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Electronic data capture is essential to advancing family-centered coordinated care in early intervention (EI). The purpose of this paper is to report on EI service coordinator response to piloting an electronic parent-reported outcome (e-PRO) assessment as part of their routine workflow, including lessons learned that may inform future phases of e-PRO implementation.
This second pilot study involved families enrolled in a large EI program (n=1040 families) in concert with their implementation of a statewide quality improvement initiative for care plan development and outcomes reporting. A total of 22 EI service coordinators and supervisors were engaged in 3 phases: initial e-PRO intervention, peer-mentor enhancement, and standard recruitment protocol.
Implementation of the e-PRO intervention and peer-mentoring enhancement yielded low enrollment rates over the first 6 months (n=17). A standard recruitment protocol has resulted in enrollment growth (n=83) towards the targeted enrollment rate (n=832).
This study reports on early insights for building and sustaining a productive academic-community partnership for e-PRO implementation to support family-centered coordinated care. Lessons learned from this academic-community partnership with respect to strategies for enhancing community significance, collaboration, return, and control are discussed as they inform further development of this intervention before scale-up.
Thrombotic microangiopathies (TMAs) describe the clinical and pathohistological effects of thrombosis in small vessels. The diagnostic challenge is the differentiation from acute fatty liver of pregnancy (AFLP), preeclampsia (PET) or eclampsia, HELLP (hemolysis, elevated liver enzymes, low platelets), antiphospholipid syndrome (APS), systemic lupus erythematosus (SLE), hemolytic uremic syndrome (HUS), and disseminated intravascular coagulation (DIC). Immune thrombocytopenic purpura (ITP) occurs in 5% of pregnancies with thrombocytopenia and is a result of immunological peripheral platelet destruction. Women presenting with thrombotic thrombocytopenic purpura (TTP) during pregnancy appear to fall into two groups: those with congenital TTP and those with acquired, antibody mediated TTP. Intrahepatic cholestasis of pregnancy (ICP) has been associated with impaired sulphation and abnormalities of progesterone metabolism. SLE is an autoimmune disease, the active phase of which may be associated with thrombocytopenia, hemolytic anemia, pancytopenia, and an increase in double-stranded DNA.
Controversy continues regarding an association between obstetric complications and risk of schizophrenia in early adult life.
To compare the rate of labour and delivery complications among persons who developed schizophrenia with controls; to establish whether any complication is associated with later schizophrenia.
We located the labour ward records of 431 individuals with schizophrenia and of same-gender controls from the same hospital birth series. Mothers were matched by age, socio-economic group and parity. Individual complications were evaluated blindly using two obstetric complication scales.
Overall, the rate of labour and delivery complications for those who developed schizophrenia did not differ from that of controls. Males who had presented to psychiatric services before the age of 30 had a greater frequency of and more severe labour/delivery complications than their matched controls.
Other than among young-onset males we found no increase in labour and delivery complications among cases.
Several reports postulate that manic depression and schizophrenia share environmental risk factors. Although obstetric adversity has been suggested as a risk factor for schizophrenia, few studies have examined its relationship to bipolar affective disorder.
To assess the rate of obstetric complications incurred by patients with mania compared with controls.
From the Dublin Psychiatric Case Register we identified individuals with a discharge diagnosis of mania and traced their birth records. Each case was matched with a control of the same gender, born in the same hospital, in the same year, matched for maternal age, parity and social class. Two obstetric complication scales were used to make blind evaluations of labour and delivery data.
Patients with mania did not experience a greater frequency or severity of labour and delivery complications than their matched controls. Rates of obstetric adversity were unrelated to the presence or absence of family history of psychiatric disorder. Obstetric adversity was unrelated to the age at first diagnosis.
These findings suggest that obstetric adversity is not a risk factor for later mania.
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