Mount Carmel Health

BackgroundAppendiceal bleeding is an infrequent cause of lower gastrointestinal bleeding (LGIB), accounting for only 0.014% of cases.Case reportWe present the case of a 48-year-old male on heparin who developed an acute LGIB from the appendicular artery requiring coil embolization and subsequently developed appendicitis.ConclusionThis case highlights appendicitis as a potential complication of appendiceal artery embolization. Careful patient selection and consideration of alternative approaches, including upfront surgery or endoscopic therapy, are essential in managing appendiceal artery bleeds.LEARNING POINTSExpands the internist’s differential and management strategy for obscure lower gastrointestinal bleeding.Identifies appendicitis as a real, not theoretical, complication of appendiceal artery embolization.

This study investigates the correlation between the conferment of the Seal of Good Local Governance (SGLG) and stakeholders' satisfaction with public service delivery in selected cities and municipalities of the First Congressional District of Negros Occidental, Philippines. Anchored in the theories of New Public Management, Public Value Management, and Good Governance, the research evaluates the extent to which Local Government Units (LGUs) fulfill performance standards across ten core governance areas, including financial administration, disaster preparedness, social protection, and environmental management, among others. Employing an explanatory sequential mixed-methods design, the study integrates quantitative data from 750 respondents, comprising stakeholders and program implementers, with qualitative insights from in-depth interviews. The research instruments demonstrated strong validity and reliability, with a Content Validity Index (CVI) of 0.94, a Cronbach’s alpha of 0.871 for the stakeholders' instrument, and 0.878 for the implementers' instrument. Results reveal a generally high level of satisfaction among stakeholders, indicating that effective implementation of SGLG indicators positively influences public perception and trust. Nonetheless, findings highlight specific areas requiring attention, particularly participatory governance and the sustainability of local programs. These results suggest that while SGLG recognition reflects commendable governance practices, it must be coupled with consistent stakeholder engagement and adaptive strategies to address evolving community needs. The study underscores the importance of transparent, accountable, and community-centered governance. The findings imply that institutionalizing performance-based frameworks like the SGLG can strengthen public administration by aligning service delivery with citizen expectations and governance standards.

Explore the article titled Chromium Resistance and Plant-Growth Promotion by a Pseudomonas sp. Isolated From Tannery Effluent from IJIRT Volume 12, Issue 6. This study evaluates the effectiveness of teaching programs on waste management knowledge among women.

This study examined the relationship between the perceived leadership styles of administrators, job satisfaction, and affective commitment among employees of higher education institutions (HEIs) in District I of Negros Occidental. Using a descriptive-comparative design, the study collected data from 221 respondents representing both private and state HEIs. The findings revealed that the dominant leadership style among administrators was laissez-faire. Employees demonstrated high levels of job satisfaction and affective commitment, indicating strong emotional attachment and loyalty to their institutions. Statistical analyses showed significant correlations between leadership style, job satisfaction, and affective commitment. These findings provide insights for academic administrators to enhance leadership practices and strengthen employee engagement and institutional performance.

Abstract Objectives People experiencing homelessness are at increased risk for addiction, with substance use both a cause and response to homelessness. Street Medicine (SM) programs provide decentralized, low-barrier care to people experiencing homelessness and have begun to offer medication for opioid use disorder (MOUD). Literature on MOUD initiation via SM is nascent. This study investigated the impact of SM-initiated MOUD on ED utilization among people experiencing homelessness in a mid-sized US city. Methods We completed a retrospective medical record review of patients initiated on buprenorphine in 2023 by the SM program. Age, gender, prescription refill status, and emergency department (ED) utilization were recorded. Outcome measures were the number of overdose-related, opioid use disorder (OUD)-related, and all-cause ED visits in the 12 months before versus 12 months after buprenorphine initiation. Results In the year prior to buprenorphine initiation, 115 patients had 221 cumulative ED visits, 79 of which were OUD-related. In the year following initiation, cumulative ED visits declined to 191, of which 44 were related to OUD (p<0.05). Overdose-related ED visits decreased from 26 to 13. In terms of prescription renewal, 44% of subjects renewed, 13% via SM and 31% via another provider. Conclusions Buprenorphine initiation by a SM program was associated with a significant decline in OUD-related ED visits and insignificant reductions in overdose-related and total ED visits. These conclusions support SM-initiated buprenorphine as a strategy for reducing opioid-related ED utilization while encouraging sustained engagement in care. SM programs represent promising avenues to initiate buprenorphine and reduce OUD-related morbidity in the unhoused population.

Abstract Introduction: Incentive spirometry (IS) is a common, minimally invasive intervention seen throughout healthcare for a multitude of conditions. IS involves a small device that allows the patient to monitor their inspiratory capacity and improve inspiratory capability. IS has been shown to maintain or increase inhaled lung volume, prevent lung infection after surgery, and improve sputum expectoration. Inspiratory muscle training helps keep the lung open and operational during illness and after surgery. The effectiveness of IS in the clinical setting remains limited. Many hospitalized patients do not use the device correctly, if at all. Targeted nursing interventions have been shown to increase outpatient patient use of IS and healthcare team confidence when administering IS. Methods: In this prospective cohort study, we aimed to measure if nursing knowledge and patient IS use is improved with a nursing educational intervention lead by a respiratory therapy educator. Patient inclusion criteria was location on a medical-surgical ward with an active incentive spirometer order. Patient endpoints were measured via direct observation, interaction, and electronic medical record review. Endpoints included if the IS was within arms’ reach, patient IS technique, patient knowledge of IS purpose and proper IS use frequency, and recent sedating medication administrations. Data was collected on 3 consecutive weeks before and again 1 month after the intervention. Nursing inclusion criteria was presence at the morning nursing huddle during a prespecified week. Nursing endpoints were measured via a multiple-choice questionnaire given immediately before and 1 month after intervention. Results: 34, predominately surgical, patients were included. There was a higher proportion in knowledge of proper IS use in the post intervention group (p=0.0007). Recent use of sedating medications did not have statistical correlation with poorer performance in patient endpoints. Table 1 includes all patient results. 22 nurses were included, 13 pre-intervention, and 10 post-intervention. 2 nurses were present for pre- and post-intervention questionnaires, all others were available for one questionnaire. The average correct in the pre-intervention group was 3.7 out of 5 and 4.1 out of 5 in the post-intervention group (p=0.6). Discussion: A targeted nursing education appears to have the potential to improve patient knowledge about IS, despite no apparent improvement in nursing knowledge. Possible reasons for this discrepancy may be the relatively high pre-intervention scores on nursing questionnaires or the substantial patient knowledge gap in proper IS use frequency. This study highlights the importance of measuring patient-centered outcomes when implementing quality improvement projects.

Ischemic stroke disrupts functional connectivity within the brain's resting-state networks (RSNs), impacting recovery. This study evaluates the effects of norepinephrine and hydralazine (NEH), a cerebral perfusion augmentation therapy, on RSN integrity in a hyperacute canine stroke model. Fifteen adult purpose-bred mongrel canines, divided into treatment and control (natural history) groups, underwent endovascular induction of acute middle cerebral artery occlusion (MCAO). Postocclusion, the treatment group received intra-arterial norepinephrine (0.1-1.52 µg/kg/min, adjusted for 25-45 mm Hg above baseline mean arterial pressure) and hydralazine (20 mg). Resting-state fMRI (rs-fMRI) data were acquired with a 3T scanner by using a blood oxygen level dependent-EPI sequence (TR/TE = 1400 ms/20 ms, 2.5 mm slices, 300 temporal positions). Preprocessing included motion correction, spatial smoothing (2.5 mm full width at half maximum), and high-pass filtering (0.01 Hz cutoff). Functional connectivity within RSNs were analyzed through group-level independent component analysis and weighted whole-brain ROI-to-ROI connectome, pre- and post-MCAO. NEH therapy significantly maintained connectivity post-MCAO in the higher-order visual and parietal RSNs, as evidenced by thresholded statistical mapping (threshold-free cluster enhancement P corr > .95). However, this preservation was network-dependent, with no significant (P corr < .95) changes in the primary visual and sensorimotor networks. NEH demonstrates potential as a proof-of-concept therapy for maintaining RSN functional connectivity after ischemic stroke, emphasizing the therapeutic promise of perfusion augmentation. These insights reinforce the role of functional connectivity as a measurable end point for stroke intervention efficacy, suggesting clinical translatability for patients with insufficient collateral circulation.