Clinical cardiovascular health is a construct that includes 4 health factors-systolic and diastolic blood pressure, fasting glucose, total cholesterol, and body mass index-which together provide an ...evidence-based, more holistic view of cardiovascular health risk in adults than each component separately. Currently, no pediatric version of this construct exists. This study sought to develop sex-specific charts of clinical cardiovascular health for age to describe current patterns of clinical cardiovascular health throughout childhood.
Data were used from children and adolescents aged 8-19 years in six pooled childhood cohorts (19,261 participants, collected between 1972 and 2010) to create reference standards for fasting glucose and total cholesterol. Using the models for glucose and cholesterol as well as previously published reference standards for body mass index and blood pressure, clinical cardiovascular health charts were developed. All models were estimated using sex-specific random-effects linear regression, and modeling was performed during 2020-2022.
Models were created to generate charts with smoothed means, percentiles, and standard deviations of clinical cardiovascular health for each year of childhood. For example, a 10-year-old girl with a body mass index of 16 kg/m
(30th percentile), blood pressure of 100/60 mm Hg (46th/50th), glucose of 80 mg/dL (31st), and total cholesterol of 160 mg/dL (46th) (lower implies better) would have a clinical cardiovascular health percentile of 62 (higher implies better).
Clinical cardiovascular health charts based on pediatric data offer a standardized approach to express clinical cardiovascular health as an age- and sex-standardized percentile for clinicians to assess cardiovascular health in childhood to consider preventive approaches at early ages and proactively optimize lifetime trajectories of cardiovascular health.
A career in pediatrics can bring great joy and satisfaction. It can also be challenging and lead some providers to manifest burnout and depression. A curriculum designed to help pediatric health ...providers acquire resilience and adaptive skills may be a key element in transforming times of anxiety and grief into rewarding professional experiences. The need for this curriculum was identified by the American Academy of Pediatrics Section on Medical Students, Residents and Fellowship Trainees. A working group of educators developed this curriculum to address the professional attitudes, knowledge, and skills essential to thrive despite the many stressors inevitable in clinical care. Fourteen modules incorporating adult learning theory were developed. The first 2 sections of the curriculum address the knowledge and skills to approach disclosure of life-altering diagnoses, and the second 2 sections focus on the provider's responses to difficult patient care experiences and their needs to develop strategies to maintain their own well-being. This curriculum addresses the intellectual and emotional characteristics patient care medical professionals need to provide high-quality, compassionate care while also addressing active and intentional ways to maintain personal wellness and resilience.
Background
Neighborhood-level characteristics, such as poverty, have been associated with risk factors for heart failure (HF), including hypertension and diabetes mellitus. However, the independent ...association between neighborhood poverty and incident HF remains understudied.
Objective
To evaluate the association between neighborhood poverty and incident HF using a “real-world” clinical cohort.
Design
Retrospective cohort study of electronic health records from a large healthcare network. Individuals’ residential addresses were geocoded at the census-tract level and categorized by poverty tertiles based on American Community Survey data (2007–2011).
Participants
Patients from Northwestern Medicine who were 30–80 years, free of cardiovascular disease at index visit (January 1, 2005–December 1, 2013), and followed for at least 5 years.
Main Measures
The association of neighborhood-level poverty tertile (low, intermediate, and high) and incident HF was analyzed using generalized linear mixed effect models adjusting for demographics (age, sex, race/ethnicity) and HF risk factors (body mass index, diabetes mellitus, hypertension, smoking status).
Key Results
Of 28,858 patients included, 75% were non-Hispanic (NH) White, 43% were men, 15% lived in a high-poverty neighborhood, and 522 (1.8%) were diagnosed with incident HF. High-poverty neighborhoods were associated with a 1.80 (1.35, 2.39) times higher risk of incident HF compared with low-poverty neighborhoods after adjustment for demographics and HF risk factors.
Conclusions
In a large healthcare network, incident HF was associated with neighborhood poverty independent of demographic and clinical risk factors. Neighborhood-level interventions may be needed to complement individual-level strategies to prevent and curb the growing burden of HF.
OBJECTIVESAutomated external defibrillators (AEDs) have demonstrated increased survival in out-of-hospital cardiac arrest, and their prevalence continues to rise. In 2009, Connecticut passed a ...legislation requiring all schools to have an AED, barring financial barriers. The objectives of this study were (1) to determine if this legislation was associated with an increase in Connecticut high school AEDs and (2) to detect disparities in the availability of AEDs based on school type, student demographics, and school size.
STUDY DESIGNA single researcher conducted a scripted telephone survey of all 54 public and 13 private high schools in New Haven County, Connecticut.
RESULTSA response rate of 100% was achieved. Forty-nine percent of high schools had an AED before the legislation, compared with 88% after (P < 0.001). Before legislation, private schools had a higher percentage of AEDs than public schools (69% vs 44%; P = 0.1). Postlegislation, the difference is less (92% vs 87%; P = 0.4). Small schools (<400 students) are significantly less likely to have an AED than larger schools (40% vs 100%; P < 0.001). Schools with a higher percentage of students with disabilities are also less likely to have an AED (P = 0.005), even when controlling for school size (P = 0.03).
CONCLUSIONSState legislation requiring schools to have an AED, if financially feasible, was associated with a significant increase in AED presence among New Haven County high schools. Small high schools and those with a higher percentage of students with disabilities remain less likely to have an AED despite legislation.
The rising prevalence of daily cannabis use among older adolescents and young adults in the United States has significant public health implications. As a result, more individuals may be seeking or ...in need of treatment for adverse outcomes (e.g., cannabis use disorder) arising from excessive cannabis use. Our objective was to explore the potential of self-reported motives for cannabis use as a foundation for developing adaptive interventions tailored to reduce cannabis consumption over time or in certain circumstances. We aimed to understand how transitions in these motives, which can be collected with varying frequencies (yearly, monthly, daily), predict the frequency and adverse outcomes of cannabis use.
We conducted secondary analyses on data collected at different frequencies from four studies: the Medical Cannabis Certification Cohort Study (
= 801, biannually), the Cannabis, Health, and Young Adults Project (
= 359, annually), the Monitoring the Future Panel Study (
= 7,851, biennially), and the Text Messaging Study (
= 87, daily). These studies collected time-varying motives for cannabis use and distal measures of cannabis use from adolescents, young adults, and adults. We applied latent transition analysis with random intercepts to analyze the data.
We identified the types of transitions in latent motive classes that are predictive of adverse outcomes in the future, specifically transitions into or staying in classes characterized by multiple motives.
The identification of such transitions has direct implications for the development of adaptive interventions designed to prevent adverse health outcomes related to cannabis use. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Background
Atrial fibrillation (AF) is a leading cause of cardiovascular morbidity and mortality. While neighborhood-level factors, such as poverty, have been related to prevalence of AF risk ...factors, the association between neighborhood poverty and incident AF has been limited.
Objective
Using a large cohort from a health system serving the greater Chicago area, we sought to determine the association between neighborhood-level poverty and incident AF.
Design
Retrospective cohort study.
Participants
Adults, aged 30 to 80 years, without baseline cardiovascular disease from January 1, 2005, to December 31, 2018.
Main Measures
We geocoded and matched residential addresses of all eligible patients to census-level poverty estimates from the American Community Survey. Neighborhood-level poverty (low, intermediate, and high) was defined as the proportion of residents in the census tract living below the federal poverty threshold. We used generalized linear mixed effects models with a logit link function to examine the association between neighborhood poverty and incident AF, adjusting for patient demographic and clinical AF risk factors.
Key Results
Among 28,858 in the cohort, patients in the high poverty group were more often non-Hispanic Black or Hispanic and had higher rates of AF risk factors. Over 5 years of follow-up, 971 (3.4%) patients developed incident AF. Of these, 502 (51.7%) were in the low poverty, 327 (33.7%) in the intermediate poverty, and 142 (14.6%) in the high poverty group. The adjusted odds ratio (aOR) of AF was higher for the intermediate poverty compared with that for the low poverty group (aOR 1.23 95% CI 1.01–1.48). The point estimate for the aOR of AF incidence was similar, but not statistically significant, for the high poverty compared with the low poverty group (aOR 1.25 95% CI 0.98–1.59).
Conclusion
In adults without baseline cardiovascular disease managed in a large, integrated health system, intermediate neighborhood poverty was significantly associated with incident AF. Understanding neighborhood-level drivers of AF disparities will help achieve equitable care.
To create and validate a checklist for high-quality documentation and pilot a multi-modal, immersive educational module across multiple institutions. We hypothesized that this module would improve ...knowledge, skills, and attitudes in medical documentation.
Module design was grounded in an established curriculum design framework. We conducted the study across 12 pediatric critical care fellowship programs between September 2017 and January 2018. Workshops were allotted 90 minutes for completion. We utilized a pre-/post- study design to determine the workshop's impact. Changes in knowledge were assessed through pre and post testing. Changes in skills were evaluated with a validated checklist for inclusion of key documentation elements. Changes in attitudes were determined through learner self-assessment
83 of 138 eligible fellows (60%) started the module and 62 of 83 (75%) completed data sets for analysis. Immediate post-testing demonstrated modest statistically significant improvement in knowledge, skills, and attitudes. The workshop was easily disseminated and deployed
This study demonstrates that a multi-modal educational intervention can lead to improvement in medical documentation knowledge, skills, and attitudes in a cohort of PCCM fellows and be easily disseminated for use by other specialties and types of clinicians.
The objective of this study was to document the frequency of pediatric resident experiences with end-of-life care for children and the educational context for these experiences, as well as to ...determine whether residents deem their preparatory training adequate.
An Internet-based survey was distributed to all categorical pediatric residents at the Johns Hopkins Children's Center. Survey items asked residents to (1) quantify their experiences with specific responsibilities associated with the death of a pediatric patient, (2) identify their educational experiences, and (3) respond to Likert scale statements of, "I feel adequately trained to... ." The responsibilities were discussion of withdrawal/limitation of life-sustaining therapy, symptom management, declaration of death, discussion of autopsy, completion of a death certificate, seeking self-support, and follow-up with families.
Forty (50%) of 80 residents completed the survey. Residents had been present for a mean (+/- SD) of 4.7 (+/- 3.0) patient deaths. More than 50% of residents had participated in discussions of withdrawal/limitation of life-sustaining therapy, symptom management, completing a death certificate, and seeking personal support; however, <50% of residents had been taught how to hold discussions of withdrawal/limitation of life-sustaining therapy, declare death, discuss autopsy, complete a death certificate, and have follow-up with families. Residents did not feel adequately trained in any of these areas.
Pediatric residents have limited experience with pediatric end-of-life care and highly varied educational experiences and do not feel adequately trained to fulfill the responsibilities associated with providing end-of-life care for children. Overall, this perception does not improve with increased level of training. This study identifies several target areas for curricular intervention that may ultimately improve the end-of-life experience for our pediatric patients and their families and the young physicians who care for them.
Residency programs are required to offer a didactic curriculum and protect resident time for education. Our institution implemented an academic half day (AHD) in the 2021–2022 academic year to ...address issues related to the standard noon conference series.
Determine the impact of AHD implementation on education, patient safety, and workflow.
This was a prospective, single-site educational intervention study. Pre- and post-implementation surveys and Accreditation Council for Graduate Medical Education (ACGME) surveys assessed changes in trainee and faculty attitudes and behaviors. Patient safety and workflow were evaluated by comparing the number of safety event reports, rapid response team activations, time to admission from the ED, and time of discharge on AHD days compared to other weekdays.
Survey response rates were: residents 68%/48%, fellows 42%/35%, and faculty 59%/29%. AHD was associated with a significant, positive change in resident attitudes and experiences and on ACGME survey items. On AHDs compared with other weekdays, there were no significant differences in safety event report rates (P = .98), nor in rapid response team activation rates (P = .99). There was not a clinically meaningful difference in median admission time from the ED on AHD weekdays (125 minutes) compared to other weekdays (130 minutes, P = .04). There was no significant difference in median discharge time on AHD vs other weekdays (P = .13).
This study suggests that there is no significant difference in patient safety or workflow with the implementation of AHD. This study supports prior studies that residents strongly prefer AHD. AHD may be a useful framework for resident education without compromising patient care.
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