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Policies that promote conversion of antibiotics from intravenous to oral route administration are considered “low hanging fruit” for hospital antimicrobial stewardship programs. We developed a simple metric based on digestive days of therapy divided by total days of therapy for targeted agents and a method for hospital comparisons. External comparisons may help identify opportunities for improving prospective implementation.
OBJECTIVES/GOALS: As the number of older adults (â‰¥65 years) with T1D grows, there are limited data to guide care. In a six-month trial, CGM reduced hypoglycemia in older adults, yet there are challenges for widespread uptake. Our objective is to characterize older adults experiences with using CGM and define suboptimal responses signaling a need for resources or support. METHODS/STUDY POPULATION: The study will engage key stakeholders (i.e., older adults with T1D, caregivers [recruited as patient-caregiver dyads], and providers [endocrinologists, geriatricians, diabetes educators]) for a Group Model Building (GMB). GMB is a participatory approach to system dynamics in which participants share perceptions and experiences with a problem and collaboratively explore the system structure that shapes those trends. A series of 8 GMB workshops will be held with 3-8 participants. The final study n will be determined by thematic saturation. Workshops comprise 1) a questionnaire, 2) a GMB session, and 3) a focus group discussion. GMB will follow a replicable process to generate a model of the complex web of causal determinants affecting CGM-related experiences, including optimal and suboptimal CGM responses. RESULTS/ANTICIPATED RESULTS: To date, the study has enrolled 33 participants, including 28 older adults living with T1D and 5 caregivers (mean age = 74 years, range 67-83 years). Twenty-four patient participants will be active CGM users and 4 will be CGM non-users. The study will report on patient data capture from the questionnaire and EMR, including demographics, experiences, familiarity, and confidence surrounding CGM use; diabetes duration; insulin pump use; history of severe hypoglycemia. Analysis of aggregated data will generate causal loop diagrams that integrate pertinent theoretical frameworks, lived experiences, and CGM outcomes. Maps will be used to identify a set of suboptimal CGM responses (i.e., key outcome trajectories) that signal a need for action, with a diagram of factors that interact to produce each response. DISCUSSION/SIGNIFICANCE: Delivering CGM to older adults with T1D demands new approaches. This study will yield critical evidence to tailor support and resources for effective CGM use in older adults. Findings may be translated into suite of pragmatic interventions to bolster CGM use and matched to individual patients expected to benefit using a precision medicine framework.
Lady Mary Wortley Montagu’s bold attack on Pope’s satire in “Verses Addressed to the Imitator of the First Satire of the Second Book of Horace” (1733) positions her in a place of literary and cultural authority. Montagu critiques Pope’s satire – “an Oyster-Knife, that hacks and hews” – on the grounds that his indiscriminate personal attacks violate the benevolent spirit of Horatian satire and fail to produce sufficient moral effects. Satire should aim judiciously at targets, she explains, and the satirist must always wield the pen with precision and self-restraint. Like a surgeon’s knife, satire will cut and wound, but it is ultimately meant to heal and should never be used to bludgeon literary, political, or personal opponents.
This chapter reviews the contribution of the learning sciences to teacher learning research, with particular consideration of how cognitive, sociocognitive, sociocultural, and improvement-focused perspectives extend teacher learning research. Learning scientists study all phases of teacher learning, including preservice education (before becoming a teacher), the first few years of teaching, and ongoing mastery throughout the career. Research often focuses on teaching practices – what teachers do in the classroom and how they move from novice to expert performance. Teacher learning can be supported through collaboration with other teachers in a professional learning community (PLC); through coaching and mentoring; through videos of expert teaching practice; and through educative curriculum materials.
This collection of innovative essays by leading scholars on eighteenth-century British women satirists showcases women's contributions to the satiric tradition and challenges the assumption that women were largely targets, rather than practitioners, of satire during the long eighteenth century. The essays examine women's satires across diverse genres, from the fable to the periodical, and attend to women writers' appropriation of a literary style and form often viewed as exclusively masculine. The introduction features a new theory of women's satire and proposes a framework for analyzing satiric techniques employed by women writers. Organized chronologically, the contributors' essays address a wide range of authors and explore the ways in which satiric writings by women engaged in contemporary cultural conversations, influencing assumptions about gender, sociability, politics, and literary practices. This inclusive yet tightly-focused collection formulates an innovative and provocative new feminist theory of satire.
To describe the development and implementation of a novel tool designed to enhance nurse–patient communication in a major academic cancer center, which nurses can learn quickly, incorporate into their primary palliative care practice, and broadly disseminate in order to improve the patient experience.
An evidence-based empathic communication tool and educational program were designed to provide essential skills to oncology nurses in having discussions with patients about their personal values. Evaluation included nurse focus groups, pre- and post-course evaluations and interviews, and patient questionnaires.
Nurses were satisfied with the educational program and found the communication tool effective in a variety of clinical situations including discussions about personal values. Patients reported increased occurrences of these discussions when nurses utilized the framework (97% vs. 58%, p < 0.0001) and a higher quality of clinician communication (mean [SD] from 0 = very worst to 10 = very best: 7.18 [2.3] vs. 5.04 [2.9], p = 0.001).
Significance of results
Skilled, empathic communication is an essential component of high-quality primary palliative care. Oncology nurses are well suited to lead communication and provide this care as part of an interprofessional team. The training and tool described here are targeted and efficient, and prepare nurses to respond skillfully to emotion while facilitating important discussions about patient values.
Early in the coronavirus disease 2019 (COVID-19) pandemic, the CDC recommended collection of a lower respiratory tract (LRT) specimen for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing in addition to the routinely recommended upper respiratory tract (URT) testing in mechanically ventilated patients. Significant operational challenges were noted at our institution using this approach. In this report, we describe our experience with routine collection of paired URT and LRT sample testing. Our results revealed a high concordance between the 2 sources, and that all children tested for SARS-CoV-2 were appropriately diagnosed with URT testing alone. There was no added benefit to LRT testing. Based on these findings, our institutional approach was therefore adjusted to sample the URT alone for most patients, with LRT sampling reserved for patients with ongoing clinical suspicion for SARS-CoV-2 after a negative URT test.
The aim of our study was to test the efficacy of the nominative technique for estimating the prevalence of wildlife part use within a small sample. We used the domestic consumption of bear Ursus thibetanus and Helarctos malayanus parts in Lao People's Democratic Republic (Laos) as a case study and performed 179 semi-structured interviews in Luang Prabang, northern Laos, in August 2017 and April 2019. We also assessed whether the specialized questioning of the nominative technique could be used for qualitative data collection methods, such as semi-structured interviews. The technique theoretically ensures more accurate statements of illegal wildlife consumption by maintaining the anonymity of an individual's sensitive behaviour through asking about the behaviour of peers. We also directly asked about participants’ use of bear parts. The nominative technique suggested that c. 11% of the participants’ peers used bear parts, whereas respondents’ direct admittance of using bear parts was approximately double, at 23%. Use of bear parts appears not to be sensitive in northern Laos. In addition, we found a strong association between responses to questioning using the nominative technique and direct questioning, indicating that users of bear parts have social networks with higher levels of use. This lends supports to theories that use of wildlife products is directly influenced by social group. The underreporting resulting from use of the nominative technique indicates the high variability of response that can occur within small samples. However, our results show that the nominative technique may be a simple, useful tool for triangulating data, assessing users’ integration into social networks of use, and assessing changes in behaviour prevalence.