Evidence-Based Elements of Child Welfare In-Home Services

In this article we discuss evidence-based elements of effective in-home child welfare services as a foundation for advancing the evidence base for family-centered child welfare practice. In 2009 the U.S. Children’s Bureau established the National Resource Center for In-Home Services to build the capacity of state and tribal child welfare agencies to ensure the safety and well-being of children and youth in their homes, prevent their initial placement or re-entry into out-of-home care, and to support families in their role as primary caregivers. Through a nationwide assessment of in-home services conducted over four years of research and technical assistance, we developed a set of core elements for in-home services. These core elements are supported by empirical research and are congruent with evidence-based practices and programs. We review each of the elements with its underlying research base. We also discuss five evidence-supported in-home services interventions that share many of the elements. We conclude with a discussion of how evidence-based elements can be implemented to strengthen family centered child welfare practice

Метод экспертных оценок в лингводидактике

Рассматривается использование метода экспертных оценок как в общей системе научно-педагогической экспертной деятельности, так и в рамках ее лингводидактического аспекта. Дается характеристика процедуры проведения экспертизы, а также оценивается перспективность обращения к интеллектуальным компьютерным системам как инструментам экспертного анализа

Impact of electronic reminders on venous thromboprophylaxis after admissions and transfers

Objective Clinical decision support has the potential to improve prevention of venous thromboembolism (VTE). The purpose of this prospective study was to analyze the effect of electronic reminders on thromboprophylaxis rates in wards to which patients were admitted and transferred. The latter was of particular interest since patient handoffs are considered to be critical safety issues. Methods The trial involved two study periods in the six departments of a university hospital, three of which were randomly assigned to the intervention group displaying reminders during the second period. At 6 h after admission or transfer, the algorithm checked for prophylaxis orders within 0-30 h of the patient's arrival, increasing the specificity of the displayed reminders. Results The significant impact of the reminders could be seen by prophylaxis orders placed 6-24 h after admission (increasing from 8.6% (223/2579) to 12% (307/2555); p<0.0001) and transfer (increasing from 2.4% (39/1616) to 3.7% (63/1682); p=0.034). In admission wards, the rate of thromboprophylaxis increased from 62.4% to 67.7% (p<0.0001), and in transfer wards it increased from 80.2% to 84.3% (p=0.0022). Overall, the rate of prophylaxis significantly increased in the intervention group from 69.2% to 74.3% (p<0.0001). No significant changes were observed in the control group. Postponing prophylaxis checks to 6 h after admissions and transfers reduced the number of reminders by 62% and thereby minimized the risk of alert fatigue. Conclusions The reminders improved awareness of VTE prevention in both admission and transfer wards. This approach may contribute to better quality of care and safer patient handoff

The Ethics Surrounding Do-it-Yourself Hormone Replacement Therapy

Healthcare is often a complicated issue to navigate, and sadly it gets no easier for those who are transgender. Gender-affirming healthcare can be incredibly tough to attain, both within and outside the United States. Research found that trans citizens in the US were less likely to be insured and more likely to experience barriers to access than cis citizens. In April and May 2021, laws were signed into effect in Arkansas and Tennessee targeting hormone replacement therapy (HRT) and puberty blockers, specifically banning such medicines being given to individuals under 18. As a result, many transgender citizens turn to online resources to obtain HRT, hereby referred to as “DIY-HRT” for its independent nature given resources without the direction of a medical professional. Non-medical sourcing can be dangerous due to a lack of advisory and possibly improper dosing, which can vary from individual to individual (Couillard & Higbee 2018). This is complicated by the fact that doctors who are properly educated on trans healthcare are rare, forcing individuals into a “pick your poison” situation – they can either try and deal with gender dysphoria until they get access to legitimate and effective healthcare, or they can take DIY-HRT while recognizing the risk that they might be harmed by this later in life

Dronedarone reduces arterial thrombus formation

Dronedarone has been associated with a reduced number of first hospitalisation due to acute coronary syndromes. Whether this is only due to the reduction in ventricular heart rate and blood pressure or whether other effects of dronedarone may be involved is currently elusive. This study was designed to investigate the role of dronedarone in arterial thrombus formation. C57Bl/6 mice were treated with dronedarone and arterial thrombosis was investigated using a mouse photochemical injury model. Dronedarone inhibited carotid artery thrombus formation in vivo (P<0.05). Thrombin- and collagen-induced platelet aggregation was impaired in dronedarone-treated mice (P<0.05), and expression of plasminogen activator inhibitor-1 (PAI1), an inhibitor of the fibrinolytic system, was reduced in the arterial wall (P<0.05). In contrast, the level of tissue factor (TF), the main trigger of the coagulation cascade, and that of its physiological inhibitor, TF pathway inhibitor, did not differ. Similarly, coagulation times as measured by prothrombin time and activated partial thromboplastin time were comparable between the two groups. Dronedarone inhibits thrombus formation in vivo through inhibition of platelet aggregation and PAI1 expression. This effect occurs within the range of dronedarone concentrations measured in patients, and may represent a beneficial pleiotropic effect of this dru