The clinical practice guideline (CPG) is the implementation of a depression screening tool to be used in the early perinatal period. The practice change occurred in a rural Obstetrical and Gynecological (OBGYN) practice in the southern United States. The CPG change has been guided by recommendations from both the American Congress of Obstetrics and Gynecology and the American College of Nurse Midwives. Implementation of this CPG change addresses the gap in practice of not doing depression screening during the perinatal period, and only screening during the postpartum period, which was being done at the OBGYN office. Theorist Lewin’s ‘change theory’ guided the implementation of the project. In order to apply this project, a process of changing practice guidelines was needed at the OBGYN office. The DNP project presented the practice change guideline of implementing the Edinburgh Postpartum Depression Screening (EPDS) tool. The need for the CPG development was evaluated by 3 nurse leaders using the AGREE II tool and was recommended 100% without modifications by all 3 evaluators. The CPG, with the results, was presented and discussed with the practice site’s practitioners. The practitioners implemented the EPDS to be given at the 12- week checkup appointment versus the confirmation of pregnancy appointment, which was suggested through the DNP project’s CPG. The implementation of this CPG has the potential to provide a safer environment for pregnant women, their newborns, and their families.

Includes bibliographical references / Background: Health care workers are at increased risk of acquiring latent tuberculosis infection (LTBI). The emergence of interferon - gamma release assays (IGRAs) for the diagnosis of LTBI, presents an opportunity for improved estimation of TB infection prevalence and incidence. Their utility in settings with high background prevalence TB and HIV infection is unknown. Major aims of the study were to: * Evaluate the prevalence and factors associated with TB infection using both tuberculin skin test (TST) and IGRA assays in a sample of health care workers. * Evaluate change in interval test response over one year to determine annual risk of infection and determinants associated with test conversion. Methods: Participants completed a questionnaire on occupational and environmental characteristics including a TB symptom screen and underwent chest radiograph and rapid HIV test. Three tests for latent TB infection were administered: TST, QuantiFERON - TB Gold In - Tube (QFT - GIT) and a T - SPOT.TB test. All tests were repeated one year later. Results: The prevalence of TB infection at baseline was 84%, 65% and 60% as measured by TST, QFT - GIT and T - SPOT.TB. There was only fair agreement between TST and IGRAs. HIV positive status was significantly associated with having a TST negative / T - SPOT.TB positive discordant test response (OR=4.72). TST had superior sensitivity than IGRAs for the diagnosis of LTBI. In primary level staff a positive TST outcome, was negatively associated with HIV positive status (OR=0.41). Long employment duration was positively associated with TST (OR=4.17) and QFT - GIT (OR= 2.42) positivity. Involvement in sputum collection (OR=3.25) and home - based care of TB patients (OR= 4.14) was associated with a positive IGRA test. The conversion rate for TST and IGRAs was 38% and 22%, respectively. Reversion rates ranged from 1 % - 16 % and was lowest for TST. Factors associated with conversion (for IGRAs) included employment sector, counselling of TB patients and a baseline positive TST. Conclusion: The annual rate of TB infection was very high pointing to occupational exposure as a contributory factor. TST had superior sensitivity than IGRAs for LTBI diagnosis but poor uptake on serial testing. IGRAs had excellent uptake but its clinical utility was negatively influenced by high rates of reversion.

As the incidence of major depressive disorders continues to rise, the need for depression screening in primary care is imperative. The objective of this quality improvement (QI) project is to increase depression screening and enhance the current referral process in an urban primary care setting in the southeast United States. To achieve a projected increase in identified depression within the current and future adult patient population, workflow processes have been restructured to incorporate consistent depression screening using the Patient Health Questionnaire-2 (PHQ-2) and -9 (PHQ-9). Revised clerical workflow processes include initiating PHQ-9 questionnaires for all new patients, while clinical workflow processes include conducting PHQ-2 questionnaires for all established patients. Scores on the PHQ-9 indicating moderate levels of depression will trigger primary care provider (PCP) notification. Providers offer three treatment options including Behavioral Health Care Navigator Services (BHCN), self-referral to a mental health care provider, or treatment by PCP. Data will be collected to determine the number of PHQ-9 questionnaires given to “New Patients” at check-in, PHQ-2 questionnaires conducted by clinical staff, PHQ-9 scores of 10 or greater, BHCN referrals placed, patients who elected self-referral, and completed initial mental health appointments with differentiation between BHCN scheduled appointments and self-referred appointments. This QI project is currently undergoing implementation with no outcomes to report, however, data collected during analysis is expected to reveal an increase in patients diagnosed with moderate to major depressive disorders and an increase in completed initial mental health appointments.

No description available.

Recently, researchers have attempted to increase the time efficiency of the smartphone DIN test by decreasing the number of presentations of the DIN. One suggestion was to use a variable step size based on the correctness of digits identified within the triplet. In contrast, another suggested using a fixed signal-to-noise ratio (SNR) presentation level for all presentations of the DIN test and producing a pass/fail result based on whether a 95% recognition level was reached. This study aimed to compare three novel DIN test procedures as a potential way to improve efficiency with acceptable reliability using smartphone technology. / Dissertation (MA (Audiology) )--University of Pretoria, 2021. / Speech-Language Pathology and Audiology / MA (Audiology) / Unrestricted

This study explored NCAA athletic departments' mental health screening practices, including the mental health concerns assessed for by the mental health screening, personnel responsible for administering and reviewing screeners, and resources available for athletes identified as "at risk." Participants were athletic department staff who had knowledge of their school's mental health screening processes. Frequencies and chi-square analyses were used to assess trends across divisional levels (DI vs. DII/DIII). Analyses show that significantly more DI than DII/DDIII institutions have a formal mental health screening program. Institutions' coverage of mental health topics in their screening did not vary significantly by Divisional level, with one exception: a larger percentage of DI institutions assessed whether student athletes had worked with a mental health practitioner than DII/DIII schools. DII/III were significantly more likely to have athletic trainers both administer and review mental health screeners and DI institutions were significantly more likely to have a sport psychologist employed within their athletic department than. DI schools were significantly more likely to have had a student athlete attempt suicide and participate in inpatient treatment than DII/III schools. Implications of the findings, limitations, and future directions are discussed.

Students with internalizing behavioral concerns are an overlooked and underserved segment within education. The trend unfortunately results in poor academic and societal outcomes. In response, early prevention and identification through universal screening practices has become an important method for combating internalizing problems in education. However, additional research in the field is needed, including better psychometric understanding of the instruments available and what types of informants provide the best evidence for proper identification. Therefore, the purpose of the following study was to investigate how student and teacher informants of internalizing behaviors influence outcomes in the context of universal screening. Comparison of these two informants were done by analyzing the relationship between a teacher completed screener, the Student Internalizing Behavioral Screener (SIBS) and a student completed behavior rating scale, the Behavioral Assessment System for Children – 2nd edition (BASC-2). In addition to exploration of informant agreement, discrepancies in test score outcomes for different student age groups were investigated along with criterion relatedness of the SIBS when using student self-report as a criterion measure. Results included low agreement between teacher and student informant, as well as poor discriminate ability of the SIBS when using student self-report as a criterion. Findings also revealed a small but significant age discrepancy in the total score for the SIBS when comparing a child vs. adolescent sample. Implications of the findings suggest teachers as a sole informant about internalizing behaviors of students may not be sufficient for desired outcomes of proper identification with internalizing behaviors. Moreover, age may be a factor in monitoring internalizing problems across development and current psychometric evaluation of screeners (e.g., type of validity) should also include other informants. Based on the findings, future directions of research are also proposed. This includes exploration of the impact teachers and teacher training as well as considerations for multi-informant screening procedures.

No / The GHQ-12 has been recommended as a reliable screening instrument for psychological distress in all clinical groups. The usefulness of the GHQ-12 was evaluated in individuals with significant facial disfigurement by examination of the impact of alternative scoring methods on case detection rates. The type of scoring method used had a significant impact on the relative prevalence of `cases'. However, examination of the receiver operating characteristics (ROC) of the alternative scoring methods revealed a good fit between methods. The use of the GHQ-12 as a screening instrument to determine psychological distress in individuals with facial disfigurement may be enhanced by inclusion of an appearance-specific measure in the screening schedule and by the adoption of one scoring method; the GHQ method.

Yes / Specialist services for dementia are seeing an increasing number of patients. We investigated whether interactional and linguistic features in the communication behaviour of patients with memory problems could help distinguish between those with problems secondary to neurological disorders (ND) and those with Functional Memory Disorder (FMD). In Part 1 of this study, a Diagnostic Scoring Aid (DSA) was developed encouraging linguists to provide quantitative ratings for 14 interactional features. An optimal cut-off differentiating ND and FMD was established by applying the DSA to 30 initial patient-doctor memory clinic encounters. In Part 2, the DSA was tested prospectively in ten additional cases analysed independently by two Conversation Analysts blinded to medical information. In part one, the median score of the DSA was +5 in ND and -5 in FMD (p<0.001). The optimal numeric DSA cut off (+1) identified patients with ND with a sensitivity of 86.7% and a specificity of 100%. In part two, DSA scores of rater one correctly predicted 10/10 and those of rater two 9/10 diagnoses. This study indicates that interactional and linguistic features can help distinguish between patients developing dementia and those with FMD and could aid the stratification of patients with memory problems. / NIHR Research for Patient Benefit (RfPB) Programme: PB-PG-0211-24079 – Using Conversation Analysis in the Differential Diagnosis of Memory Problems: a pilot study. 2013-2015

Acral Lentiginous Melanoma (ALM) is a rare diagnosis that typically appears in places people do not normally check, in the nail beds and on the palms and soles of the hands and feet. This subtype of melanoma is unique in that, unlike most melanomas, it does not arise from sun exposure and it mainly affects the black population. Most diagnoses of ALM are made in late stages, leading to a higher mortality. As evident from community-based surveys, there is a lack of awareness in the black population about melanoma and sun risks and most black individuals do not regularly visit a dermatologist. Thus, there is a need for a community intervention to raise awareness to this problem and to detect these cancers before they reach the late stages of disease progression. In the past, community interventions in the black community have focused on prostate cancer, hypertension, and breast health with good success using the barber shop model. In this study, we utilize the salon model to implement a melanoma training course that educate nail technicians to recognize signs of ALM and detect this cancer on their clients’ nails and soles. We also complement this training with a tele-dermatology service so that customers can get timely follow-up from a medical provider. By using a community intervention, we can tackle multiple problems simultaneously; detection of early signs of ALM and improving dermatology access to patients on Medicaid.