•No mortality events were observed among infected patients.•SARS-CoV-2 infection was associated with pulmonary complications.•Symptomatic infection was not associated with adverse outcomes.
To ...understand whether perioperative SARS-CoV-2 infection increases risk of pulmonary complications in children.
A retrospective cohort study of children who underwent surgery with perioperative SARS-CoV-2 infection at a children's hospital from March 1, 2020, to June 30, 2021. Uninfected, age-matched control patients who underwent the same procedure as infected patients over the past ten years were included in the study in a 3:1 ratio to infected patients. Primary outcomes were 7- and 30-day mortality. Secondary outcomes were development of pulmonary complications, readmission, length of hospital or ICU stay, and oxygen administration in post-anesthesia care unit (PACU).
Our study included 73 patients who underwent surgery with perioperative diagnosis of SARS-CoV-2, and 218 control patient undergoing similar procedures. One total mortality event was observed within 7 days in an uninfected control patient, and none occurred in infected patients. Perioperative SARS-CoV-2 infection was associated with increased risk for pulmonary complications in univariate analysis. Infection was not associated with any of our other secondary outcomes. Symptomatic SARS-CoV-2 infection and timing of diagnosis was not associated with development of pulmonary complications among infected patients.
Children with perioperative SARS-CoV-2 infection may be at increased risk for development of pulmonary complications. Larger studies should be performed to confirm our results.
To evaluate the decision making processes of pediatricians regarding diagnosis and management of developmental dysplasia of the hip (DDH) by conducting a survey of pediatricians in the United States.
...An electronic survey was sent to multiple American Academy of Pediatrics state chapters and academic pediatrics groups, and responses were received from pediatricians in 10 states. The survey included demographics, guideline use, clinical scenarios, and referrals/imaging practices. The number of responses to each survey question and their relative frequencies were calculated.
We received 139 responses and included 126 in our analyses. Only 50% of the responding pediatricians (63 of 126) practiced in an institution that endorses a care pathway for DDH. Only 5.6% of the pediatricians (7 of 125) have referred patients at 12-18 months between diagnosis and management to a specialist for suspected DDH, and 9.5% (12 of 125) have referred patients between 6 and 9 months. Almost one-quarter of the pediatricians (23%; 29 of 126) cited “hip click” as an abnormality that would prompt them to refer a patient to a specialist, and 72.2% (91 of 126) indicated that family history of DDH warrants an ultrasound regardless of the physical examination findings. Moreover, 10.3% of the surveyed pediatricians (13 of 126) reported being only “somewhat” or “moderately” familiar with the Barlow and Ortolani maneuvers.
The results of this study indicate that there is an opportunity to better distribute and implement DDH guidelines. The large number of pediatrician respondents who would not refer patients to a specialist or order imaging studies appropriately represents an opportunity for education. The implementation of a care map with standard referral and imaging practices could improve the care of patients with DDH.
BACKGROUND:Developmental dysplasia of the hip (DDH) is a common condition, affecting 1% to 2% of full-term infants. The American Academy of Orthopaedic Surgeons (AAOS) and American Academy of ...Pediatrics have published guidelines detailing best practices for DDH screening and treatment. The purpose of this survey was to determine DDH treatment practices of pediatric orthopaedic surgeons in North America.
METHODS:We queried orthopaedic surgeon members of the Pediatric Orthopaedic Society of North America (POSNA) about referral patterns, treatment practices, and use of DDH guidelines. The survey included demographics, clinical scenarios, referrals patterns, and ultrasound practices.
RESULTS:Of the 1392 members of POSNA, we received 432 total responses and included 353 in statistical analyses. Results show that 68% (233/342) of surgeons practice in an institution that does not endorse a standard care pathway for DDH. Of surgeons who personally use a DDH care pathway, the AAOS guidelines were most cited (143/353, 41%). The majority (94%, 316/337) of surgeons do not believe that universal ultrasound screening should be adopted in the United States. Responses regarding ultrasound screening for “high risk” infants as outlined by AAOS varied based on risk factor. Many (57%, 200/353) surgeons have performed initial evaluations for patients over 12 months of age. While 80% (260/327) of orthopaedic surgeons believe that primary care providers are referring patients appropriately, only 57% (183/323) believe that primary care providers are ordering imaging studies appropriately.
CONCLUSIONS:Results from this survey of POSNA membership indicate an opportunity to better distribute and implement DDH guidelines. In addition, the implementation of a care map with a focus on standard referral and imaging practices could improve the care of patients with DDH by(1) reducing the total cost of care, (2) increasing the use of appropriate imaging, (3) increasing timely referral for DDH care, and (4) reducing the presentation rate of walking age DDH patients.
LEVEL OF EVIDENCE:The level of evidence rating for this survey-based study is level IV.
Background
We evaluated screening, referral and treatment practices for developmental dysplasia of the hip (DDH) in India by surveying Orthopaedic surgeons who treat patients with DDH. The survey ...assessed the timing of DDH presentation, resource availability, and current state of screening and diagnosis, which would help in the development of a DDH care pathway for India.
Methods
An online survey was distributed to Orthopaedic surgeons practicing in India via email and administered onsite to those attending the annual conference of the Pediatric Orthopaedic Society of India in 2019.
Results
173 completed surveys were received from surgeons practicing in a predominantly urban setting. 68.8% of respondents had performed initial evaluations on children with DDH aged over 1 year in the past 12 months, and 49.1% had assessed children with DDH aged > 2 years on initial presentation. There was no consistent use of established guidelines, with only 30% of respondents stating that a care pathway was in place at their institution. However, 91.9% would support the implementation of a care pathway developed in India, to decrease the incidence of delayed diagnosis and facilitate earlier intervention. 85% of respondents had ready access to ultrasound scans and 95.4% had access to X-rays.
Conclusions
In India, there is still a large number of late-presenting cases of DDH, which could be improved with effective screening. The development of a care pathway for DDH in India is well-supported by Orthopaedic surgeons and may help decrease the incidence of late presenting cases; potentially improving outcomes, decreasing morbidity, and upskilling local practitioners.
The Alliance for Innovation on Maternal Health program is a national investment in promoting safe care for every birth in the United States and lowering rates of preventable maternal mortality and ...severe maternal morbidity. Through its work with state and jurisdiction-based teams on patient safety bundle implementation, the program supports data-driven quality improvement. This paper details key aspects of the Alliance for Innovation on Maternal Health including patient safety bundles, technical assistance, implementation resource development, data support, and partnerships while providing an overview of the program's evolution, reach, impact, and future opportunities.
While the efficacy of peer‐led support groups such as Alcoholics Anonymous (AA) are well established for people recovering from addiction, the “active ingredients” which underpin their efficacy are ...less understood. Drawing on social identity perspectives, in particular the Social Identity Model of Cessation Maintenance, the current study aimed to explore the relative effects of two possible processes: social identification and involvement with the group's activities. A sample (n = 44) of AA members completed measures pertaining to their social identification with AA, their involvement in the group's activities and their quit efficacy. The findings suggest that AA involvement was significantly related to identity. Mediation analysis revealed a relationship between involvement and efficacy meditated by identity. However, in contrast, the identity‐efficacy link was not mediated by involvement. The findings suggest that social identification with AA is as important as, or more important than, simple involvement in the group's activities. This suggests that group planners and facilitators should therefore encourage opportunities to generate a sense of belonging alongside the activities the group revolve around.
ABSTRACT
How the State aid rules are applied to the creation of new development institutions by Member States varies significantly depending on the exact structure that is adopted by the Member State ...for the creation of that institution. That results in differences in the legal powers and scope of these institutions that, while explicable from a legal perspective, can be difficult to rationalize in policy terms. The purpose of this article is to explore first of all the reasons for those differences in approach and then to consider whether there is, within the framework of the existing regime, scope for modification of the approach that is taken to the State aid analysis that would address or ameliorate some of the policy conflicts by using an approach more akin to that adopted when considering cases involving services of general economic interest.
The development of German archival appraisal theory since 1990 has been little discussed in the English-speaking world. This article provides an introductory overview of the Federführungsmodell ...developed by the Bundesarchiv (Federal Archives), the horizontal and vertical appraisal approach of the Landesarchiv (State Archives) of Baden-Württemberg, and the documentation plans typical of municipal and university archives. It also examines the new focus on records management and calls for collaboration in appraisal between different archives, levels of government and heritage institutions.
Imaginary worlds and how they are constructed are central to fiction. The term world-building, however, has been applied so broadly in scholarship that it has become ambiguous and difficult to use in ...critical discussions. Aiming to contribute to greater clarity in the critical use of the term, this article introduces the concept of critical world-building . This is distinguished from other types of world-building, such as that performed by an author or reader, mainly by the fact that a critic analyses a world through a combination of their sequential presentation, as complete world, and with critical interpretation and theoretical filters in place, applying all three perspectives simultaneously. Two possible approaches to critical world-building are presented, based on the functions of a world’s building-blocks and how to interpret those functions. The first approach focuses on a world’s “architecture” – its structural and aesthetic system of places – and the form, function, and meaning of those places. The second emphasises the dynamic interplay between building-blocks and their interconnections in a web of explicit, implied, and interpreted information about the world. The authors base their discussion on textual, secondary fantasy worlds but invite applications of critical world-building to other genres and media.
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