BackgroundThis paper evaluated the implementation West Central Alabama Area Health Education Center programs for high school students in grades 9–12 through participant-reported evaluations and feedback during the September 1st, 2013 to August 31st, 2014 fiscal year. The programs targeted racial/ethnic minorities and/or rural individuals interested in pursuing a career as a healthcare provider in medically underserved counties of Alabama.MethodsStudents participated in enrichment activities related to prospective health careers that included: successful college preparedness, knowledge about health careers, and the types of primary care health professions that are needed in underserved Alabama communities. The curriculum studied 593 (ACT preparation: n = 172, AHEC 101: n = 56, FAFSA: n = 109, Health Career Exploration: n = 159, College Career Readiness: n = 67, Dixie Scholars NERD: n = 30) baseline measures for the programs to evaluate effectiveness when rated by participants both quantitatively and qualitatively.ResultsInteractive activities with video incorporation, hands-on experiences, and group discussions paired with student motivation and interest in specific health career-related activities provided the highest program ratings.ConclusionsIt is important to use a variety of successful program strategies when forming healthcare workforce development interventions. Student evaluations can help adapt methods for future program implementation to ultimately achieve strategies for health professional recruitment, training, and retention in areas that lack access to quality healthcare.
Positive End Expiratory Pressure (PEEP) is a fundamental ventilator setting selected by critical care providers and is thought to mitigate atelectasis and atelectotrauma. Optimal PEEP is often studied in the setting of ARDS, but there have been few investigations on the selection of initial PEEP in its absence. Five cm H 2 O is believed to be a physiologic level and is often set as a standard starting point for intubated patients. We sought to explore if an initial use of PEEP$7.5 cmH 2 O compared to lower initial levels of PEEP may reduce the incidence of Ventilator Associated Events (VAE). METHODS:We retrospectively reviewed charts of patients who received mechanical ventilation in 3 Intensive Care Units staffed by the same group of critical care providers. Consecutive cases were reviewed from September 2017 through September 2018. Exclusion criteria included a ventilator course of less than 3 calendar days, inpatient ventilation with alternate facilities or services prior to transfer, or the use of home ventilation prior to arrival. A total of 146 patients met inclusion criteria and data were recorded in a standardized format. Potential VAE were verified by the most senior reviewer using strict CDC criteria. Two cohorts were delineated, those who received an initial PEEP$7.5 cmH 2 O and those initiated on <7.5 cmH 2 O. The initial PEEP was defined as the first setting that was sustained for a period of 8 hours. Fisher's Exact and Wilcoxon Rank Sum tests were used to assess for differences of dichotomous and nonparametric continuous variables, respectively. The primary outcome was the rate of VAE. Secondary outcomes included ICU and hospital mortality, ventilator days, and ICU and hospital days. Multivariate logistic regression analysis was performed to evaluate for any confounders noted in baseline characteristics.RESULTS: Of the 146 cases reviewed, 106 received higher initial PEEP and 40 received lower initial PEEP. Baseline characteristics between groups were similar, though an exception favoring the higher PEEP group was hypoxia as the reason for intubation (67% vs 35%, p¼0.001). The cohort with PEEP$7.5 had fewer VAE (9% vs 23%, p¼0.04) and lower ICU mortality (48% vs 65%, p¼0.02) compared to the lower PEEP cohort. Median number of ventilator days also trended towards significance in the former group (7 vs 11, p¼0.07). Controlling for BMI and reason for intubation, PEEP$7.5 independently reduced VAE 4-fold (OR 0.2, p¼0.01) and ICU mortality 3-fold (OR 0.3, p¼0.01). BMI$30 also increased VAE 3-fold (OR 3.2, p¼0.03) regardless of initial PEEP but had no effect on ICU mortality. CONCLUSIONS:The rates of VAE and ICU mortality were lower in patients who received an initial PEEP$7.5 cmH 2 O compared to lower levels of initial PEEP. This observation was persistent after controlling for differences in baseline characteristics between groups. Obesity was an independent risk factor for VAE. A trend towards reduction of ventilator days was also seen among patients receiving higher levels of initial PEEP.CLINICAL IMPL...
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