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- Creators: Nunez, Diane
- Creators: Arizona State University
Purpose: Implementation of a postpartum depression (PPD) screening while using evidence-based interventions to improve depressive symptoms, enhance breastfeeding (BF) self-efficacy, and strengthen the mother-infant dyad (MID).
Background and Significance: PPD is highly prevalent among women living in the United States and threatens the physical and psychological health of MIDs. Many of these women go undiagnosed and without treatment, further worsening symptoms and outcomes. This has inspired world healthcare leaders and organizations to address maternal mental health among postpartum women.
Methods: A 12-week evidenced-based project consisted of two-sets of participants including mothers and staff. A comprehensive maternal support program guided by an informational pamphlet (IP) and implementation of PPD screening using the Edinburgh Postnatal Depression Scale served as the two-part intervention for this project. Goals were to decrease PPD, enhance BF satisfaction, and strengthen the MID. Comprehensive maternal support encompasses interventions proven to meet the project goals and includes tailored BF education and care to maternal needs, social support by peer/family involvement, skin-to-skin contact during BF, emotion-regulation strategies, and availability of community resources.
Outcomes: The BSES-SF scores did result in statistical significance based on an alpha value of 0.10, t(3) = -2.98, p = .059, proving a positive effect was seen in breastfeeding self-efficacy post intervention. The results did not show statistical significance (t(3) = 0.60, p = .591) in regard to pre and post-depression scores. However, the mean pre-score (M =3.50, SD 3.11) did decrease post-intervention (M =2.75, SD 1.26) and exemplifies clinical significance.
Conclusion: The outcomes of this Quality-Improvement project showed improved scores for depression and BF self-efficacy post-intervention. This demonstrates the value in screening for PPD using a validated screening tool and instituting comprehensive maternal support guided by evidence-based practice in a community setting.
As a step in model development, statistically designed screening experiments may be used to identify the main effects and interactions most significant on a response of a system. However, traditional approaches for screening are ineffective for complex systems because of the size of the experimental design. Consequently, the factors considered are often restricted, but this automatically restricts the interactions that may be identified as well. Alternatively, the designs are restricted to only identify main effects, but this then fails to consider any possible interactions of the factors.
To address this problem, a specific combinatorial design termed a locating array is proposed as a screening design for complex systems. Locating arrays exhibit logarithmic growth in the number of factors because their focus is on identification rather than on measurement. This makes practical the consideration of an order of magnitude more factors in experimentation than traditional screening designs.
As a proof-of-concept, a locating array is applied to screen for main effects and low-order interactions on the response of average transport control protocol (TCP) throughput in a simulation model of a mobile ad hoc network (MANET). A MANET is a collection of mobile wireless nodes that self-organize without the aid of any centralized control or fixed infrastructure. The full-factorial design for the MANET considered is infeasible (with over 10^{43} design points) yet a locating array has only 421 design points.
In conjunction with the locating array, a ``heavy hitters'' algorithm is developed to identify the influential main effects and two-way interactions, correcting for the non-normal distribution of the average throughput, and uneven coverage of terms in the locating array. The significance of the identified main effects and interactions is validated independently using the statistical software JMP.
The statistical characteristics used to evaluate traditional screening designs are also applied to locating arrays.
These include the matrix of covariance, fraction of design space, and aliasing, among others. The results lend additional support to the use of locating arrays as screening designs.
The use of locating arrays as screening designs for complex engineered systems is promising as they yield useful models. This facilitates quantitative evaluation of architectures and protocols and contributes to our understanding of complex engineered networks.
Homeless individuals encounter barriers such as lack of health insurance, increased cost of care and unavailability of resources. They have increased risk of comorbid physical disease and poor mental health. Depression is a prevalent mental health disorder in the US linked to increased risk of mortality. Literature suggests depression screening can identify high-risk individuals with using the patient health questionnaire (PHQ-9).
The objective of this project is to determine if screening identifies depression in the homeless and how it impacts healthcare access. Setting is a local organization in Phoenix offering shelter to homeless individuals. An evidence-based project was implemented over two months in 2019 using convenience sampling. Intervention included depression screening using the PHQ-9, referring to primary care and tracking appointment times. IRB approval obtained from Arizona State University, privacy discussed, and consent obtained prior to data collection. Participants were assigned a random number to protect privacy.
A chart audit tool was used to obtain sociodemographics and insurance status. Descriptive statistics used and analyzed using Intellectus. Sample size was (n = 18), age (M = 35) most were White-non-Hispanic, 44% had a high school diploma and 78% were insured. Mean score was 7.72, three were previously diagnosed and not referred. Three were referred with a turnaround appointment time of one, two and seven days respectively. No significant correlation found between age and depression severity. A significant correlation found between previous diagnosis and depression severity. Attention to PHQ-9 varied among providers and not always addressed. Future projects should focus on improving collaboration between this facility and providers, increasing screening and ensuring adequate follow up and treatment.
Background and Significance: Evidence shows primary care providers (PCPs) are not adhering to the GOLD Guidelines for COPD screening.
Methods: Guideline education with pre/post-intervention survey and percent of eligible participants screened.
Results: Pre-intervention surveys (n=10) and post-intervention surveys (n=8) completed. Significant increase in knowledge regarding the CAT score (M score = 11.50, U = 24.000, p<.05). Part 2) 24% (n=6) of participants were screened with the CAT questionnaire.
Conclusions: PCPs are aware of the GOLD Guidelines, but do not always adhere to its recommendations. Future research should concentrate on effective ways to implement the GOLD Guidelines screening recommendations in primary care clinics.
Background: Sepsis remains a significant healthcare problem associated with high treatment costs and high mortality rates. Older adults are at an increased risk for developing sepsis, especially when age is combined with any type of compromising factor, such as chronic illness, recent hospitalizations, wounds, or invasive devices. Current evidence demonstrates that sepsis screening is effective for early identification of sepsis. Early identification of sepsis improves time to treatment initiation, which improves outcomes.
Methods: An evidence-based, provider approved clinical guideline was developed for a post-acute care facility after an extensive review of the literature. Upon implementation, brief educational sessions were provided to direct patient care staff. Participants completed pre- and post-tests as well as a demographic survey. A satisfaction survey was administered 30 days post intervention. A paired samples t-test was used to analyze the difference in test scores. Pearson's correlation was used to analyze the relationship between staff comfort levels and the clinical guideline.
Results: The samples included 25 participants in the educational intervention and 18 in the satisfaction survey. There was a significant difference in the scores between pre-test (M = 72.3, SD = 12.43) and post-test scores (M = 86.6, SD = 10.2); t(24) = -5.578, p < 0.001. There was a significant correlation between staff who felt comfortable in identifying sepsis with ease of screening (r = .831, p < .01) and high comfort levels with the policy (r = .889, p < .01).
Conclusion: Utilizing a clinical guideline, coupled with education, improves staff knowledge and comfort identifying sepsis in the post-acute care setting, which may improve early recognition and treatment initiation. This outcome is clinically significant as patients in this setting represent a vulnerable population.