Telemedicine use in the field of wound care had been increasing in popularity when the novel coronavirus 2019 paralyzed the globe in early 2020. To combat the constraints of healthcare delivery during this time, the use of telemedicine has been further expanded. Though many limitations of telemedicine are still being untangled, the benefits of virtual care are being realized in both inpatient and outpatient settings. In this article, the advantages and disadvantages of telemedicine are discussed through two case examples that highlight the promise of implementation during and beyond the pandemic.

Background Prone positioning improves mortality in patients intubated with acute respiratory distress syndrome and has been proposed as a treatment for non-intubated patients with COVID-19 outside the ICU. However, there are substantial patient and operational barriers to prone positioning on acute floors. Our objective was to increase the frequency of prone positioning among acute care patients with COVID-19. Methods We conducted a retrospective analysis of all adult patients admitted to the acute care floors with COVID-19 respiratory failure. We used a run chart to quantify the frequency of prone positioning over time. For the subset of patients assisted by a dedicated physical therapy team, we compared oxygen before and after positioning. Our initiative consisted of four separate interventions: (1) nursing, physical therapy, physician, and patient education; (2) optimization of supply management and operations; (3) an acute care prone positioning team; and (4) electronic health record optimization. Results From March 9, 2020 to August 26, 2020, 176/875 (20.1%) patients were placed in prone position. Among these, 43 (24.4%) were placed in prone position by the physical therapy team. Only 2/94 (2%) eligible patients admitted in the first two weeks of the pandemic were ever documented in prone position. After launching our initiative, weekly frequency peaked at 13/28 (46.4%). Mean oxygen saturation was 91% prior to prone positioning versus 95.2% after ( p < 0.001) in those positioned by physical therapy. Conclusion A multidisciplinary quality improvement initiative increased frequency of prone positioning by proactively addressing barriers in knowledge, equipment, training, and information technology.

Pharmacovigilance is the science of monitoring the effects of medicinal products to identify and evaluate potential adverse reactions and provide necessary and timely risk mitigation measures. Intelligent automation technologies have a strong potential to automate routine work and to balance resource use across safety risk management and other pharmacovigilance activities. While emerging technologies such as artificial intelligence (AI) show great promise for improving pharmacovigilance with their capability to learn based on data inputs, existing validation guidelines should be augmented to verify intelligent automation systems. While the underlying validation requirements largely remain the same, additional activities tailored to intelligent automation are needed to document evidence that the system is fit for purpose. We propose three categories of intelligent automation systems, ranging from rule-based systems to dynamic AI-based systems, and each category needs a unique validation approach. We expand on the existing good automated manufacturing practices, which outline a risk-based approach to artificially intelligent static systems. Our framework provides pharmacovigilance professionals with the knowledge to lead technology implementations within their organizations with considerations given to the building, implementation, validation, and maintenance of assistive technology systems. Successful pharmacovigilance professionals will play an increasingly active role in bridging the gap between business operations and technical advancements to ensure inspection readiness and compliance with global regulatory authorities.

Abstract1. Play and socio-sexual behaviors were studied in a captive chimpanzee group composed of three mothers and their offspring. 2. Mother-other infant relationships were more extensive and varied than those reported among wild chimpanzees. These relationships did not affect the motherinf ant bond. 3. Socio-sexual behaviors were regularly directed toward infants by all group members, including other infants. It is suggested that infant socio-sexuality should be viewed not only as a developmental phenomenon, but as an important factor in group interaction patterns. 4. Group play centered around the oldest male infant and two mothers played more with other infants than with their own infants. 5. Patterns of interaction among group members were shown to be heavily dependent on age-sex status. 6. Young infants initially tried to behave toward one another much as they behaved toward their own mothers. The way in which this tendency produced entirely new behavior patterns is discussed.

OBJECTIVE: An interprofessional team known as the Tracheostomy SteeringCommittee (TSC) was established to prevent tracheotomy-related pressure injuries (TRPIs) and standardize practice for tracheostomy insertion and care of patients with tracheostomies. In addition to reducing the number TRPIs, the TSC sought establish an escalation process for all clinicians to raise concerns about the care and management of patients with tracheostomies. METHODS:This quality improvement initiative used the Define, Measure, Analyze, Improve, and Control framework with a pre-and postintervention design. The TSC created a TRPI-prevention bundle that included recommendations for protective foam dressing and skin barrier film use, suture tension, timing of suture removal, stoma care, offloading and positioning, escalation, documentation, and dual skin assessment. An electronic tracheostomy report was developed to track patients with a tracheostomy across the enterprise. RESULTS:A total of 289 patients had a tracheostomy during their inpatient hospital stay from January 2018 through December 2019. There was an observed a reduction in the daily rate of TRPIs by 50% with the use of the standardized TRPI-prevention bundle.CONCLUSIONS: Use of the bundle resulted in a significant reduction in the incidence of TRPI. Timely escalation of possible tracheostomy injuries or tracheostomies at risk enabled rapid intervention, likely preventing many injuries, and real-time feedback to clinicians reinforced best practices. Interprofessional collaboration is necessary to provide optimal tracheostomy care and ensure the best outcomes.

Three female chimpanzees and their offspring were housed together to investigate the effect of a mother-infant social group on individual mother-infant interaction patterns. Mother-other-infant and infant-infant interactions were also studied. When the social group was formed infants moved away from their mothers more frequently but the total amount of contact between mother and infant also increased. Mothers displayed no aggression toward other infants or toward their own infants at any time. Mothers groomed nonmobile infants more frequently following group housing but groomed mobile infants less frequently. Infants played frequently with each other and with all mothers. Mothers carried other infants both ventrally and dorsally and occasionally allowed them to nurse for brief periods. Infant-infant play patterns were qualitatively different than mother-infant play patterns.

GENERAL PURPOSETo discuss a standardized methodology for wound photography with a focus on aiding clinicians in capturing high-fidelity images.TARGET AUDIENCEThis continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.LEARNING OBJECTIVES/OUTCOMESAfter participating in this educational activity, the participant will be able to:1. Discriminate the components of high-quality wound photography.2. Identify the technological innovations that can augment clinical decision-making capacity.3. Choose strategies that can help clinicians avoid adverse medicolegal outcomes.

OBJECTIVE To assess pressure injury knowledge of Skin Care Council nursing members using the Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT), to design an educational intervention informed by the results of the baseline assessment, and to evaluate the effect of the intervention. METHODS This was a single-group pretest-posttest project conducted in an urban, academic, tertiary medical center from January to August 2017. Participants were measured on the pretest, received the intervention, and then were reevaluated on the posttest 3 months later. Pretest results informed the design of the intervention, which was a 1-day interactive, targeted educational program referred to as the “Skin Care Council Boot Camp.” Paired-samples t tests were conducted to examine differences between pretest and posttest scores on the PZ-PUKT overall and in each test section. RESULTS Seventy-seven participants enrolled in the project and completed the pretest. Of those, 58 (75.3%) were retained through the intervention and the posttest evaluation. Participants had a mean pretest score of 78.9 and a mean posttest score of 85.3. There were significant mean differences among pretest and posttest PZ-PUKT scores: 6.4 (t = 9.419, P < .001) overall; 4.6 (t = 5.356, P < .001) in the Prevention/Risk category; 4.1 (t = 3.668, P < .001) in the Staging category; and 10.5 (t = 7.938, P < .001) in the Wound Description category. CONCLUSIONS By testing pressure injury knowledge before developing a program, investigators created a tailored, education program that addressed knowledge gaps. Posttest results provided insight into the program’s success and opportunities for future improvement.