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Kroese L, Lobo K, Meyer M, Tate J, Mays M, Adye R, Qureshi H, Al-Shammaa B, Brito A, Seo-Mayer P, Moyer K, Port C. Improving food insecurity screening across a health system throughout the COVID-19 pandemic. BMJ Open Qual 2024; 13:e002462. [PMID: 38296603 PMCID: PMC10831437 DOI: 10.1136/bmjoq-2023-002462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/10/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Food insecurity has direct and indirect negative outcomes on the physical and mental health of children, with impacts throughout adult life. Rates of food insecurity have increased dramatically since the start of the COVID-19 pandemic. The American Academy of Pediatrics recommends paediatricians screen and intervene to address food insecurity. We aimed to increase the percentage of patient encounters with food insecurity screening completion at the paediatric medical home from 0% to 85% by July 2020 with extension to the paediatric emergency department (ED) and paediatric specialty clinic in the following year. METHODS This multicentre project occurred in three sites within our health system: a teaching safety-net, paediatric medical home; a paediatric ED; and five divisions within paediatric specialty medical clinics. A screening tool was created using the validated Hunger Vital Sign Questionnaire. A standard screening, documentation and referral process was developed. The Model for Improvement was used testing changes via Plan-Do-Study-Act cycles. RESULTS The percentage of households screened for food insecurity increased from a median of 0% to 30% for all sites combined. There was significant variability in screening with the ED screening a median of 24% and the medical home screening 80% by the end of the study period. A total of 9842 households (20.9%) screened were food insecure. During the study period, 895 families with 3925 household members received 69 791 pounds of food from our primary community resource using our clinic's food prescription. Of these families, 44% (398) also qualified for the US Department of Agriculture programme ensuring ongoing food distribution up to twice a month. DISCUSSION Using quality improvement methodology to address a critical community need, we implemented food insecurity screening across a hospital system including multiple sites and specialties and provided critical resources to households in need.
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Affiliation(s)
- Lani Kroese
- Pediatrics, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Kenia Lobo
- Pediatrics, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Mary Meyer
- Pediatrics, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Jordan Tate
- Pediatrics, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Mitra Mays
- Pediatrics, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Rebecca Adye
- Inova Children's Multispecialty Center, Inova Health System, Fairfax, Virginia, USA
| | - Henna Qureshi
- Inova Cares Clinic for Children, Inova Health System, Falls Church, Virginia, USA
- University of Virginia School of Medicine, Inova Regional Campus, Falls Church, Virginia, USA
| | - Bann Al-Shammaa
- Inova Cares Clinic for Children, Inova Health System, Falls Church, Virginia, USA
- University of Virginia School of Medicine, Inova Regional Campus, Falls Church, Virginia, USA
| | - Albert Brito
- Inova Cares Clinic for Children, Inova Health System, Falls Church, Virginia, USA
- University of Virginia School of Medicine, Inova Regional Campus, Falls Church, Virginia, USA
| | - Patty Seo-Mayer
- Inova Children's Multispecialty Center, Inova Health System, Fairfax, Virginia, USA
- University of Virginia School of Medicine, Inova Regional Campus, Falls Church, Virginia, USA
| | - Katherine Moyer
- Inova Children's Multispecialty Center, Inova Health System, Fairfax, Virginia, USA
| | - Courtney Port
- Pediatrics, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- University of Virginia School of Medicine, Inova Regional Campus, Falls Church, Virginia, USA
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Gowda C, Smith S, Crim L, Moyer K, Sánchez PJ, Honegger JR. Nucleic Acid Testing for Diagnosis of Perinatally Acquired Hepatitis C Virus Infection in Early Infancy. Clin Infect Dis 2021; 73:e3340-e3346. [PMID: 32640018 PMCID: PMC8563185 DOI: 10.1093/cid/ciaa949] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 07/03/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Most US children with perinatal hepatitis C virus (HCV) exposure fail to receive the recommended anti-HCV antibody test at age ≥18 months. Earlier testing for viral RNA might facilitate increased screening, but sensitivity of this approach has not been established. We hypothesized that modern HCV-RNA RT-PCR platforms would adequately detect infected infants. METHODS Nationwide Children's Hospital electronic health records from 1/1/2008 to 30/6/2018 were reviewed to identify perinatally exposed infants tested by HCV-RNA RT-PCR at age 2-6 months. Diagnostic performance was determined using a composite case definition: (1) infected children had positive repeat HCV-RNA testing or positive anti-HCV at age ≥24 months; (2) uninfected children lacked these criteria and had negative anti-HCV at age ≥18 months. RESULTS 770 perinatally exposed infants underwent HCV-RNA testing at age 2-6 months. Of these, 28 (3.6%) tested positive; viremia was confirmed in all who underwent repeat testing (n = 27). Among 742 infants with negative HCV-RNA results, 226 received follow-up anti-HCV testing at age ≥18 months, of whom 223 tested negative. Three children had low-positive anti-HCV results at age 18-24 months that were negative upon retesting after age 24 months, possibly indicating waning maternal antibodies. Using the composite case definitions, early HCV-RNA screening demonstrated sensitivity of 100% (87.5-100%, Wilson-Brown 95% CI) and specificity of 100% (98.3-100%). CONCLUSIONS Modern HCV-RNA RT-PCR assays have excellent sensitivity for early diagnosis of perinatally acquired infection and could aid HCV surveillance given the substantial loss to follow-up at ≥18 months of age.
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Affiliation(s)
- Charitha Gowda
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Nationwide Children’s Hospital–The Ohio State University College of Medicine, Columbus, Ohio, USA
- Partners For Kids, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Stephanie Smith
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Nationwide Children’s Hospital–The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Linda Crim
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Nationwide Children’s Hospital–The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Katherine Moyer
- Division of Pediatric Infectious Diseases, Inova Children’s Hospital, Falls Church, Virginia USA
| | - Pablo J Sánchez
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Nationwide Children’s Hospital–The Ohio State University College of Medicine, Columbus, Ohio, USA
- Division of Neonatology, Department of Pediatrics, Nationwide Children’s Hospital–The Ohio State University College of Medicine, Columbus, Ohio, USA
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Jonathan R Honegger
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Nationwide Children’s Hospital–The Ohio State University College of Medicine, Columbus, Ohio, USA
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA
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Wang H, Diaz A, Moyer K, Mele-Casas M, Ara-Montojo MF, Torrus I, McCoy K, Mejias A, Leber AL. Molecular and Clinical Comparison of Enterovirus D68 Outbreaks among Hospitalized Children, Ohio, USA, 2014 and 2018. Emerg Infect Dis 2019; 25:2055-2063. [PMID: 31454311 PMCID: PMC6810223 DOI: 10.3201/eid2511.190973] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Enterovirus D68 (EV-D68) causes respiratory tract infections and neurologic manifestations. We compared the clinical manifestations from 2 EV-D68 outbreaks in 2014 and 2018 and a low-activity period in 2016 among hospitalized children in central Ohio, USA, and used PCR and sequencing to enable phylogenetic comparisons. During both outbreak periods, infected children had respiratory manifestations that led to an increase in hospital admissions for asthma. The 2018 EV-D68 outbreak appeared to be milder in terms of respiratory illness, as shown by lower rates of pediatric intensive care unit admission. However, the frequency of severe neurologic manifestations was higher in 2018 than in 2014. During the same period in 2016, we noted neither an increase in EV-D68 nor a significant increase in asthma-related admissions. Phylogenetic analyses showed that EV-D68 isolates from 2018 clustered differently within clade B than did isolates from 2014 and are perhaps associated with a different EV-D68 subclade.
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Moyer K, Wang H, Salamon D, Leber A, Mejias A. Enterovirus D68 in Hospitalized Children: Sequence Variation, Viral Loads and Clinical Outcomes. PLoS One 2016; 11:e0167111. [PMID: 27875593 PMCID: PMC5119825 DOI: 10.1371/journal.pone.0167111] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/08/2016] [Indexed: 12/11/2022] Open
Abstract
Background An outbreak of enterovirus D68 (EV-D68) caused severe respiratory illness in 2014. The disease spectrum of EV-D68 infections in children with underlying medical conditions other than asthma, the role of EV-D68 loads on clinical illness, and the variation of EV-D68 strains within the same institution over time have not been described. We sought to define the association between EV-D68 loads and sequence variation, and the clinical characteristic in hospitalized children at our institution from 2011 to 2014. Methods May through November 2014, and August to September 2011 to 2013, a convenience sample of nasopharyngeal specimens from children with rhinovirus (RV)/EV respiratory infections were tested for EV-D68 by RT-PCR. Clinical data were compared between children with RV/EV-non-EV-D68 and EV-D68 infections, and among children with EV-D68 infections categorized as healthy, asthmatics, and chronic medical conditions. EV-D68 loads were analyzed in relation to disease severity parameters and sequence variability characterized over time. Results In 2014, 44% (192/438) of samples tested positive for EV-D68 vs. 10% (13/130) in 2011–13 (p<0.0001). PICU admissions (p<0.0001) and non-invasive ventilation (p<0.0001) were more common in children with EV-D68 vs. RV/EV-non-EV-D68 infections. Asthmatic EV-D68+ children, required supplemental oxygen administration (p = 0.03) and PICU admissions (p <0.001) more frequently than healthy children or those with chronic medical conditions; however oxygen duration (p<0.0001), and both PICU and total hospital stay (p<0.01) were greater in children with underlying medical conditions, irrespective of viral burden. By phylogenetic analysis, the 2014 EV-D68 strains clustered into a new sublineage within clade B. Conclusions This is one of the largest pediatric cohorts described from the EV-D68 outbreak. Irrespective of viral loads, EV-D68 was associated with high morbidity in children with asthma and co-morbidities. While EV-D68 circulated before 2014, the outbreak isolates clustered differently than those from prior years.
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Affiliation(s)
- Katherine Moyer
- Department of Pediatrics, Division of Infectious Diseases, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Huanyu Wang
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Douglas Salamon
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | - Amy Leber
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- * E-mail: (AM); (AL)
| | - Asuncion Mejias
- Department of Pediatrics, Division of Infectious Diseases, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children’s Hospital, The Ohio State University, Columbus, Ohio, United States of America
- * E-mail: (AM); (AL)
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Dulaurier M, Moyer K, Wallihan R. Ebola virus disease: epidemiology, clinical presentation, and diagnostic and therapeutic modalities. Pediatr Emerg Med Pract 2016; 13:1-20. [PMID: 27328168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 04/10/2016] [Indexed: 06/06/2023]
Abstract
Ebola virus disease (EVD) is a severe multisystem disease. Prehospital personnel, hospitals, and clinicians must be prepared to provide care for patients with EVD, with special attention to rigorous infection control in order to limit the spread of infection. Children with EVD are an especially challenging population, as the initial symptoms are nonspecific and difficult to differentiate from several common infections. For children presenting with a syndrome consistent with EVD, it is extremely important that healthcare workers identify epidemiologic risk factors, such as recent travel to an affected country or exposure to a patient with suspected or known EVD. Given the high morbidity and mortality of this disease, clinical efforts should focus on early diagnosis, appropriate infection control, and supportive care.
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Affiliation(s)
- Marlie Dulaurier
- Pediatric Emergency Medicine, Nationwide Children's Hospital; Assistant Professor of Pediatrics, The Ohio State University, Columbus, OH
| | - Katherine Moyer
- Pediatric Infectious Diseases Fellow, Nationwide Children's Hospital, Columbus, OH
| | - Rebecca Wallihan
- Assistant Professor of Clinical Pediatrics, Section of Infectious Diseases, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH
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Moyer K, Bunsow E, Salamon D, Leber A, Ramilo O, Mejias A. 990Implementation of Routine Testing for Human Rhinovirus (HRV) detection and quantitation: Impact of Coinfections, Age and Disease Severity. Open Forum Infect Dis 2014. [DOI: 10.1093/ofid/ofu052.698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Katherine Moyer
- Infectious Diseases, Nationwide Children's Hospital, Columbus, OH
| | | | - Douglas Salamon
- Department of Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Amy Leber
- Nationwide Children's Hospital, Columbus, OH
| | - Octavio Ramilo
- Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Asuncion Mejias
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH
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Knox J, Moyer K, Yacoub N, Soldaat C, Komosa M, Vassilieva K, Wilk R, Hu J, Vazquez Paz LDL, Syed Q, Krause HM, Georgescu M, Jacobs JR. Syndecan contributes to heart cell specification and lumen formation during Drosophila cardiogenesis. Dev Biol 2011; 356:279-90. [PMID: 21565181 DOI: 10.1016/j.ydbio.2011.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 04/08/2011] [Accepted: 04/11/2011] [Indexed: 10/18/2022]
Abstract
The transmembrane proteoglycan Syndecan contributes to cell surface signaling of diverse ligands in mammals, yet in Drosophila, genetic evidence links Syndecan only to the Slit receptor Roundabout and to the receptor tyrosine phosphatase LAR. Here we characterize the requirement for syndecan in the determination and morphogenesis of the Drosophila heart, and reveal two phases of activity, indicating that Syndecan is a co-factor in at least two signaling events in this tissue. There is a stochastic failure to determine heart cell progenitors in a subset of abdominal hemisegments in embryos mutant for syndecan, and subsequent to Syndecan depletion by RNA interference. This phenotype is sensitive to gene dosage in the FGF receptor (Heartless), its ligand, Pyramus, as well as BMP-ligand Decapentaplegic (Dpp) and co-factor Sara. Syndecan is also required for lumen formation during assembly of the heart vessel, a phenotype shared with mutations in the Slit and Integrin signaling pathways. Phenotypic interactions of syndecan with slit and Integrin mutants suggest intersecting function, consistent with Syndecan acting as a co-receptor for Slit in the Drosophila heart.
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Affiliation(s)
- Jessica Knox
- Department of Biology, McMaster University, 1280 Main St. W., Hamilton, Ontario, Canada
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Andriano KP, Chandrashekar B, McEnery K, Dunn RL, Moyer K, Balliu CM, Holland KM, Garrett S, Huffer WE. Preliminary in vivo studies on the osteogenic potential of bone morphogenetic proteins delivered from an absorbable puttylike polymer matrix. J Biomed Mater Res 2000; 53:36-43. [PMID: 10634950 DOI: 10.1002/(sici)1097-4636(2000)53:1<36::aid-jbm5>3.0.co;2-h] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This article describes preliminary in vivo studies evaluating the osteogeneic potential of bone morphogenetic proteins (BMPs) delivered from an absorbable puttylike polymer matrix. In the first study, bovine-derived bone morphogenetic proteins were incorporated in an polymer matrix consisting of 50:50 poly(DL-lactide-co-glycolide) dissolved in N-methyl-2-pyrrolidone. The matrix was implanted in an 8 mm critical-size calvarial defect created in the skull of adult Sprague-Dawley rats (n = 5 per treatment group). After 28 days, the implant sites were removed and examined for new bone formation, polymer degradation, and tissue reaction. Gamma-irradiated polymer matrices appeared to give more bone formation than nonirradiated samples (histological analysis; 2. 76 + 1.34 mm(2) of bone versus 1.30 + 0.90 mm(2) of bone, respectively and x-ray analysis; 27.2 + 15.9 mm(2) of bone versus 20. 7 + 16.7 mm(2) of bone, respectively) and less residual polymer (0.0 + 0.0 versus 0.2 + 0.4, respectively). The polymer implants with bone morphogenetic protein also gave less inflammatory response than the polymer controls (gamma irradiated polymer/BMP = 1.8 + 0.4 and nonirradiated polymer/BMP = 1.2 + 0.4 versus polymer only = 3.0 + 1. 2, respectively). However, despite trends in both the x-ray and histological data there was no statistical difference in the amount of new bone formed among the four treatment groups (P > 0.05). This was most likely due to the large variance in the data scatter and the small number of animals per group. In the second animal study, bovine-derived BMPs and the polymeric carrier were gamma irradiated separately, at doses of 1.5 or 2.5 Mrad, and their ability to form bone in a rat skull onlay model was evaluated using Sprague-Dawley rats (n = 5 per treatment group). Histomorphometry of skull caps harvested 28 days after implantation showed no significant differences as compared to non-irradiated samples, in implant area, new bone area, and percent new bone (P > 0.05). These results suggest gamma irradiation may be useful in sterilization of the bovine-derived BMPs and the polymeric carrier for potential bone repair and/or regeneration applications.
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Affiliation(s)
- K P Andriano
- Atrix Laboratories, Inc., 2579 Midpoint Drive, Fort Collins, Colorado 80525, USA.
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Moyer K. Employment practices liability protects you from frivolous lawsuits. Balance 1998; 2:28. [PMID: 10178540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- K Moyer
- Hirsch Wolf & Company, Brooklyn, NY, USA
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Moyer K. There's no place like rural home care. Kans Nurse 1987; 62:3. [PMID: 3648295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Bobek JR, Fleck MA, Moyer K, Paules CA. Selection of medical technology students in a hospital-based program. J Allied Health 1984; 13:197-204. [PMID: 6501078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This article describes a process for selection of medical technology students into a hospital-based program. The process uses a weighting method for selection criteria and numerical ranking of applicants by a point system. Tools developed by the selection committee are discussed: Pre-Interview Rating Form, Interview Rating Form, Interview Rating Form Score Sheet, and Interview Questions Sets. The structured selection interview is described in detail. The process might easily be adapted to other hospital-based allied health programs.
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Griff LC, Konikiewicz LW, Moyer K. Bioelectrography in cancer detection. Pa Med 1983; 86:54-9. [PMID: 6685853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Moyer K. Nursing management of the patient undergoing medical amputation. Crit Care Update 1983; 10:7-17. [PMID: 6554161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Ghiglieri S, Woods SA, Moyer K. Toward a competency-based safe practice. Nurs Manag (Harrow) 1983; 14:16-8. [PMID: 6550750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Abstract
The Inglis Street Activity Centre was initiated in November 1975 to meet the growing need in Halifax for a structured aftercare program for the long-term psychiatric patients being discharged from the Abbie J. Lane Memorial Hospital. It is a pilot program, operated by the Abbie J. Lane staff five afternoons per week, in a large house in a residential area of the city. Inpatients who are being prepared for discharge begin attending the program while in hospital, and continue after discharge until they are able to fully integrate into the community. Clients are accepted from other agencies as well, and the program is seen as being preventive as well as a provider of aftercare. Of the 64 clients seen in the first year of operation, only seven were readmitted to hospital, and the length of hospital stay for these seven was significantly reduced. The operating expenses were minimal ($11,456 including salaries) and it is felt that this has been an effective model for assisting the long-term psychiatric client to successfully make the transition from hospital to community.
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Moyer K. Sharp Instruments. Am J Dent Sci 1904; 35:112. [PMID: 30750376 PMCID: PMC6075100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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