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Autism and Pervasive Developmental Disorder Not Otherwise Specified are common developmental problems often seen by child neurologists. There are currently no cures for these lifelong and socially impairing conditions that affect core domains of human behavior such as language, social interaction, and social awareness. The etiology may be multifactorial and may include autoimmune, genetic, neuroanatomic, and possibly excessive glutaminergic mechanisms. Because memantine is a moderate affinity antagonist of the N-methylD-aspartic acid (NMDA) glutamate receptor, this drug was hypothesized to potentially modulate learning, block excessive glutamate effects that can include neuroinflammatory activity, and influence neuroglial activity in autism and Pervasive Developmental Disorder Not Otherwise Specified. Open-label add-on therapy was offered to 151 patients with prior diagnoses of autism or Pervasive Developmental Disorder Not Otherwise Specified over a 21-month period. To generate a clinician-derived Clinical Global Impression Improvement score for language, behavior, and self-stimulatory behaviors, the primary author observed the subjects and questioned their caretakers within 4 to 8 weeks of the initiation of therapy. Chronic maintenance therapy with the drug was continued if there were no negative side effects. Results showed significant improvements in open-label use for language function, social behavior, and self-stimulatory behaviors, although self-stimulatory behaviors comparatively improved to a lesser degree. Chronic use so far appears to have no serious side effects.

IntroductionGlobal health education is becoming more important for developing well-rounded physicians and may encourage students toward a career in primary care. Many medical schools, however, lack adequate and structured opportunities for students beginning the curriculum.MethodsSecond-year medical students initiated, designed, and facilitated a pass–fail international health elective, providing a curricular framework for preclinical medical students wishing to gain exposure to the clinical and cultural practices of a developing country.ResultsAll course participants (N=30) completed a post-travel questionnaire within one week of sharing their experiences. Screening reflection essays for common themes that fulfill university core competencies yielded specific global health learning outcomes, including analysis of health care determinants.ConclusionMedical students successfully implemented a sustainable global health curriculum for preclinical student peers. Financial constraints, language, and organizational burdens limit student participation. In future, long-term studies should analyze career impact and benefits to the host country.

ObjectivesDescribe the factors that impact readmission of patients with chronic illness being managed at Skilled Nursing Facilities.Recognize the key drivers that improved communication will try to achieve by the warm handoff protocol. Describe creation of a comprehensive discharge packet with a relevant summary of hospital course.Background. Unplanned 30-day hospital readmissions are an important measure of hospital quality and a focus of national regulations. The readmission rate for patients being discharged to skilled nursing facilities (SNF) has been an area of improvement for all healthcare systems. The vast majority of SNF will receive a penalty on their Medicare payments for fiscal year 2019 for poor 30-day readmission rates back to hospitals.Aim Statement. We aim to reduce the 30 day all cause readmission rate at an urban medical center for skilled nursing facility discharges from the collaborative from Accountable Care Unit from 18% in 2018 to 16% from April to December 2019 at the largest teaching campus for the health system.Methods. We used our palliative care training to help improve the communication between 2 facilities. Through the discovery phase some potential Key Drivers identified for the readmissions are lack of verbal communication/wound care orders/nutrition and feeding orders/comprehensive discharge summary/ advance directives. Change Concepts devised include a warm handoff between the discharging team and receiving team at SNF, creating a comprehensive discharge packet, improve the hospital course in the discharge summary, create a standardized system for discharge to a skilled nursing facility.Results. We are in process of PDSA Cycle 3. Results of PDSA Cycle 1 and 2 for warm handoff and creating a comprehensive discharge packet show a reduction of 40% for the readmissions. PDSA Cycle 1: 10 patients were discharged after a warm handoff was given to SNF and left facility with a comprehensive discharge packet. At end of 30 days of PDSA Cycle 1, only 4 patients were readmitted. Multiple change concepts and PDSA cycles are ongoing. PDSA Cycle 2 is ongoing.Conclusions and Implications. By improving communication between 2 facilities, we achieved our aim in the initial PDSA Cycle by implementing our palliative care skills. We aim to continue to discover other factors and decrease readmission for chronically ill nursing home patients at our urban medical center.