Early Goal Research Articles

Healthcare professionals perspectives on feasibility and acceptability of family engagement in early mobilisation for adult critically ill patients: A descriptive qualitative study.

To explore healthcare professionals' perceptions of the feasibility and acceptability of family engagement in early mobilisation for adult critically ill patients. Early mobilisation is beneficial to minimise intensive care unit acquired-weakness in critically ill patients and family engagement can help with meeting early mobilisation goals, but it is not widely practiced. Understanding healthcare professionals' perceptions of feasibility and acceptability of family engagement in early mobilisation of adult critically ill patients is required to inform future implementation strategies to promote early mobilisation. A descriptive qualitative study. Face-to-face, individual, semi-structured interviews were conducted between August 2021 and March 2022 with healthcare professionals working in two intensive care units in Australia. The interviews were analysed using the inductive content analysis, and descriptive statistics were used to summarise participant characteristics. The COREQ checklist was followed when reporting this study. Eleven ICU nurses, five physiotherapists and four physicians participated in the interviews. Three main categories were identified: (i) healthcare professionals' readiness, (ii) mediators of engagement and (iii) foundations for successful implementation. Most participants demonstrated a positive attitude towards an implementation of family engagement in early mobilisation for adult critically ill patients; however, capability and capacity of healthcare professionals, family members' willingness, availability and readiness and the care context were considered factors that could influence the successful implementation. From the perspectives of healthcare professionals, family engagement in early mobilisation is feasible and acceptable to enact but implementation is influenced by contextual factors including, healthcare professionals' capability and capacity and family members' willingness, availability and readiness. Collaborative teamwork and preparing family members and healthcare professionals are needed to support this practice. The findings provide important information to further identify potential strategies of family engagement in early mobilisation and to help and mitigate factors that impede implementation.

Harnessing neuroplasticity to improve motor performance in infants with cerebral palsy: a study protocol for the GAME randomised controlled trial

IntroductionCerebral palsy (CP) is the most common physical disability of childhood worldwide. Historically the diagnosis was made between 12 and 24 months, meaning data about effective early interventions to improve...

MHealth Apps Delivering Early Intervention to Support Parents of Children With Autism Spectrum Disorder: A Scoping Review

Early intervention, and parent-mediated intervention are effective in achieving early childhood development goals for children with autism spectrum disorder. There is a surge in mHealth technologies delivering such interventions. This review aims to explore the concept, context and methodology of implementation of such mHealth apps. A search was conducted using NICE (National Institute of Clinical Excellence) healthcare database, including keyword 'early intervention,' 'mHealth,' 'parent support,' 'apps,' and 'autism.' The quantitative, qualitative, mixed-methods, case reports, grey literature, systematic reviews, clinical trials, and feasibility studies of children between 2 to 6 years with ASD were included from inception of database to December, 2021. Web/Internet-based or computer-dependent programs were excluded. The initial search yielded 3786 studies; 17 were finally included based on the inclusion and exclusion criteria. Studies on a total of mhealth apps were reviewed. Nine apps, apart from TOBY (Therapy outcome by you), lacked a holistic approach and instead targeted a specific difficulty in autism. The provision of support to parents using apps was equally beneficial as in-person support, reduced costs, and improved outcomes in children. The review revealed limited evidence-based mHealth apps available currently in a community setting. This also underscores an opportunity for clinicians to re-direct parents towards evidence-based information and interventions.

Relentless, aggressive, and pervasive: Exploring gender minimization and sexual abuse experienced by women ex-military veterans.

Contextually embedded and sanctioned gender minimization and sexual abuse toward female personnel within the military appears widespread. Left unabated, mental health complications of female personnel will challenge care responsibilities for military organizations. Interview data from six ex-military women that sought positive and negative interpretations of gender minimization and sexual abuse while in the military was analyzed using interpretative phenomenological analysis. Analysis revealed two superordinate themes: (a) Immature Culture, and (b) Ejection and Growth. These overarched four subordinate themes that explored fostered patriarchy and male privilege in the military. Participants expressed experiencing relentless belittling that eroded early adolescent goals of success and aborted their ability to thrive psychologically. By association, interpersonal violence compounded by organizational complicity triggered internalized shame and narcissistic defenses. Discharging from the military is remembered as a painful, isolated struggle for these participants as they sought to make sense of their fragmented identities as women. With time, all participants acknowledged pride in skills achieved during military life, and the strength to speak out against embedded organizational abuse. A persistent ruminative struggle to make sense of complex systemic biases against women that allowed organizational abuse to flourish facilitated posttraumatic growth. For these participants, personal experiences of gender minimization and sexual abuse in the military incubated a betrayal of hope and moral safety. As women, they felt violated at an organizational level seemingly orchestrated by male privilege and patriarchy. Clinical priorities include reparative validation and holistic trauma support underpinned by trauma and posttraumatic growth frameworks. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Diagnosis and Treatment of AL Amyloidosis.

Systemic light chain (AL) amyloidosis is caused by an usually small B cell clone that produces a toxic light chain forming amyloid deposits in tissue. The heart and kidney are the major organs affected, but all others, with the exception of the CNS, can be involved. The disease is rapidly progressive, and it is still diagnosed late. Screening programs in patients followed by hematologists for plasma cell dyscrasias should be considered. The diagnosis requires demonstration in a tissue biopsy of amyloid deposits formed by immunoglobulin light chains. The workup of patients with AL amyloidosis requires adequate technology and expertise, and patients should be referred to specialized centers whenever possible. Stagings are based on cardiac and renal biomarkers and guides the choice of treatment. The combination of daratumumab, cyclophosphamide, bortezomib and dexamethasone (dara-CyBorD) is the current standard of care. Autologous stem cell transplant is performed in eligible patients, especially those who do not attain a satisfactory response to dara-CyBorD. Passive immunotherapy targeting the amyloid deposits combined with chemo-/immune-therapy targeting the amyloid clone is currently being tested in controlled clinical trials. Response to therapy is assessed based on validated criteria. Profound hematologic response is the early goal of treatment and should be accompanied over time by deepening organ response. Many relapsed/refractory patients are also treated with daratumumab combination, but novel regimens will be needed to rescue daratumumab-exposed subjects. Immunomodulatory drugs are the current cornerstone of rescue therapy, while immunotherapy targeting B-cell maturation antigen and inhibitors of Bcl-2 are promising alternatives.

"A Different Ride": A Qualitative Interview Study of Parents' Experience with Early Diagnosis and Goals, Activity, Motor Enrichment (GAME) Intervention for Infants with Cerebral Palsy.

Cerebral palsy is the most common physical disability of childhood, and early diagnosis followed by best practice early intervention is important for optimizing child and family outcomes. We investigated parents' views of an early diagnosis of cerebral palsy (CP), followed by Goals, Activity, Motor Enrichment (GAME) intervention. Semi-structured interviews were conducted within a pilot randomised clinical trial. Transcriptions were analyzed using grounded theory. Participants were nine mothers whose infants had received GAME intervention because they were identified as being at high risk for cerebral palsy early in infancy. The parenting experience was described as a "different ride". The diagnosis was devastating with many time-consuming challenges, but acceptance ensued. Parents wanted an early diagnosis, prognosis, and early intervention, despite the anxiety and workload, because it meant they could help. Parents perceived that GAME was beneficial because they were taught how to help; it was goal-based and home-based. They believed the collaboration and communication skills of the therapist shaped success. Future research should focus on a broader range of participants to understand parent's experiences with key aspects of early intervention more fully.

Early goals

Melody Gater, BA Early Childhood Student, early years practitioner and mother, tells us about her journey into working with children starting early, and how having her own child alongside studying has significantly added to her knowledge of children's development.

Greek Orthodox.

There are approximately 300 million members of the Greek Orthodox Church worldwide. It is the second-largest Christian church. Followers of this religion believe in eternal life. Thus, the church strongly emphasizes a positive outcome in death- "the deceased is alive with God." God is believed to be the healer of our souls and bodies, which is facilitated through prayer and participation in the life of the Church. Traditional medical interventions are generally accepted. Artificial life support is justifiable only when it offers a hope for meaningful recovery. Just as death should not be hastened, the natural dying process should not be prolonged. Timely advance care planning and early treatment goals discussions to help understand how the patient would define quality of life is paramount to setting limitations on what could be considered as nonbeneficial care. The medical team should not assume that all patients of the Greek Orthodox faith will feel the same around end-of-life beliefs and practices. This chapter aims to identify common themes and the historical contextual framework that may influence the way in which medical decision making is made by those who specifically subscribe to the Greek Orthodox faith.

Community perspectives on support goals for young autistic children: A qualitative investigation

Goal setting is integral to the provision of effective support, but little is known about community perspectives on support goals for autistic children. A total of 41 autistic adults, 50 parents of autistic children and 31 clinical professionals living in New Zealand and Australia completed open-ended survey questions regarding their perceptions of support goals for young autistic children. Reflexive thematic analysis resulted in five overarching themes related to early support goals: (a) neurodiversity affirming, (b) change the environment, not the child, (c) helping adults to support autistic children, (d) quality of life and (e) respect boundaries. The perspectives of autistic adults, parents and professionals were mostly aligned.

Beyond Vaccination Coverage: Population-Based Measurement of Early Childhood Immunization Schedule Adherence.

The immunization schedule recommended by the U.S. Advisory Committee on Immunization Practices (ACIP) provides a structure for how 10 different vaccine series should be administered to children in the first 18 months of life. Progress toward US early childhood immunization goals has largely focused on measuring vaccination coverage at age 24 months. However, standard vaccination coverage measures do not reflect whether children received vaccine doses by recommended ages, or whether vaccines were given concomitantly, per the schedule. In this paper, we describe innovations in population-level measurement of immunization schedule adherence through quantifying vaccination timeliness and undervaccination patterns. Measuring vaccination timeliness involves comparing when children received vaccine doses relative to ACIP age recommendations. To assess undervaccination patterns, children's vaccination histories are analyzed to determine whether they were vaccinated consistent with the ACIP schedule. Some patterns, such as spreading out vaccines across visits, are indicative of parental hesitancy. Other patterns, such as starting all recommended series but missing doses, are largely indicative of other immunization services delivery challenges. Since 2003, at least 12 studies have used National Immunization Survey-Child, immunization information system, or integrated health plan data to measure vaccination timeliness or undervaccination patterns at national or state levels. Moving forward, these novel measures can be leveraged for population-based surveillance of vaccine confidence, and for distinguishing undervaccination due to parental vaccine hesitancy from undervaccination due to other causes. Broader adoption of these measures can facilitate identification of targeted strategies for improving timely and routine early childhood vaccination uptake across the United States.

1279: EARLY GOALS-OF-CARE DISCUSSION IN GERIATRIC TRAUMA IS ASSOCIATED WITH INCREASED CODE STATUS CHANGES

Introduction: The Trauma Quality Improvement Program guidelines recommend early goals of care (GOC) discussions within 72 hours of admission for geriatric trauma patients. Despite this recommendation family meetings and GOC conversations are often performed in a delayed fashion. We hypothesized that early GOC discussions are associated with higher incidence of goal concordant care manifested as code status changes and implementation of comfort measures only (CMO), as well as shorter hospital length of stay (LOS). Methods: A retrospective chart review was performed on patients aged ≥65 years admitted to Hartford Hospital intensive care units (ICU) with a trauma diagnosis between January 2020 and December 2021. Demographics, timing of GOC discussion, and clinical outcomes were collected. Results: Of 273 identified patients, 78% were male, and median age was 79 years (interquartile range, IQR 71 – 86). Median injury severity scale (ISS) was 13 (IQR 9 – 21), and the most common mechanism of injury was falls (77%). Only 51 (19%) had a GOC discussion documented in the chart within 72 hours of admission. In a logistic regression model adjusting for significant variables, early GOC discussion was associated with higher likelihood for changing code status (adjusted odds ratio, OR 6.0; p< 0.001) and transitioning to CMO (OR 3.4; p=0.008), compared to having GOC discussion after 72 hours or not at all. Among those who had GOC discussion during hospitalization, early GOC discussion was associated with shorter ICU LOS (β=-7.4; p=0.014) and hospital LOS (β=-10.9; p=0.008), adjusting for significant variables identified on the univariable analysis. Patients who had GOC discussion within 72 hours were at significantly lower odds of undergoing invasive procedures (OR 0.41; p=0.02). Conclusions: Early GOC discussion within 72 hours of admission is associated with higher likelihood of code status change and election of CMO in geriatric trauma patients. Interventions to increase adherence to the early GOC meeting recommendation should be emphasized at an institutional level.

Commodifiaction Of Workers On Esports Athletes In Digital Sports Industry

The Esports industry has begun to produce various media platforms that display interesting game content played by athletes, to attract viewers to join the platform through live streaming. The purpose of this study is to analyze the meaning of commodification of workers from the athlete's perspective, who are already involved as commodities. The expected benefits are recommendations to minimize the forms of commodification such as exploitation of workers. This study uses a review of media political economy theory that is associated with the movement of the esports industry ecosystem. The approach used in this research is qualitative by using a descriptive study. The data collection technique uses an in-depth interview method with esports athletes, virtual observation, and collecting documents. The findings are that esports athletes consciously feel that their identity as an athlete becomes a commodity that has a selling value to agencies and other actors in the digital sports industry. However, the good income and not being seriously regulated, allows them to reach as much profit as possible, although there are still revenue cuts from the agency. This profit also changes their early goals and mindset as esports athletes, from being a games players and start thinking about profit even though they realize are being exploited. The finding is the athlete's ability to conjure up their role as a commodity in the industry, by utilizing the athlete's identity as a valueable commodity for their own benefit.

In-hospital, 30- and 90-day mortality in elderly trauma patients with operative feeding tubes

BackgroundNutrition is essential in the treatment of elderly trauma patients (ETP). ETP experience dysphagia at rates six times higher than the non-trauma elderly population (NTEP) and are at increased risk for malnutrition. Operative feeding tube (OFT) placement is often used to aid with the nutritional management of ETP. Elderly patients experience higher rates of morbidity and mortality when compared to the general population, especially in the traumatic setting, with some data suggesting in-hospital mortality as high as 10%. However, the mortality rates and associated comorbidities associated with OFT in ETP are unknown. The purposes of this study were to establish the mortality rate in hospital as well as 30- and 90-days following discharge among elderly trauma patients (ETP) receiving OFT, and to assess factors associated with mortality within this population. MethodsA retrospective review of all trauma patients from a single Level I Trauma Center from 01/2010-09/2020 was conducted. Exclusion criteria were patients under 65 years of age or those with previously placed OFT. Demographics, comorbidities, injury mechanisms, injury severity scores (ISS), and OFT data were collected from the institutional trauma registry. Mortality data were obtained using the Social Security Death Index. Mortality at discharge, 30 days, and 90 days following discharge were the primary outcomes. Bivariate analysis was conducted to compare characteristics and comorbidities of patients alive and dead at the time points of interest. ResultsThere were 151 ETP who received OFT. Patients were largely male (67.5%), severely injured via a blunt mechanism (95%), and had a median age of 76 years. 11 (7.3%) experienced in-hospital mortality following feeding tube placement, 21 (13.9%) died within 30 days, and 31 (20.5%) within 90 days. Bivariate analysis demonstrated that ETP who died were more likely to have a history of dementia (p = 0.004), congestive heart failure (p = 0.014), and end-stage liver disease (p = 0.034). No other patient or injury factors were associated with mortality after OFT placement. ConclusionMortality rates for ETP with OFT were higher than anticipated, yet favorable compared to recently reported data. Patients who died were more likely to have dementia, CHF, or ESLD than those who survived. The few comorbidities associated with mortality suggest that nearly all ETP who undergo OFT placement are at risk for mortality. Additionally, the data highlights the importance of early goals of care discussions for ETP and their loved ones when operative feeding tubes are being considered. Level of evidenceLevel III. Study typePrognostic/Therapeutic/Diagnostic Test/Economic/Decision;

Integrating invasive species risk assessment into environmental DNA metabarcoding reference libraries.

Environmental DNA (eDNA) metabarcoding has shown promise as a tool for estimating biodiversity and early detection of invasive species. In aquatic systems, advantages of this method include the ability to concurrently monitor biodiversity and detect incipient invasions simply through the collection and analysis of water samples. However, depending on the molecular markers chosen for a given study, reference libraries containing target sequences from present species may limit the usefulness of eDNA metabarcoding. To explore the extent of this issue and how it may be resolved to aid biodiversity and invasive species early detection goals, we focus on fishes in the well-studied Laurentian Great Lakes region. First, we provide a synthesis of species currently known from the region and of non-indigenous species identified as threats by international, national, regional, and introduction pathway-specific fish risk assessments. With these species lists, we then evaluate 23 primer pairs commonly used in fish eDNA metabarcoding with available databases of sequence coverage and species specificity. Finally, we identify established and potentially invasive non-indigenous fish that should be prioritized for genetic sequencing to ensure robust eDNA metabarcoding for the region. Our results should increase confidence in using eDNA metabarcoding for fisheries conservation and management in the Great Lakes region and help prioritize reference sequencing efforts. The ultimate utility of eDNA metabarcoding approaches will come when conservation management of existing fish communities is integrated with early detection efforts for invasive species surveillance to assess total fish biodiversity.

A REVIEW METHOD FOR IDENTIFICATION OF RARE AND ENDANGERED PLANTS THROUGH DNA BARCODING

DNA barcoding is a new concept. It has been developed for providing fast, precise and automatable species identification which uses standardized DNA sequences as tags. DNA barcoding can provide the taxonomists; conservationists. The early goal of the DNA barcoding process is to build online libraries of barcode sequences for all known species that can serve as a standard to which DNA barcodes of any identified or unidentified specimens can be matched. This can improve several inherent problems related with traditional taxonomic identification, based on morphological characters, such as incorrect identification of species due to phenotypic plasticity and genotypic variability of the characters, such as incorrect identification of species due to phenotypic plasticity and genotypic variability of the characters, overlooking cryptic taxa, difficulty in finding reliable characters due to long maturity periods (CBOL Plant Working Group, 2009). It is particularly of much use in areas where species identification with morphological characters is not practicable due to widespread damage or delayed expression. It should be enduring in mind that DNA barcoding is not an alternative to taxonomy, and it cannot replace taxonomy as such, but is a useful tool that creates information on unknown taxa. In this paper, methods of the process of selecting and redefining barcodes for plants evaluation of the factors which manipulate the discriminatory power of the advance with some early applications of DNA barcoding are discussed and then added the authors’ for their views and recommendations.

Surviving White-out: How to Manage Severe Noninfectious Acute Lung Allograft Dysfunction of Unknown Etiology.

Surviving White-out: How to Manage Severe Noninfectious Acute Lung Allograft Dysfunction of Unknown Etiology.

POS-055 EMPHYSEMATOUS PYELONEPHRITIS IN THE COVID & CANCER ERA- CASE SERIES FROM A TERTIARY CARE HOSPITAL IN CHENNAI, SOUTH INDIA

Emphysematous pyelonephritis (EPN) is a rare yet life threatening, necrotizing renal parenchymal infection with a mortality rate of 20-25%. With advent of CT, early goal directed therapy with antibiotics, aggressive treatment of sepsis and percutaneous drainage techniques, the mortality and morbidity rates are not as grim as earlier reports. Nephrectomy, treatment of the past has been replaced with nephron sparing surgery with better patient outcomes. A retrospective study was conducted at Government Kilpauk Medical College Hospital between January 2020 and April 2022.

Constructing “People’s Science-Technology”: The Culture of Science and Technology in Early North Korea, 1945-1950

This article examines how North Korean leadership in 1945-50 strove to popularize “people’s science-technology 인민의 과학기술,” equipping an assertive attitude in matters of science and technology, arguing that the Soviet Union served as the most important point of reference that tremendously inspired, and to a lesser degree materially supported, North Korean planners to employ this attitude as a mobilization scheme. Drawing upon a range of previously unexamined Soviet archival sources and relevant North Korean publications, it is this author’s intent to offer original narratives of how limited but crucial Soviet assistance undergirded North Korean leaders’ quest for an advanced economy and how various North Korean actors understood and acted upon “people’s science-technology.” Charting the intentions and roles of North Korean policy-makers, North Korean expert communities, and the Soviet authorities in the making of the culture of science and technology in early North Korea, the expectations and goals as perceived and practiced by the North Koreans are revealed in this research. Additionally, North Koreans’ understanding of science and technology, which greatly boosted the country’s extended engagement with the socialist bloc in the search for its own mode of continuing industrial development in the subsequent decade, is examined.

Evaluating the efficacy of urinary trypsinogen-2 Dipstick test in diagnosing acute pancreatitis

Acute Pancreatitis (AP) is a very common cause of acute abdomen in emergency department. The disease may vary from mild self-limiting symptoms to multi organ failure and has high mortality rate. Although most of the cases are treated by mild symptomatic treatment but severe cases require intensive monitoring, so early diagnosis and goal directed treatment is very essential to reduce mortality and morbidity of disease. The present study aims to know the efficacy of urinary trypsinogen-2 dipstick test in early diagnosis of acute pancreatitis. The prospective study sample included 98 patients who were presented to emergency department of Maharaja Krishna Chandra Gajapati Medical College &amp; Hospital (MKCGMCH), Berhampur between August 2018 and July 2020 with acute severe pain abdomen suggestive of acute pancreatitis. Urine sample were obtained and results were recorded. Blood sample of all the patients were sent for serum amylase, lipase. Urinary Trypsinogen (UT)-2 dipstick test, based on principle of immunochromatographic, was done at the time of admission and serum amylase and lipase were sent for all patients. Serum Lipase was done through Calorimetric Method and Serum Amylase was done through Coupled Enzymatic Assay Method. Ultrasonography (USG) and Contrast-Enhanced Computed tomography (CECT) abdomen were sent after 4-5 days of admission and final diagnosis was made on the basis of CECT report. Of 98 patients, 47 cases were final diagnosed to have acute pancreatitis. Sensitivity and specificity of Urinary Trypsinogen (UT)-2 was found to be 91.48% and 94.11% respectively and Positive Predictive Value (PPV) and Negative Predictive Value (NPV) was found to be 93.47% and 92.30% respectively. Sensitivity, specificity, PPV and NPV of Serum Amylase was found to be 76.5%, 74.5%, 74.5% and 74.5% respectively and similarly, sensitivity, specificity, PPV and NPV was found to be 80.85%, 72.5%, 73.1% and 80.4% respectively. Urinary Trypsinogen (UT)-2 Dipstick test has high sensitivity, specificity, PPV and NPV and therefore can be used reliably in emergency setting for diagnosis and thereby start a goal directed treatment and thus, reduce the mortality and morbidity of the disease.

Analysis of Extended Length of Stay in a Comprehensive Cancer Center

Background: The management of cancer patients is complex and usually requires hospital admission in order to diagnose and treat complications related to cancer or its therapies. Solid tumor patients have a mean length of stay (LOS) of about 6 to 9 days. A large portion of the cancer patients has extended length of stay more than 10 days. Long hospital stays utilize more resources and is more expensive. Methods: We aimed to assess characteristics of patients with an extended length of stay at UT MD Anderson OncoHospitalist service in 2019 to identify focus areas that can help decrease extended LOS. Results: 172 out of 1449 patients with extended LOS were analyzed. This study has a 95% confidence interval of finding the true value within (±7%) of the real value. The results showed that 84% of prolonged admissions were due to medical issues and 18% of the patients were either discharged to hospice or died during their hospital stay. Further breakdown of the medical reasons for extended LOS indicated less 4% of these patients received inpatient radiation therapy; around 3% had complications from immunotherapy; 2% patients had issues with pain control and 7% of these patients had issues with placement. Overall, 50% of the patients who had issues with placement had Medicare and 25% had no health insurance. The study was unable to determine any association between the distances of primary residence from hospital to extended LOS. Conclusion: The study was able to identify focus areas such as early Goals of Care (GOC) in end-of-life care, protocolization of immunotherapy adverse reaction therapy, and criteria-based approach to earlier radiation oncology consultation for palliative radiation therapy. All of which will help decrease the extended LOS at places like UT MD Anderson and others.