.organism_classification ,medicine.disease_cause ,Combined test ,Medicine ,Clinical staff ,Dysuria ,medicine.symptom ,business ,Order set - Abstract
Background Trichomonas is a common adolescent sexually transmitted infection (STI), causing vaginal pain, discharge and dysuria. Affected individuals are more likely to have co-occurrence of other STIs as well, including HIV. Improving the Trichomonas testing process in the ED may result in a higher, targeted testing rate and thus improved detection and treatment. Objectives To increase Trichomonas testing in the ED among high-risk adolescent patients from 40% in July 2014 to 100% by March 31,2015 and sustain through 2015. Methods A team of MDs, CRNPs, RNs and QI professionals assembled in 2014 to address this need. Six months data was collected to define the baseline rate of testing. Deploying the IHI Model for Improvement, the team formulated an aim statement and identified key drivers. Using root cause analysis, interventions were proposed for each problem area. A series of PDSA cycles were undertaken, and the results of each were monitored using a control chart. These interventions included increasing awareness and education for clinical staff; combined test availability; use of order sets for STI; and adding Licensed Professional Initiated Protocol to nurse ordering practice. This was all done in conjunction with feedback for individual missed cases. Results Over an 18 month period, the rate of Trichomonas testing in the ED rose with each intervention: from 25% (January 2014) to 98% (March 2015) which has been sustained through August of 2015. Conclusions Improving the process of Trichomonas testing of symptomatic adolescents in the ED, results in higher screening rates among ED pediatric providers.[⇓][1][⇓][2] ![Figure 1][3] Figure 1 Trichomonas testing in the ED. ![Figure 2][3] Figure 2 Adolescents with STD and Trichomonas testing. [1]: #F1 [2]: #F2 [3]: pending:yes
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- 2015
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16. Bringing home the right to food in Canada: challenges and possibilities for achieving food security.
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Karen Rideout, Graham Riches, Aleck Ostry, Don Buckingham, and Rod MacRae
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FOOD ,PUBLIC health ,NUTRITION policy - Abstract
AbstractWe offer a critique of Canada's approach to domestic food security with respect to international agreements, justiciability and case law, the breakdown of the public safety net, the institutionalisation of charitable approaches to food insecurity, and the need for ?joined-up? food and nutrition policies. We examined Canada's commitments to the right to food, as well as Canadian policies, case law and social trends, in order to assess Canada's performance with respect to the human right to food. We found that while Canada has been a leader in signing international human rights agreements, including those relating to the right to food, domestic action has lagged and food insecurity increased. We provide recommendations for policy changes that could deal with complex issues of state accountability, social safety nets and vulnerable populations, and joined-up policy frameworks that could help realise the right to adequate food in Canada and other developed nations. [ABSTRACT FROM AUTHOR]
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- 2007
- Full Text
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