Background
Motor vehicle collision (MVC) is a leading cause of accidental death in children. Despite effective forms of child safety restraint (eg, car seat and booster seat), studies demonstrate ...poor compliance with guidelines. The goal of this study was to delineate injury patterns, imaging usage, and potential demographic disparities associated with child restraint use following MVC.
Methods
A retrospective review of the North Carolina Trauma Registry was performed to determine demographic factors and outcomes associated with improper restraint of children (0-8 years) involved in MVC from 2013 to 2018. Bivariate analysis was performed by the appropriateness of restraint. Multivariable Poisson regression identified demographic factors for the relative risk of inappropriate restraint.
Results
Inappropriately restrained patients were older (5.1 years v. 3.6 yrs, P < .001) and weighed more (44.1 lbs v. 35.3 lbs, P < .001). A higher proportion of African American (56.9% v. 39.3%, P < .001) and Medicaid (52.2% v. 39.0%, P < .001) patients were inappropriately restrained. Multivariable Poisson regression showed that African American patients (RR 1.43), Asian patients (RR 1.51), and Medicaid payor status (RR 1.25) were associated with a higher risk of inappropriate restraint. Inappropriately restrained patients had a longer length of stay, but injury severity score and mortality were no different.
Discussion
African American children, Asian children, and Medicaid insurance payor status patients had an increased risk of inappropriate restraint use in MVC. This study describes unequal restraint patterns in children, which suggests opportunity for targeted patient education and necessitates research to further delineate the underlying etiology of these differences.
Introduction
Enhanced recovery protocols (ERP) have been associated with fewer postoperative complications in adult colorectal surgery patients, but there is a paucity of data on pediatric patients. ...Our aim is to describe the effect of an ERP, compared to conventional care, on pediatric colorectal surgical complications.
Materials and Methods
We performed a single institution, retrospective cohort study (2014-2020) on pediatric (≤18 years old) colorectal surgery patients pre- and post-implementation of an ERP. Bivariate analysis and logistic regression were used to assess the effect of an ERP on return visits to the emergency room, reoperation, and readmission within 30-days.
Results
There were 194 patients included in this study, with 54 in the control cohort and 140 in the ERP cohort. There was no significant difference in the age, BMI, primary diagnosis, or use of laparoscopic technique between the cohorts. The ERP cohort had a significantly shorter foley duration, postoperative stay, and had nerve blocks performed. After controlling for pertinent covariates, the ERP cohort experienced higher odds of reoperation within 30 days (OR 5.83, P = .04). There was no significant difference in the other outcomes analyzed.
Conclusion
In this study, there was no difference in the odds of overall complications, readmission or return to the ER within 30-days of surgery. However, although infrequent, there were higher odds of returns to the OR within 30 days. Future studies are needed to analyze how adherence to individual components may influence patient outcomes to ensure patient safety during ERP implementation.
Background
Fecal diversion after ileal pouch anal anastomosis (IPAA) in children with ulcerative colitis (UC) remains controversial. We hypothesize that a modified two-stage IPAA omitting diverting ...ileostomy (DI) after IPAA, found to be safe in adults, would produce similar results in children.
Methods
Retrospective, single-institution study of children (≤18 years) undergoing staged total proctocolectomy with IPAA from 2014 to 2020. Traditional two-stage and three-stage approaches including DI after IPAA were compared to two-stage approach without DI.
Results
32 patients were included; of these, 7 (22%), 14 (44%), and 11 (34%) patients underwent traditional two-stage, modified two-stage, or three-stage IPAA, respectively. Following IPAA, modified two-stage patients had shorter operative time, decreased opioid utilization, quicker return to regular diet, and shorter stoma duration. After IPAA, there was similar postoperative length of stay, complication rates, readmissions, visits to the emergency department, or unplanned return to the operating room (OR) within 30 days. Anastomotic leak occurred in 2 patients; both were managed nonoperatively without evidence of pouch dysfunction.
Conclusion
Modified two-stage IPAA with omission of DI after the IPAA stage is safe to perform in pediatric UC patients. Prospective studies with larger sample sizes are needed to identify risk factors associated with operative complications.
Enhanced recovery protocols (ERP) are a multimodal approach to standardize perioperative care. To substantiate the benefit of a pediatric-centered pathway, we compared outcomes of children treated ...with pediatric ERP (pERP) versus adult (aERP) pathways. We aimed to compare components of each pathway to create a new comprehensive pERP to reduce variation in care.
Retrospective study of children (≤18 y) undergoing elective colorectal surgery from August 2015 to April 2019 at a single institution managed with pERP versus aERP. Multivariable linear and logistic regression, adjusting for demographics and operation characteristics, were used to compare outcomes.
Out of 100 hospitalizations (72 patients) were identified, including 37 treated with pERP. pERP patients were, on average, younger (13 versus 16 y), more likely to be ASA III (70% versus 30%), and more likely to receive regional (32% versus 3%) or neuraxial (35% versus 8%) anesthesia. Epidural use was an independent risk factor for longer length of stay (P = 0.000). After adjustment, pERP patients had similar LOS and time to oral intake, but shorter foley duration. pERP patients used significantly fewer opioids and were less likely to return to the operating room within 30 d. 30-d readmissions and ED visits were also lower, but this was not statistically significant.
At our institution, data from both ERPs contributed formation of a synthesized pathway and reflected the pERP approach to opioid utilization and the aERP approach to earlier enteral nutrition.
Introduction
Clinical experiences expose learners to the patient perspective, which can have a lasting impact on students’ professional identity. However, in busy clinical settings where ...opportunities for reflection may be limited, listening to patients’ stories is often neglected. We used a reflection assignment to augment a new maternal-child health integrated curriculum.
Methods
Medical students completed a brief assignment from their session in the neonatal intensive care unit (NICU), which included reflective writing, between fall 2016 and summer 2017. The Depth of Reflection rubric was used to score reflections on a scale: “Knowledge and Comprehension” (Level I), “Analysis” (Level II), and “Synthesis and Evaluation” (Level III). A constant comparison method based on grounded theory elicited prenatal and postnatal themes from medical students’ reflective writing.
Results
All students completed narratives (n = 166); 70% (n = 116) achieved a Depth of Reflection of Level II or III. Six overarching themes emerged: (1)
Conception, Pregnancy, and Delivery Experiences
; (2)
Positive Support Structures
; (3)
Barriers and Stressors to Care
; (4)
Future Plans
; (5)
Unexpected Complications
; and (6)
Student Career and Professional Considerations
.
Discussion
Reflections from a novel and brief integrated maternal-child health experience demonstrated high levels on the Depth of Reflection scale. This experience exposed students to core themes central to a family’s pregnancy and perinatal experience. Professional identity formation also emerged as a theme. Reflective writing assignments in a busy NICU can facilitate exploration of medical students’ knowledge of maternal-child health patient experiences.
Background:
TranscranialDoppler ultrasound (TCD) screening for stroke risk is one of the major advances in pediatric sickle cell disease, since the landmark STOP study. TCD screening is among the ...measures for quality of pediatric sickle cell care proposed by expert consensus (Wang 2011, NHLBI guidelines 2014). Reeves et al 2016 shows that TCD screening rates are low but still improving (22% in 2006 -44% in 2010). To improve the quality-of-care provided to pediatric sickle cell patients at University of Illinois Hospital, we conducted chart review in 2014 to establish a baseline report of UI Hospitalsadherence to the expert care standards. At that time TCD screening rates were much lower than immunization rates. We then introduced a reminder table in the electronic medical record. 18 months since this change in EMR we re-evaluated our compliance with TCDs.
Objectives:
To evaluate the improvement atUIHealthpediatric sickle cell clinic compliance with annual TCD.
Methods:
A manual chart review of these pediatric sickle cell patients was employed to determine adherence to TCD screening standards. All patients ages 2-16yowith SCD-SS and SCD-S/Beta-0-thalassemia that were seen in pediatric sickle cell clinic and adolescent-adult transition clinics two times over 15 months from 2/1/15-5/1/16 were included in study. TCD compliance was determined if patient had TCD between 5/1/2015 through 5/31/16. 5-15 minutes per patient was spent evaluating EMR for TCD compliance
Data from the 2014 previous study was also re-evaluated using the same criteria of 2 visits within 15 months of original study date and TCD within 1 year of study.
Results:
In this work, the charts of 91 pediatric SCD-SS and SCD-S/Beta0 patients were reviewed (ages 2-16 years; M: 34 F 28, 5 ineligible 2 on chronic transfusion, 1 high hemoglobin, 1 yearly MRI, 1 last visit before 2yo. Lost to follow-up (Seen in clinic since 2014 but not 2 visits from 2/1/15-5/1/16): 24 The rate of TCD screening among these eligible children was 53 out of 62, or 85.5% in 2016. Comparable figures from the 2014 chart review were 17 out of 27, or 63% in 2014. Fishers exact test indicates that this was a significant improvement, p=0.05.
Conclusions:
We focused our quality-improvement efforts onTranscranialDoppler screening, adding a reminder table in the Electronic Medical Record then re-assessing 18 months later. The rate of TCD screening significantly improved from 63% to 85%. Although less than 100%, these compare favorably to other published TCD rates (Table). The next step is to improve clinic attendance and tracking, to reduce the rate of patients who are "lost to follow-up." To facilitate future chart reviews we have incorporated the key parameters into our "Screening & Management Table" as a component of the electronic medical record.
Display omitted
Hsu:Purdue Pharma: Research Funding; Mast Therapeutics: Research Funding; Eli Lilly: Research Funding; Sancilio: Research Funding; Centers for Medicare and Medicaid Innovation: Research Funding; Pfizer: Consultancy, Research Funding; EMMI Solutions: Consultancy; Gerson Lehman Group: Consultancy; Astra Zeneca: Consultancy, Research Funding; Hilton Publishing: Consultancy, Research Funding.
The technique proposed herein reveals the internal morphology of calcareous and agglutinated foraminifers in transmitted light, aiding in taxonomic identifications. It involves eliminating air ...bubbles inside tests through the application of a vacuum or high heat during oil immersion, and the subsequent mounting of the oil-clarified tests in compatible QSMM thermoplastics. The technique is rapid, nondestructive, allows internal viewing of large tests and is especially useful for small tests that are difficult to thin section. The technique has been used for mounting other microfossils, such as polycystine radiolarians.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background:
Existing best practices to monitor and prevent health care–associated infections (HAIs) were ineffective during the COVID-19 pandemic due to increased patient susceptibility toward ...infections, reduced resources, and increased use of agency nurses.
Problem:
A review of the US hospitals revealed a 60% increase in central line–associate bloodstream infections (CLABSIs) and a 43% increase in catheter-associated urinary tract infections (CAUTIs) in 2020. A large, academic, level 1 trauma center in Houston, Texas, experienced similar challenges at the start of the COVID-19 pandemic.
Approach:
An interdisciplinary team of nurses, infection preventionists, and hospital educators combined and adapted existing evidence-based practices in a novel way to create a nursing-led toolkit for quality improvement tracking, improving, and sustaining HAI improvements.
Outcomes:
CLABSI and CAUTI rates were reduced over time following the introduction of the Nurse-Sensitive Indicator Quality Improvement (NSIQI) Toolkit. The CLABSI standardized infection ratio (SIR) decreased by 19%, and the CAUTI SIR decreased by 19.4%.
Conclusions:
The novel NSIQI Toolkit is a scalable tool for improving and sustaining CLABSI and CAUTI rates, which may have the potential for other nurse-sensitive quality indicators.
Background:Existing best practices to monitor and prevent health care–associated infections (HAIs) were ineffective during the COVID-19 pandemic due to increased patient susceptibility toward ...infections, reduced resources, and increased use of agency nurses.Problem:A review of the US hospitals revealed a 60% increase in central line–associate bloodstream infections (CLABSIs) and a 43% increase in catheter-associated urinary tract infections (CAUTIs) in 2020. A large, academic, level 1 trauma center in Houston, Texas, experienced similar challenges at the start of the COVID-19 pandemic.Approach:An interdisciplinary team of nurses, infection preventionists, and hospital educators combined and adapted existing evidence-based practices in a novel way to create a nursing-led toolkit for quality improvement tracking, improving, and sustaining HAI improvements.Outcomes:CLABSI and CAUTI rates were reduced over time following the introduction of the Nurse-Sensitive Indicator Quality Improvement (NSIQI) Toolkit. The CLABSI standardized infection ratio (SIR) decreased by 19%, and the CAUTI SIR decreased by 19.4%.Conclusions:The novel NSIQI Toolkit is a scalable tool for improving and sustaining CLABSI and CAUTI rates, which may have the potential for other nurse-sensitive quality indicators.
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