Recovery Center Research Articles

Acute Ischemic Stroke Large Vessel Occlusion treated with Mechanical Thrombectomy in the Pediatric Populatio (P8-5.015)

<h3>Objective:</h3> We sought to assess the safety and efficacy of mechanical thrombectomy performed in children at our institution for acute ischemic stroke (AIS) due to large vessel occlusion (LVO). <h3>Background:</h3> AIS due to large vessel occlusion (LVO) is relatively rare in the pediatric population, and evidence supporting thrombectomy in children is limited. The use of thrombectomy in the pediatric population is extrapolated from data in the adult stroke literature. <h3>Design/Methods:</h3> We performed a retrospective chart review of pediatric patients (age &lt; 18 years) with AIS due to LVO who underwent thrombectomy at our comprehensive academic stroke center from January 2019 to June 2022. <h3>Results:</h3> We identified 4 cases of pediatric AIS with LVO treated with thrombectomy. The mean age was 12 years old (range, 9–17), 3 were males. The mean National Institutes of Health Stroke Scale was 16 (range, 10 to 28). One patient received partial thrombolysis (aborted with 20% of dose received). Prior to thrombectomy, 1 patient had CT brain perfusion which showed MCA mismatch favorable for thrombectomy, whereas the remaining 3 patients had MRI brain showing acute infarct in the territory of LVO. LVO sites included M1 occlusion (2), carotid T occlusion (1), and M2 occlusion (1). All 4 patients had successful revascularization including 3 patients with thrombolysis in cerebral infarction (TICI) 3 and 1 patient with TICI 2b. There were no symptomatic hemorrhages. The mean time from last known normal to groin puncture was 5.7 hours (range, 2.9 to 9.2). The clinical outcomes included 2 patients with modified rankin scores (mRS) 1 and 2 patients with mRS 3. <h3>Conclusions:</h3> In our case series of pediatric AIS cases with LVO, thrombectomy was feasible and associated with successful revascularization. There were no safety concerns. The majority of cases were diagnosed by MRI brain, highlighting the difficulty in diagnosis of LVO in the pediatric population. <b>Disclosure:</b> Mrs. Glenn has nothing to disclose. Dr. Lee has nothing to disclose. Shahid Nimjee has nothing to disclose. The institution of Dr. Lo has received research support from NIH. Dr. Lo has received publishing royalties from a publication relating to health care. Mrs. Forrest has nothing to disclose. Randheer Yadav has stock in Quest Recovery Center LLC. Patrick Youssef has nothing to disclose.

Exploring the Impact of Buprenorphine/naloxone (Suboxone) Use to Length of Sobriety After Opioid Detoxification

PurposeThe purpose of this descriptive correlational study with retrospective chart review was to explore the relationship between inpatient buprenorphine/naloxone (Suboxone) protocols and discharge prescription practices with LOS at an inpatient western Washington Recovery Center. An approval letter from the organization's Director and IRB approval was obtained. The opioid crisis remains a public health concern. Utilization and access to quality Medication Assisted Treatment (MAT) for detoxification can impact length of sobriety (LOS). Relapse rates remain significant for opioid use disorder (OUD). Providers must consider many factors when prescribing buprenorphine/naloxone (Suboxone) inpatient and at discharge. Protocol and prescription practices play a role in relation to LOS and readmission. The conceptual framework was the John Hopkin's evidence-based practice (EBP) model which promotes an inquiry-based approach using evidence-based practice. MethodsWhat is the relationship between inpatient buprenorphine/naloxone (Suboxone) protocols, discharge prescriptions, and LOS? A convenient medical record sample of 150 patient charts were utilized between January 1, 2020, to December 31, 2021, which included a total of 244 readmissions, resulting in a total of 394 admissions. The sample included male and female adult patients over age 18 years who readmitted within one year after completing prior opioid detoxification treatment. Discharge summary and admission intake forms were utilized. ResultsRisk of relapse within 115 days was significantly higher without buprenorphine/naloxone (Suboxone) at discharged, compared to with (RR 3, CI 1.97-5.17; RR 0.34, CI 0.22-0.58). Buprenorphine/naloxone (Suboxone) prescription increased LOS by 42 days (95% CI, p<.0008). Buprenorphine/naloxone (Suboxone) protocol BID increased LOS significantly compared to other protocol groups. Conclusions: Buprenorphine/naloxone (Suboxone) is a partial opioid agonist, and this study is significant for persons involved in pain management, OUD, and the prescription practices impact LOS. It is unclear if it improves quality of life for patients and decreases opioid cravings. Future research is warranted.

Cluster analysis of COVID-19 recovery center patients at a clinic in Boston, MA 2021–2022: impact on strategies for access and personalized care

BackgroundThere are known disparities in COVID-19 resource utilization that may persist during the recovery period for some patients. We sought to define subpopulations of patients seeking COVID-19 recovery care in terms of symptom reporting and care utilization to better personalize their care and to identify ways to improve access to subspecialty care.MethodsProspective study of adult patients with prior COVID-19 infection seen in an ambulatory COVID-19 recovery center (CRC) in Boston, Massachusetts from April 2021 to April 2022. Hierarchical clustering with complete linkage to differentiate subpopulations was done with four sociodemographic variables: sex, race, language, and insurance status. Outcomes included ICU admission, utilization of supplementary care, self-report of symptoms.ResultsWe included 1285 COVID-19 patients referred to the CRC with a mean age of 47 years, of whom 71% were female and 78% White. We identified 3 unique clusters of patients. Cluster 1 and 3 patients were more likely to have had intensive care unit (ICU) admissions; Cluster 2 were more likely to be White with commercial insurance and a low percentage of ICU admission; Cluster 3 were more likely to be Black/African American or Latino/a and have commercial insurance. Compared to Cluster 2, Cluster 1 patients were more likely to report symptoms (ORs ranging 2.4–3.75) but less likely to use support groups, psychoeducation, or care coordination (all p < 0.05). Cluster 3 patients reported greater symptoms with similar levels of community resource utilization.ConclusionsWithin a COVID-19 recovery center, there are distinct groups of patients with different clinical and socio-demographic profiles, which translates to differential resource utilization. These insights from different subpopulations of patients can inform targeted strategies which are tailored to specific patient needs.

Contraception use among individuals with substance use disorder increases tenfold with patient-centered, mobile services: a quasi-experimental study

BackgroundIndividuals with substance use disorders (SUD) have disproportionately high rates of unintended pregnancy. Reducing harm associated with this risk and its biopsychosocial consequences requires evidence-based, non-coercive interventions that ensure access to contraception for individuals who choose to prevent pregnancy. We examined feasibility and impact of SexHealth Mobile, a mobile unit-based intervention that aimed to increase access to patient-centered contraceptive care for individuals in SUD recovery programs.MethodsWe conducted a quasi-experimental study (enhanced usual care [EUC] followed by intervention) at three recovery centers with participants (n = 98) at risk for unintended pregnancy. EUC participants were offered printed information on community locations where they could access contraception care. SexHealth Mobile participants were offered same-day, onsite clinical consultation on a medical mobile unit and contraception if desired. The primary outcome was use of contraception (hormonal or intrauterine device) at one-month post-enrollment. Secondary outcomes were at two-weeks and three-months. Confidence in preventing unintended pregnancy, reasons for non-use of contraception at follow-up, and intervention feasibility were also assessed.ResultsParticipants (median age = 31, range 19–40) enrolled in the intervention period were almost 10 times more likely to be using contraception at one-month (51.5%) versus the those enrolled in the EUC period (5.4%) (unadjusted relative risk [URR] = 9.3 [95%CI: 2.3–37.1]; adjusted relative risk [ARR] = 9.8 [95%CI: 2.4–39.2]). Intervention participants were also more likely to be using contraception at 2-weeks (38.7% vs. 2.6%; URR = 14.3 [95%CI: 2.0–104.1]) and three-months (40.9% vs. 13.9%; URR = 2.9 [95% CI: 1.1–7.4]). EUC participants reported more barriers (cost, time) and less confidence in preventing unintended pregnancies. Mixed-methods feasibility data indicated high acceptability and feasible integration into recovery settings.ConclusionsMobile contraceptive care based on principles of reproductive justice and harm reduction reduces access barriers, is feasible to implement in SUD recovery settings, and increases contraception use. Expanding interventions like SexHealth Mobile may help reduce harm from unintended pregnancies among individuals in SUD recovery.Trial Registration NCT04227145.

Inpatient and outpatient treatment by specialist infant nutrition centres in Argentina effectively reduced child malnourishment.

We evaluated the impact of inpatient and outpatient treatment provided by an infant nutrition foundation in Las Heras, Mendoza, Argentina and identified the factors that influenced nutritional recovery. This 2010-2018 retrospective study was based on 300 children up to 5 years of age with primary malnutrition, who were treated by an inpatient recovery centre, then an outpatient prevention centre. We analysed the children's height, weight, psychomotor development and living conditions when they were admitted, discharged and had received 1 year of outpatient treatment. There were full data on 241 children and just admission and discharge data for 59. The children's mean age on admission and weight were 14.8 ± 12.4 months and 6.9 ± 2.3kg and they stayed in hospital for a mean of 59.5 ± 49.7 days. We observed a significant increase in the weight-for-age, height-for-age and weight-for-height z-scores when all three time points were compared (p < 0.001). Psychomotor development improved considerably in all patients after treatment. The factors that negatively influenced nutritional recovery were higher age at admission, suboptimal breastfeeding practices, low birth weight, longer hospital stays, younger maternal age and overcrowded housing. Combining inpatient recovery and outpatient preventive treatment was effective for undernourished children in Argentina.

A Public Health, Whole-of-Government Approach to National Suicide Prevention Strategies

A Public Health, Whole-of-Government Approach to National Suicide Prevention Strategies

About a case: affective psychosis and hyperthyroidism

IntroductionHyperthyroidism due to Graves-Basedow disease is a common cause of neuropsychiatric manifestations, such as anxiety, psychomotor restlessness, mood disturbances, insomnia and psychosis. Hashimoto’s encephalopathy rarely occurs in so-called autoimmune thyroiditis, which can present with hyperthyroidism and neuropsychiatric symptoms similar to Graves’ disease. We add that the mystical-religious beliefs, present in all human cultures, and decisive in the case at hand, make us propose an evolutionary origin of them.ObjectivesClinical case descriptionMethodsA clinical case based on medical reports is describedResultsWe present the case of a 72-year-old woman, a member of the Seventh-day Adventist Church, well adapted to the Community. Known history of elevated antithyroid antibodies since 2019, brought to the emergency room involuntarily due to a mystical-religious delusional condition associated with behavioral disturbance. On examination, cachectic appearance, distal tremor, emotional exaltation and megalomanic speech were highlighted. Laboratory tests revealed primary hyperthyroidism with elevated antibodies. During admission, the differential diagnosis between Graves-Basedow disease and Hashimoto’s encephalopathy was considered. Thyroid scintigraphy oriented the diagnosis to Graves-Basedow disease, not requiring lumbar puncture or corticosteroid treatment. Treatment was based on high-dose antithyroid and antipsychotic drugs, with clinical and analytical remission at 3 weeks. The patient was referred to a Social Health Center for functional recovery. The family refers to a similar episode in 2014, of less intensity and self-limited, which is proposed to be a hashitoxicosis.ConclusionsDifferential diagnosis between Graves-Basedow and Hashimoto disease is essential as they differ in treatment and prognosis. The continuity that the delusion presents with the previous beliefs of the patient, differing mainly in the affective-behavioral implication, makes us consider a predisposition to psychosis in our patient. Religiosity can be adaptive in certain environments, since mystical beliefs have existed throughout the history of the human species and seem to be part of our nature.Disclosure of InterestNone Declared

The 20-year paradigm shift toward organ recovery centers: 2500 donors at Mid-America Transplant and broader adoption across the United States

On March 1, 2001, Mid-America Transplant, the organ procurement organization (OPO) located in St Louis, Missouri, performed the first organ recovery of a brain-dead donor in a hospital-independent, free-standing, organ recovery center (ORC), with successful transplantation of a liver. This was the inception of a paradigm shift in donor management and organ procurement, moving away from the traditional method of using the donor hospital. In the last 20 years, many advances have occurred in the ORC. Brain-dead donors are moved within hours of authorization to fully equipped intensive care units. Some ORCs are equipped with computed tomography scanners, portable radiography, laboratory facilities, bronchoscopy, and a cardiac catheterization laboratory. ORCs have dedicated surgical suites, and operating time is frequently during the day and is rarely delayed. Donor management in an ORC is more consistent, efficient, and effective than that in a donor hospital, and studies have demonstrated increased organ yield. Multiple studies have demonstrated a cost benefit of an ORC as well as providing an ideal environment for donor research studies. Currently, there are 24 of 57 OPOs that are using an independent or hospital-based ORC to manage their donors. We review the history and describe the current state of ORCs.

Integrated Supports for Women and Girls Experiencing Substance Use and Complex Needs.

There is strong research to support integrated and gender-sensitive harm reduction approaches for supporting women, girls, and gender diverse people. For individuals who are pregnant, flexible and integrated treatment approaches may be especially important. In this study, we report on an integrated program in rural Canada designed to support pregnant women, girls, and gender diverse people experiencing substance use and other complex needs. Program data (N = 393) from the 2nd Floor Women's Recovery Centre (2nd Floor) at the Lakeland Centre for Fetal Alcohol Spectrum Disorder (LCFASD) was analyzed with several aims. Study goals were to (1) describe characteristics and needs of clients, (2) identify factors associated with program completion, and (3) for a subset of clients, examine resources, wellbeing, and social and behavioral outcomes after treatment. Clients (Mage = 27.4 years, range 15-64) presented at the 2nd Floor with complex medical and mental health needs, and experiences of significant socioenvironmental adversity. However, almost two-thirds (63.4%) successfully completed the program, which was more likely for clients who had stable housing at intake and a possible or confirmed diagnosis of FASD. After treatment, clients reported high levels of wellbeing, and most were connected to health care and community resources. In the year after program completion, clients who were contacted for follow-up maintained strong connection to resources and reported notable improvements in social and behavioral functioning. Many were working or volunteering, most were in stable home environments, rates of substance use and legal involvement were substantially reduced, and many clients were actively caring for their children. This study offers important findings to inform future research, practice, and policy for supporting health and wellbeing for women, children, families, and communities.

Scenario-based multi-objective optimisation model based on supervised machine learning to configure a plastic closed-loop supply chain network

Plastic recycling has received a lot of attention around the world. In this regard, a multi-objective optimisation model for plastic closed loop supply chain (CLSC) configuration is developed. Specifically, this paper simultaneously investigates the impact of adding washing machines to plastic recovery centres and corporations' role in consumer awareness on plastic recycling on plastic CLSC network configuration cost and carbon dioxide (i.e., CO2) emissions. Our numerical results indicate that the combination of adding washing machines to recovery centres, and increased return of plastic products due of increased corporate responsibility in consumer awareness have the potential to contribute to both economic and environmental pillars of sustainability by decreasing the design cost, i.e., by 3.93%, and CO2 emissions, i.e., by 14.24%. Furthermore, sensitivity analysis is conducted to consider the effects of unpredictable changes in demand and return. The implications of our study concerning social sustainability, policymakers, and municipalities are discussed.

АРХІТЕКТУРА ІоТ-ЕКОСИСТЕМИ РЕАБІЛІТАЦІЙНОГО ЦЕНТРУ ВІДНОВЛЕННЯ ОПОРНО-РУХОВОГО АПАРАТУ

Background. A study of the use of IoT technologies in modern medicine, primarily in Ukraine, was conducted. Based on the analogs of the existing systems considered, taking into account the entire complex situation, the number of people in need of rehabilitation is only increasing, and there are simply not enough centers for such assistance. Rehabilitation doctors spend a lot of their time, while not everyone can get the necessary help due to the lack of specialists. As a result, there is a need to create your own IoT system to automate and optimize treatment processes. Methods. Methods of analysis, synthesis and complex systems design are employed in the research. Results. The architecture of the IoT ecosystem of the rehabilitation center for recovery after injuries, traumas, assaults and operations was developed. The project architecture consists of simulators with sensors and a Wi-Fi module for data transmission to the cloud with a database and cloud computing. The end user, i. e. the doctor, can access this data through the app, process it, monitor performance and enter a training plan for each patient. It should be noted that each patient will be issued a card with an RFI tag or an IoT beacon. The card identifies the patient on each simulator. The simulator is adjusted according to the indicators. The indicators of a specific person’s condition are transferred to a database for tracking by a doctor. Сonclusions. Implementation of the proposed solutions is expected to allow one to substantially increase the quality of medical treatment provision to the population in Ukraine.

Evaluation of resilience components of the identity of recovered addicts in resocialization: a case study of clients in addiction rehabilitation centers in districts 4, 6 and 22 of Tehran)

Background and Aim: Drug addiction is one of the most important problems of the present era, which has gained a global scope, has gone beyond the boundaries of health and treatment, and has turned into a social and family problem. Addiction, in most cases, causes a person to be isolated from society. Therefore, the present study aimed to evaluate the resilience components of the identity of recovered addicts in resocialization: the case study of referrals in addiction recovery centers in districts 4, 6 and 22 of Tehran). Methods: The current research was a descriptive survey research in terms of its practical purpose and in terms of the method of data collection. The method of conducting this study (post-event) as well as this study was in the scope of quantitative research. In the present study, the population included all people who recovered from addiction in rehabilitation centers in Tehran's 4th, 6th, and 22nd districts. The method of selecting samples randomly was simple. Among the 2580 people who referred to these centers, 388 people were selected randomly and with a probability proportional to the volume of the center's clients. For this, a list of centers and the number of its clients was prepared, and 11 centers were systematically selected. This study was carried out in accordance with ethical considerations. The data collection tools were demographic characteristics, resilience scale, and a researcher-made questionnaire on the factors affecting addiction recovery. Data analysis was done by SPSS 24.0 statistical software. Results: The results showed a significant difference between the average scores of identity resilience of those who recovered from addiction in the post-test with resocialization (P&lt;0.01) so the level of socialization had increased. Conclusion: According to the obtained results, it can be claimed that environmental protective factors, environmental risk factors, and exchange-environmental processes are effective in resiliency against abuse and prevention of re-addiction.

Tetracycline Resistance Genes in Wild Birds from a Wildlife Recovery Centre in Central Italy

Wild animals are less likely to be exposed directly to clinical antimicrobial agents than domestic animals or humans, but they can acquire antimicrobial-resistant bacteria through contact with humans, animals, and the environment. In the present study, 254 dead free-living birds belonging to 23 bird species were examined by PCR for the presence of tetracycline resistance (tet) genes. A fragment of the spleen was collected from each bird carcass. A portion of the intestine was also taken from 73 of the 254 carcasses. Extracted DNA was subjected to PCR amplification targeting the tet(L), tet(M), and tet(X) genes. In total, 114 (45%) of the 254 birds sampled belonging to 17 (74%) of the 23 bird species tested were positive for one or more tet genes. The tet(M) gene showed a higher frequency than the other tested genes, both in the spleen and in the intestine samples. These results confirm the potential role of wild birds as reservoirs, dispersers, or bioindicators of antimicrobial resistance in the environment.

Impact of a trauma recovery center on emergency department utilization for victims of violence

BackgroundVictims of violence are at high risk for unmet mental and physical health care needs which can translate into increased Emergency Department (ED) visits. We investigated the effectiveness of participation in a psychosocial, case management-based trauma recovery program on ED utilization. MethodsA retrospective cohort study of ED utilization before and after referral to a Trauma Recovery Center (TRC). Charts of TRC participants from 6/2017–5/2019 who consented in clinic to their medical records being used for research were reviewed. The primary outcome was the change in ED utilization 6 months pre- and post-referral to a TRC. The secondary outcomes were factors associated with ED visits after TRC referral, including victimization or mental health issues. ResultsThe study group contained 143 patients, of which 82% identified as female and 62% identified as white. Many (39%, n = 56) were part of one or more vulnerable populations and type of victimization varied extensively. Intervention uptake was high as almost all (92%, n = 132) had at least one TRC encounter [median of 6 encounters (IQR 2–13)] and an average of 2.7 services used. Most participants (67.1%, n = 96) had no change in ED use. Forty (28.0%) had at least 1 ED visit 6 months before, 38 (26.8%) had at least 1 ED visit 6 months afterwards, and 81 (56.6%) had no ED visits during either timeframe. ED visits per person in the 6 months prior to referral were not different from visits per person in the 6 months after referral (0.52 vs 0.49, p = 0.76, paired t-test). Negative binomial regression indicated number of ED visits before referral (IRR 1.5, 95% confidence interval [1.27–1.79]) and pre-existing mental health conditions (IRR 2.2, 95% confidence interval [0.98–5.02]) were most associated with an increase in the incidence rate ratio of ED visits in the 6 months after referral. ConclusionDespite high engagement, a multidisciplinary Trauma Recovery Center did not reduce ED utilization. ED utilization prior to TRC was the most predictive factor of ED utilization afterwards.

Using a stakeholder-engaged, iterative, and systematic approach to adapting collaborative decision skills training for implementation in VA psychosocial rehabilitation and recovery centers

BackgroundAdaptation of interventions is inevitable during translation to new populations or settings. Systematic approach to adaptation can ensure that fidelity to core functions of the intervention are preserved while optimizing implementation feasibility and effectiveness for the local context. In this study, we used an iterative, mixed methods, and stakeholder-engaged process to systematically adapt Collaborative Decision Skills Training for Veterans with psychosis currently participating in VA Psychosocial Rehabilitation and Recovery Centers.MethodsA modified approach to Intervention Mapping (IM-Adapt) guided the adaptation process. An Adaptation Resource Team of five Veterans, two VA clinicians, and four researchers was formed. The Adaptation Resource Team engaged in an iterative process of identifying and completing adaptations including individual qualitative interviews, group meetings, and post-meeting surveys. Qualitative interviews were analyzed using rapid matrix analysis. We used the modified, RE-AIM enriched expanded Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME) to document adaptations. Additional constructs included adaptation size and scope; implementation of planned adaptation (yes–no); rationale for non-implementation; and tailoring of adaptation for a specific population (e.g., Veterans).ResultsRapid matrix analysis of individual qualitative interviews resulted in 510 qualitative codes. Veterans and clinicians reported that the intervention was a generally good fit for VA Psychosocial Rehabilitation and Recovery Centers and for Veterans. Following group meetings to reach adaptation consensus, 158 adaptations were completed. Most commonly, adaptations added or extended a component; were small in size and scope; intended to improve the effectiveness of the intervention, and based on experience as a patient or working with patients. Few adaptations were targeted towards a specific group, including Veterans. Veteran and clinician stakeholders reported that these adaptations were important and would benefit Veterans, and that they felt heard and understood during the adaptation process.ConclusionsA stakeholder-engaged, iterative, and mixed methods approach was successful for adapting Collaborative Decision Skills Training for immediate clinical application to Veterans in a psychosocial rehabilitation center. The ongoing interactions among multiple stakeholders resulted in high quality, tailored adaptations which are likely to be generalizable to other populations or settings. We recommend the use of this stakeholder-engaged, iterative approach to guide adaptations.

770: AN INTERNATIONAL, MULTICENTER EVALUATION OF PHARMACIST MEDICATION MANAGEMENT IN ICU RECOVERY CENTERS

Introduction: Post Intensive Care Syndrome (PICS) is a new or worsening impairment in physical, cognitive, or mental health following critical illness. Similar to PICS, survivors of critical illness due to COVID-19 may develop Post Acute Sequelae of SARS-CoV-2 Infection (PASC) or Long COVID. ICU recovery centers (ICU-RC) are suggested as an interprofessional approach to treat patients with PICS or PASC. Currently, over 40 different ICU-RC worldwide report having a clinical pharmacist. The purpose of this study was to describe the role of pharmacists in identifying and treating medication-related problems in survivors of critical illness. Methods: This prospective, observational study was conducted in 12 ICU-RC between September 2019 and July 2021. A full medication review comprising of medication reconciliation, a patient interview, and counseling session was conducted by a clinical pharmacist on patients seen at the ICU-RC. Baseline demographic and hospital course data were obtained from the electronic health record and at the ICU-RC appointment. Data are reported using descriptive statistics. Results: A total of 507 patients were referred to an ICU-RC, of which 474 attended and 472 had a full medication review performed by a pharmacist. 237 (47%) of referred patients had a diagnosis of COVID-19. Pharmacy interventions were made in 397 (84%) patients. The median number of pharmacy interventions per patient was 2 (IQR 1,3). Medications were stopped and started in 124 (26%) and 91 (19%) patients, respectively. There was no difference in median total number of medications prescribed at the start and end of the patient visit (10, IQR = 5, 15). The number of patients that had a dose decreased and a dose increased was 51 (11%) and 43 (9%) patients, respectively. Adverse drug event (ADE) preventive measures were implemented in 115 (24%) patients and ADEs were identified in 69 (15%) patients. Drug interactions were identified in 30 (6%) patients. Conclusions: Pharmacists play an integral role in ICU-RC resulting in identification, prevention, and treatment of numerous medication-related problems. This paper should serve as a call to action on the importance of including a pharmacist on the interprofessional team in ICU-RC.

Antimicrobial resistance patterns of bacteria isolated from chicks of Canarian Egyptian vultures (Neophron percnopterus majorensis): A “one health” problem?

Antimicrobial resistance in Gram-negative bacteria isolated from cloacal samples of chicks of Canarian Egyptian vultures was investigated. Prevalence of Salmonella was also studied. Forty-seven isolates, obtained from 23 animals, were analysed. Escherichia coli (n = 29), Proteus mirabilis (n = 17) and Salmonella spp. (n = 1) were identified using API 20E system. Antimicrobial susceptibility to 13 antibiotics included in nine different categories was determined using disk-diffusion technique. The higher percentages of susceptible E. coli isolates were found for aminoglycosides and cefoxitin, and the lower ones were found for ampicillin, enrofloxacin and tetracycline. Proteus mirabilis isolates were susceptible to most of antimicrobials tested. Multidrug resistance patterns were found in 13 E. coli and four Proteus mirabilis. Salmonella spp. was detected in one chick (4.37%), and the isolate was also resistant to ampicillin and tetracycline. Thirteen E. coli isolates and four Proteus isolates showed a multidrug-resistance pattern, being resistant at least to one antibiotic in three or more different antimicrobial categories. This high level of antibiotic resistance in chickens of an endangered bird may be a limitation for possible treatments of infections in this species, as well as representing a source of resistant bacteria for animal care staff and for other animals in wildlife recovery centres. A “One Health” approach to this problem is necessary to reduce the levels of antimicrobial resistance in wild birds.

A New Wooden Supply Chain Model for Inventory Management Considering Environmental Pollution: A Genetic algorithm

Abstract Nowadays, companies need to take responsibility for addressing growing markets and the growing expectations of their customers to survive in a highly competitive context that is progressing on a daily basis. Rapid economic changes and increasing competitive pressure in global markets have led companies to pay special attention to their supply chains. As a result, in this research, a mathematical model is proposed to minimize closed loop supply chain costs taking into account environmental effects. Thus, suppliers first send wood as raw materials from forests to factories. After processing the wood and turning it into products, the factories send the wood to retailers. The retailers then send the products to the customers. Finally, customers send returned products to recovery centers. After processing the products, the recovery centers send their products to the factories. The considered innovations include: designing a supply chain of wood products regarding environmental effects, customizing the genetic solution approach to solve the proposed model 3-Considering the flow of wood products and determining the amount of raw materials and products sent and received.

In Memoriam: Alexander W. Dromerick Jr, MD, July 1, 1958-August 21, 2021.

HomeStrokeVol. 53, No. 12In Memoriam: Alexander W. Dromerick Jr, MD, July 1, 1958–August 21, 2021 No AccessObituaryRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessObituaryRequest AccessFull TextIn Memoriam: Alexander W. Dromerick Jr, MD, July 1, 1958–August 21, 2021 Sean I. Savitz, MD, Elissa L. Newport, PhD and Dorothy Edwards, PhD Sean I. SavitzSean I. Savitz Correspondence to: Sean I. Savitz, MD, Institute for Stroke and Cerebrovascular Disease, UTHealth-Houston, 6431 Fannin St, Houston, TX 77030. Email E-mail Address: [email protected] https://orcid.org/0000-0003-4637-1790 Department of Neurology, Institute for Stroke and Cerebrovascular Disease, UTHealth-Houston, TX (S.I.S.). Search for more papers by this author , Elissa L. NewportElissa L. Newport https://orcid.org/0000-0002-2783-5062 Center for Brain Plasticity and Recovery, Georgetown University Medical Center, Washington DC (E.L.N.). Search for more papers by this author and Dorothy EdwardsDorothy Edwards Collaborative Center for Health Equity, University of Wisconsin, Madison (D.E.). Search for more papers by this author Originally published28 Nov 2022https://doi.org/10.1161/STROKEAHA.122.039909Stroke. 2022;53:3525–3528FootnotesFor Sources of Funding and Disclosures, see page 3528.Correspondence to: Sean I. Savitz, MD, Institute for Stroke and Cerebrovascular Disease, UTHealth-Houston, 6431 Fannin St, Houston, TX 77030. Email sean.i.[email protected]tmc.edu Previous Back to top Next FiguresReferencesRelatedDetails December 2022Vol 53, Issue 12 Advertisement Article InformationMetrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.122.039909PMID: 36441835 Originally publishedNovember 28, 2022 PDF download Advertisement

Telehealth of Coordinated Specialty Care in Early Psychosis During COVID-19.

Background: The coronavirus 2019 (COVID-19) pandemic forced health care globally to provide remote services when feasible. In March 2020, psychiatric outpatient services across the United States transitioned to telehealth. Persons with early psychosis (EP) face challenges to maintain connection with care, an important element associated with better outcome. The ongoing pandemic offers the opportunity to review the feasibility of EP services using telehealth and to evaluate implications for continued implementation.Methods: We examined delivery of coordinated specialty care (CSC) for 49 individuals aged 16-30 years enrolled in an EP (first-episode psychosis and clinical high risk) university-affiliated outpatient clinic located in Philadelphia, Pennsylvania, from March 2020 to July 2021, during which most appointments were delivered through telehealth. The services evaluated in this setting include psychotherapy, medication management, employment and educational services, peer support, and multifamily psychoeducation group. We compared completed and missed appointment rates across services and new enrollment rates with in-person versus hybrid telehealth and in-person care pre-COVID-19 and during the pandemic.Results: In 6 months pre-COVID-19 (September 2019-February 2020), the Psychosis Evaluation and Recovery Center enrolled a mean of 4 people/mo compared to during the pandemic (March 2020-July 2021), when a mean of 2.2 people/mo were enrolled. The total number of completed psychology appointments pre-COVID-19 ranged from 51 to 88 and during the pandemic ranged from 72 to 137. The rate of missed psychology appointments ranged from 1.4% to 6.4% pre-COVID-19 and from 3.4% to 11.3% during the pandemic. The total number of completed medication management appointments pre-COVID-19 ranged from 35 to 59 and during the pandemic ranged from 22 to 66. The rate of missed medication management appointments ranged from 2.1% to 8.0% pre-COVID-19 and from 1.7% to 9.1% during the pandemic. The total number of completed supported education and employment services appointments pre-COVID-19 ranged from 5 to 11 and during the pandemic ranged from 3 to 16. Finally, the mean number of family members in attendance at the family psychoeducation group was 8.3 pre-COVID-19 and 17.1 during the pandemic.Conclusions: New and continued engagement across services in EP CSC during the COVID-19 pandemic supports feasibility of telehealth and suggests that offering a hybrid model of in-person and telehealth should be considered once restrictions are lifted.