Background: Healthcare providers are encouraged to prepare their practice to effectively manage the care of mild to moderate adolescent depression. Cost-effective screening, diagnostic, and newly developed pediatric primary care depression management guidelines have been established. To integrate guidelines into practice, primary care providers (PCPs) must document effectively to ensure a complete treatment plan is in place in the patient’s electronic health record (EHR).

Intervention: Elements from a flowsheet were implemented into the EHR to promote thorough assessment and documentation of care delivered to adolescents with depression.

Methods: An initial chart review was completed on patients diagnosed with depression. An updated depression template was implemented within the EHR for six weeks. A follow-up chart review was completed post-intervention to determine if documentation of elements from the adolescent depression guidelines improved after the EHR update. Pre-intervention and post- intervention surveys were delivered to PCP’s to understand their perspective on adolescent depression management.

Outcomes: The chart review revealed that baseline PHQ-9 screenings were documented in 91% (n=43) of the charts reviewed in the pre-intervention timeframe. Only 78% (n=7) of the charts reviewed during post-intervention included PHQ-9 screenings. Early intervention treatment options documented in the pre-intervention timeframe included education 100% (n=47), medication prescriptions 53% (n=25), and psychotherapy referrals 18% (n=18). During post- intervention, education 100% (n=9), medication prescriptions 78% (7), and psychotherapy referrals 22% (n=7) were documented by the PCPs.

Recommendation: The quality improvement project focused heavily on documentation completed over a one year pre-intervention timeframe compared to a six-week post-intervention timeframe. Further evaluation and chart review over the next year will provide a more adequate comparison of documentation within primary care practice.

Disease burden is higher in the United States than in comparable countries. The Patient Self Determination Act of 1990 requires healthcare facilities to provide Advance Care Planning (ACP) information to all Medicare patients. The healthcare staffs’ (n=7) commitment to 3-days of ACP training increase ACP rates in the primary care setting. The Medicare Incentive Program is the platform for this initiative. This quantitative project used a valid and reliable pre and posttest design that consisted of 27 items on a Likert-scale. A 3.5-month chart audit (n=91) was conducted to assess the completion rate. Descriptive statistics was used to describe the demographic data.

The results of the two-tailed Wilcoxon signed rank test were significant based on an alpha value of 0.05, V = 0.00, z = -2.37, p = .018. There was a significant increase in the post-readiness to change average scores. A Mann Whitney test was used to analyze the statistically significant difference between the averages in two ACP types and electronic health record documentation (EHR). Staff did not always code (Mdn = 0.00) but they documented in the EHR (Mdn =1.00; 512.00, p = 0.003). ACP discussion was performed 63% of the time during Annual Wellness Visits (AWV), and there was a 49% increase in the EHR documentation. Trained staff are key stakeholders in guiding ACP conversations. They understand the barriers, impact, and consequences related to the lack of advance directives.

While the majority of the scholarship around surrealist relationships with fashion look at the era of the 1930s onwards, this article considers the first period of surrealism during the 1920s, including its prehistory in the mouvement flou as it emerged via Paris Dada and Littérature, asking two related questions: what was the presence and status of the discourse of fashion for surrealism during these formative years; and in what kinds of fashion practices did its members engage? In response to the first of these, an examination of the group’s journals, publications and documents suggests that fashion stands as a significant and abiding area of interest for the group and its members. Writings by André Breton, Louis Aragon, René Crevel and others are correlated with surrealist images and artworks to reflect upon this sustained and informed engagement with men’s and above all women’s fashion, and suggest a particularly keen awareness of the changes in clothing styles over the recent past. The second question has rarely been asked in a systematic way: how did the early Parisian surrealists reflect these interests in their own day-to-day fashion choices and preferences? Given that the majority of the early Parisian surrealist group was male, the focus here is predominantly on men’s fashion, and analysis of memoirs, correspondence and documents such as the photographs taken in the Bureau de recherches surréalistes provides evidence of collective and individual positions. The fashion choices of Simone and André Breton form a particular area of concern, revealing some nuanced developments and unorthodox moments in their day-to-day attitudes.

During his wartime exile in New York City, André Breton responded to the popular entrenchment of Surrealism as a language of shop window merchandising by leading a small group of artists and writers to take the publicity of Surrealism into their own hands. At Breton’s behest, Marcel Duchamp designed three shop windows to advertise texts released by the French publishing arm of the Fifth Avenue bookstore Brentano’s in 1943 and 1945. Although art historians have called attention to the relationship between these designs and the iconography of better-known works by Duchamp, this paper considers them as instantiations of Breton’s evolving thought within the context of a commercial environment already saturated with surrealist imagery. It places them within an iconographic web that includes, among others, Salvador Dalí’s famed fashion displays of the preceding decade, multiple iterations of Duchamp’s “twine,” and works by Kurt Seligmann, Roberto Matta, and Breton himself. The paper argues that, exemplifying the prewar surrealist motif of interior and exterior permeability and bringing it to a breaking point, these obscure windows for French-language texts became an important laboratory for the engaged critique of consumerism that would come to the forefront of the surrealist movement during the postwar period.