An interprofessional collaborative practice model was established at Hennepin County Medical Center to improve discharge management from the transitional care unit of the skilled nursing facility (SNF) to home. The practice model involves a geriatrician, nurse practitioner, and pharmacist who care for individuals at a community-based SNF. Before SNF discharge, the pharmacist conducts a chart and in-person medication review and collaborates with the nurse practitioner to determine the discharge medication regimen. The pharmacist’s review focuses on assessing the indication, safety, effectiveness, and convenience of medications. The pharmacist provides follow-up in-home or over the telephone 1 week after SNF discharge, focusing on reviewing medications and assessing adherence. Hospitalizations and emergency department (ED) visits 30 days after SNF discharge of individuals who received care from this model was compared with those of individuals who received usual care from a nurse practitioner and geriatrician. From October 2012 through December 2013, the intervention was delivered to 87 individuals, with 189 individuals serving as the control group. After adjusting for age, sex, race, and payor, those receiving the intervention had a lower risk of ED visits (odds ratio (OR) = 0.46, 95% confidence interval (CI) = 0.22–0.97), although there was no significant difference in hospitalizations (OR = 0.47, 95% CI = 0.21–1.08). The study suggests that an interprofessional approach involving a pharmacist may be beneficial in reducing ED visits 30 days after SNF discharge.

Most evaluations of the effects of human activities on wild animals have focused on estimating changes in abundance and distribution of threatened species; however, ecosystem disturbances also affect aspects of animal behavior such as short-term movement, activity budgets, and reproduction. It may take a long time for changes in behavior to manifest as changes in abundance or distribution. Therefore, it is important to have methods with which to detect short-term behavioral responses to human activity. We used continuous acoustic and seismic monitoring to evaluate the short-term effects of seismic prospecting for oil on forest elephants (Loxodonta cyclotis) in Gabon, Central Africa. We monitored changes in elephant abundance and activity as a function of the frequency and intensity of acoustic and seismic signals from dynamite detonation and human activity. Elephants did not flee the area being explored; the relative number of elephants increased in a seasonal pattern typical of elsewhere in the ecosystem. In the exploration area, however, they became more nocturnal. Neither the intensity nor the frequency of dynamite blasts affected the frequency of calling or the daily pattern of elephant activity. Nevertheless, the shift of activity to nocturnal hours became more pronounced as human activity neared each monitored area of forest. This change in activity pattern and its likely causes would not have been detected through standard monitoring methods, which are not sensitive to behavioral changes over short time scales (e.g., dung transects, point counts) or cover a limited area (e.g., camera traps). Simultaneous acoustic monitoring of animal communication, human, and environmental sounds allows the documentation of short-term behavioral changes in response to human disturbance.

To the Editor:Morbidity and mortality associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are extremely visible 1 ; however, the effect of the COVID-19 pandemic on the management of other pathologies requiring complex interventions and critical care resources-the bystander effect 2 -is not well described. This is certainly true of stroke patients whose clinical outcomes are a function of early presentation, timely diagnosis, emergent intervention, and critical care management. [3][4][5] With the arrival of COVID-19 cases in the month of March in the hotspot of Michigan, we describe the bystander effect of the COVID-19 pandemic on ischemic and hemorrhagic stroke. METHODSThis is a retrospective analysis of deidentified data submitted from 11 Comprehensive Stroke Centers (CSCs) and 1 Primary Stroke Center (PSC) in Michigan and northwest Ohio. The study was approved by the University Institutional Review Board. Patient consent was not required given the retrospective nature of the study. Using Poisson regression analysis, we calculated the incidence-rate ratios (IRRs) comparing the study period of March 2020 to each of the control periods (February 2020 and March 2019). Additionally, the unpaired t-test for continuous variables and the Chi-square test for categorical variables were used as appropriate.

Implementing a standardized discharge order reconciliation process that includes pharmacists led to decreased readmission rates and improved care for patients discharged to SNFs.

Background There are concerns that the use of electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS) in children and adolescents could potentially be harmful to health. Understanding the extent of use of these devices is crucial to informing public health policy. We aimed to synthesise the prevalence of ENDS or ENNDS use in children and adolescents younger than 20 years. MethodsIn this systematic review and meta-analysis, we undertook an electronic search in five databases (MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Embase, and Wiley Cochrane Library) from Jan 1, 2016, to Aug 31, 2020, and a grey literature search. Included studies reported on the prevalence of ENDS or ENNDS use in nationally representative samples in populations younger than 20 years and collected data between the years 2016 and 2020. Studies were excluded if they were done in those aged 20 years or older, used data from specialist panels that did not apply appropriate weighting, or did not use methods that ensured recruitment of a nationally representative sample. We included the most recent data for each country. We combined multiple national estimates for a country if they were done in the same year. We undertook risk of bias assessment for all surveys included in the review using the Joanna Briggs Institute Critical Appraisal Checklist (by two reviewers in the author list). A random effects meta-analysis was used to pool overall prevalence estimates for ever, current, occasional, and daily use. This study was prospectively registered with PROSPERO, CRD42020199485.Findings The most recent prevalence data from 26 national surveys representing 69 countries and territories, with a median sample size of 3925 (IQR 1=2266, IQR 3=10 593) children and adolescents was included. In children and adolescents aged between 8 years and younger than 20 years, the pooled prevalence for ever (defined as any lifetime use) ENDS or ENNDS use was 17•2% (95% CI 15-20, I²=99•9%), whereas for current use (defined as use in past 30 days) the pooled prevalence estimate was 7•8% (6-9, I²=99•8%). The pooled estimate for occasional use was 0•8% (0•5-1•2, I²=99•4%) for daily use and 7•5% (6•1-9•1, I²=99•4%) for occasional use. Prevalence of ENDS or ENNDS use was highest in high-income geographical regions. In terms of study quality, all surveys scored had a low risk of bias for the sampling frame used, due to the nationally representative nature of the studies. The most poorly conducted methodological feature of the included studies was subjects and setting described in detail. Few surveys reported on the use of flavours or types of ENDS or ENNDS.Interpretation There is significant variability in the prevalence of ENDS and ENNDS use in children and adolescents globally by country income status. These findings are possibly due to differences in regulatory context, market availability, and differences in surveillance systems.Funding World Health Organization and the Bill & Melinda Gates Foundat...