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Pediatric critical and emergency care

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https://www.readbyqxmd.com/read/29345207/thresholds-and-interpretations-how-clinical-competency-committees-identify-pediatric-residents-with-performance-concerns
#1
Daniel J Schumacher, Catherine Michelson, Sue Poynter, Michelle M Barnes, Su-Ting T Li, Natalie Burman, Daniel J Sklansky, Lynn Thoreson, Sharon Calaman, Beth King, Alan Schwartz, Sean Elliott, Tanvi Sharma, Javier Gonzalez Del Rey, Kathleen Bartlett, Shannon E Scott-Vernaglia, Kathleen Gibbs, Jon F McGreevy, Lynn C Garfunkel, Caren Gellin, John G Frohna
BACKGROUND: Clinical competency committee (CCC) identification of residents with performance concerns is critical for early intervention. METHODS: Program directors and 94 CCC members at 14 pediatric residency programs responded to a written survey prompt asking them to describe how they identify residents with performance concerns. Data was analyzed using thematic analysis. RESULTS: Six themes emerged from analysis and were grouped into two domains...
January 2018: Medical Teacher
https://www.readbyqxmd.com/read/29336920/pediatric-nurse-practitioners-perspectives-on-health-care-transition-from-pediatric-to-adult-care
#2
Lisa Lestishock, Alison Moriarty Daley, Patience White
INTRODUCTION: This study examined the perspectives of pediatric nurse practitioners (PNPs) regarding the needs of adolescents, parents/caregivers, clinicians, and institutions in the health care transition (HCT) process for adolescents/young adults. METHODS: PNPs (N = 170) participated in a luncheon for those interested in transition at an annual conference. Small groups discussed and recorded their perspectives related to health care transition from adolescent to adult services...
January 12, 2018: Journal of Pediatric Health Care
https://www.readbyqxmd.com/read/29336197/neurosensory-deficits-vary-as-a-function-of-point-of-care-in-pediatric-mild-traumatic-brain-injury
#3
Andrew Mayer, Chris Wertz, Sephira Ryman, Eileen Storey, Grace Park, John Phillips, Andrew Burke Dodd, Scott Oglesbee, Richard Campbell, Ron Yeo, Ben Wasserott, Nicholas Shaff, John J Leddy, Rebekah Mannix, Kristy B Arbogast, Timothy Meier, Matthew Grady, Christina Master
Neurosensory abnormalities are frequently observed following pediatric mild traumatic brain injury (pmTBI) and may underlie the expression of several common concussion symptoms and delay recovery. Importantly, active evaluation of neurosensory functioning more closely approximates real-world (e.g., physical and academic) environments that provoke symptom-worsening. The current study determined whether symptom provocation (i.e., during neurosensory exam) improved classification accuracy relative to pre-exam symptom levels and whether symptoms varied as a function of point of care...
January 16, 2018: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29318344/severe-casualties-from-bastille-day-attack-in-nice-france
#4
Federico Solla, Joseph Carboni, Arnaud Fernandez, Audrey Dupont, Nathalie Chivoret, Gilles Brézac, Virginie Rampal, Jean Bréaud
PURPOSE: To describe the most severe casualties from the July 14th, 2016 terror attack in Nice that were treated at the Lenval University Children's Hospital (LUCH) of Nice (France). METHODS: Retrospective study about casualties treated at LUCH from Bastille Day Attack with injuries resulting in the need for surgery, resuscitation, or death. The type of lesions and surgery, duration of hospitalizations, complications, psychological status, and outcome at discharge were collected...
January 9, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29294931/unique-interactions-of-interpersonal-trauma-and-positive-peer-and-family-experiences-on-traumatic-distress-among-pediatric-primary-care-patients
#5
Shirley B Wang, Joanna Herres, Guy Diamond
Individuals with histories of interpersonal trauma are at increased risk for posttraumatic stress disorder (PTSD). Risk of PTSD is particularly salient during critical periods of development, such as adolescence and emerging adulthood. However, little is known about the unique effects and interactions of protective factors and interpersonal trauma on PTSD symptoms in adolescents and young adults. The current study tested whether positive peer and family experiences decrease the associations between interpersonal trauma and PTSD symptoms and whether these associations differed by victim-perpetrator relationships...
September 1, 2017: Journal of Interpersonal Violence
https://www.readbyqxmd.com/read/29294792/clinician-response-to-child-abuse-presentations-in-the-vietnamese-hospital-emergency-setting
#6
Tara Flemington, Cathrine Fowler, Quang Nhat Tran, Jennifer Fraser
Ongoing fiscal stability has enabled the National Assembly in Vietnam to turn its attention to improving the health and well-being of women and children. Training pediatric health care professionals in the recognition and response to child abuse presentations in the emergency setting has the potential to improve outcomes for the disproportionate number of vulnerable children presenting to the emergency setting with nonaccidental injuries. This study explored the training needs and expectations of the staff preparing to undertake such a clinical training program...
June 1, 2017: Journal of Interpersonal Violence
https://www.readbyqxmd.com/read/29287880/revisits-after-pediatric-tracheotomy-airway-concerns-result-in-returns
#7
Sophie Shay, Nina L Shapiro, Neil Bhattacharyya
OBJECTIVES: Children undergoing tracheotomy represent a medically vulnerable patient population, and understanding the reasons for revisiting the hospital setting following tracheotomy is critical for improving the quality of care for these patients. This study aims to investigate the incidence and characteristics of revisits following pediatric tracheotomy. METHODS: Cross-sectional, population-based study using state databases. The State Inpatient Databases and State Emergency Department Databases for California, Florida, Iowa and New York 2010-11 were linked and examined for cases of pediatric tracheotomy (patients < 18...
January 2018: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/29248322/-can-a-simple-lung-ultrasound-score-predict-length-of-ventilation-for-infants-with-severe-acute-viral-bronchiolitis
#8
M Taveira, N Yousef, J Miatello, C Roy, C Claude, B Boutillier, C Dubois, A-F Pierre, P Tissières, P Durand
BACKGROUND: Lung ultrasound (LU) is a bedside point-of-care technique in critical care and emergency medicine. LU is quick and non-irradiating, and provides accurate diagnostic information when compared with chest radiographs. Specific LU signs have been described for bronchiolitis. This study aimed to evaluate the correlation between severity of LU-diagnosed lung lesions, using a quantitative LU score, and the length of non-invasive ventilation (LOV) for infants diagnosed with severe viral bronchiolitis...
December 13, 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/29240568/the-epidemiology-of-pediatric-head-injury-treated-outside-of-hospital-emergency-departments
#9
Cheryl K Zogg, R Sterling Haring, Likang Xu, Joseph K Canner, Hatim A AlSulaim, Zain G Hashmi, Ali Salim, Lilly D Engineer, Adil H Haider, Jeneita M Bell, Eric B Schneider
BACKGROUND: Although head trauma-related deaths, hospitalizations, and emergency department visits are well characterized, few studies describe pediatric patients presenting outside of emergency departments. We compared the epidemiology and extent of healthcare-seeking pediatric (0-17y) patients presenting in outpatient settings with those of patients seeking non-hospitalized emergency department care. METHODS: We used MarketScan Medicaid and commercial claims, 2004-2013, to identify patients managed in two outpatient settings (physician's offices/clinics, urgent care) and the emergency department...
December 13, 2017: Epidemiology
https://www.readbyqxmd.com/read/29232353/improving-pediatric-preparedness-in-critical-access-hospital-emergency-departments-impact-of-a-longitudinal-in-situ-simulation-program
#10
Jessica H Katznelson, Jiangxia Wang, Martha W Stevens, William A Mills
OBJECTIVES: Critical access hospitals (CAH) see few pediatric patients. Many of these hospitals do not have access to physicians with pediatric training. We sought to evaluate the impact of an in situ pediatric simulation program in the CAH emergency department setting on care team performance during resuscitation scenarios. METHODS: Five CAHs conducted 6 high-fidelity pediatric simulations over a 12-month period. Team performance was evaluated using a validated 35-item checklist representing commonly expected resuscitation team interventions...
January 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29210925/frequency-of-desaturation-and-association-with-hemodynamic-adverse-events-during-tracheal-intubations-in-picus
#11
Simon Li, Ting-Chang Hsieh, Kyle J Rehder, Sholeen Nett, Pradip Kamat, Natalie Napolitano, David A Turner, Michelle Adu-Darko, J Dean Jarvis, Conrad Krawiec, Ashley T Derbyshire, Keith Meyer, John S Giuliano, Joana Tala, Keiko Tarquinio, Michael D Ruppe, Ronald C Sanders, Matthew Pinto, Joy D Howell, Margaret M Parker, Gabrielle Nuthall, Michael Shepherd, Guillaume Emeriaud, Yuki Nagai, Osamu Saito, Jan Hau Lee, Dennis W Simon, Alberto Orioles, Karen Walson, Paula Vanderford, Asha Shenoi, Anthony Lee, Geoffrey L Bird, Michael Miksa, Ana Lia Graciano, Jesse Bain, Peter W Skippen, Lee A Polikoff, Vinay Nadkarni, Akira Nishisaki
OBJECTIVES: Oxygen desaturation during tracheal intubation is known to be associated with adverse ICU outcomes in critically ill children. We aimed to determine the occurrence and severity of desaturation during tracheal intubations and the association with adverse hemodynamic tracheal intubation-associated events. DESIGN: Retrospective cohort study as a part of the National Emergency Airway Registry for Children Network's quality improvement project from January 2012 to December 2014...
November 28, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29208694/variation-in-care-and-clinical-outcomes-in-children-hospitalized-with-orbital-cellulitis
#12
Jessica L Markham, Matthew Hall, Jessica L Bettenhausen, Angela L Myers, Henry T Puls, Russell J McCulloh
OBJECTIVES: To describe variation in the care of children hospitalized with orbital cellulitis and to determine associations with length of stay (LOS), emergency department (ED) revisits, and hospital readmissions. METHODS: By using the Pediatric Health Information System, we performed a multicenter, retrospective study of children aged 2 months to 18 years with a primary International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis code for orbital cellulitis from 2007 to 2014...
December 5, 2017: Hospital Pediatrics
https://www.readbyqxmd.com/read/29206726/standardization-of-pediatric-interfacility-transport-handover-measuring-the-development-of-a-shared-mental-model
#13
Anthony A Sochet, Kelsey S Ryan, Jennifer L Bartlett, Thomas A Nakagawa, Ladonna Bingham
OBJECTIVES: To determine if standardization of pediatric interfacility transport handover is associated with the development of a prototypical shared mental model between healthcare providers. DESIGN: A single center, prepost, retrospective cohort study. SETTINGS: A 259-bed, tertiary care, pediatric referral center. PATIENTS: Children 0 to 18 years old transferred to our critical care units or emergency center from October 2016 to February 2017...
December 4, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29200142/burnout-rates-in-pediatric-emergency-medicine-physicians
#14
Jasmine Patterson, Alison Gardner
OBJECTIVE: Burnout is a syndrome in which a reduced sense of personal accomplishment, depersonalization, and emotional exhaustion develop in response to prolonged stress. It is well known that physicians suffer high rates of burnout; emergency medicine physicians experience significantly increased rates of burnout, whereas physicians in other specialties, like pediatrics, may be spared. Pediatric emergency medicine physicians are on the frontline of care for the critically ill child, which could put them at high risk for burnout...
December 1, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29194282/frequency-and-characterization-of-tracheal-intubation-adverse-events-in-pediatric-sepsis
#15
Sarah K Schmidt, Lina Brou, Sara J Deakyne, Rakesh D Mistry, Halden F Scott
OBJECTIVES: Intubation in critically ill pediatric patients is associated with approximately 20% rate of adverse events, but rates in the high-risk condition of sepsis are unknown. Our objectives were to describe the frequency and characteristics of tracheal intubation adverse events in pediatric sepsis. DESIGN: Retrospective cohort study of a sepsis registry. SETTING: Two tertiary care academic emergency departments and four affiliated urgent cares within a single children's hospital health system...
November 30, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29190172/implementation-of-a-real-world-school-based-asthma-therapy-program-targeting-urban-children-with-poorly-controlled-asthma
#16
Elizabeth D Allen, Kimberly Arcoleo, Courtney Rowe, William W Long
OBJECTIVE: Describe implementation and clinical impact of a "real world" School-Based Asthma Therapy (SBAT) Program serving an urban, largely Medicaid population in a large midwestern city in the United States. METHODS: A retrospective, descriptive evaluation of SBAT was conducted. Students were referred by school nurses or providers, enrolled throughout the year, and could reenroll in subsequent years. A total of 286 students participated in the 2015-2016 school year...
November 30, 2017: Journal of Asthma: Official Journal of the Association for the Care of Asthma
https://www.readbyqxmd.com/read/29189706/unplanned-extubations-in-intensive-care-unit-evidences-for-risk-factors-a-literature-review
#17
Chiara Cosentino, Mattia Fama, Chiara Foà, Giorgia Bromuri, Serena Giannini, Marco Saraceno, Angela Spagnoletta, Mbemo Tenkue, Elena Trevisi, Leopoldo Sarli
BACKGROUND AND AIM: Unplanned extubations (UE) are getting more and more relevant in Critical Care, becoming a quality and care safeness outcome. This happens because after an UE the patient can face some complications concerning the airway management, respiratory and hemodynamic problems, lengthen in the hospital stay and in the mechanical ventilation time.  The aim of this review is identify and classify the factors that could increase UE risk. METHODOLOGY: A systematic review of scientific articles was performed consulting the databases PubMed, Cinahl, Medline, EBSCOhost and Google Scholar...
November 30, 2017: Acta Bio-medica: Atenei Parmensis
https://www.readbyqxmd.com/read/29189593/association-of-insurance-with-use-of-emergency-medical-services-among-children
#18
Parul Dayal, Timothy K Ruttan, Jamie L Kissee, Ilana S Sigal, James P Marcin
OBJECTIVE: The use of emergency medical services (EMS) can be lifesaving for critically ill children and should be defined by the child's clinical need. Our objective was to determine whether nonclinical demographic factors and insurance status are associated with EMS use among children presenting to the emergency department (ED). METHODS: In this cross-sectional study using the National Hospital Ambulatory Medical Care Survey, we included children presenting to EDs from 2009 to 2014...
November 20, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29187102/education-and-training-in-pediatric-cardiac-critical-care
#19
Mary E McBride, Dorothy M Beke, James D Fortenberry, Annette Imprescia, Louise Callow, Lindsey Justice, Ronald A Bronicki
Pediatric cardiac critical care is a new and emerging field. There is no standardization to the current education provided, and high-quality patient outcomes require such standardization. For physicians, this includes fellowship training, specific competencies, and a certification process. For advanced practice providers, a standardized curriculum as well as a certification process is needed. There is evidence that supports a finding that critical care nursing experience may have a positive impact on outcomes from pediatric cardiac surgery...
November 2017: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/29176086/choosing-to-care-for-children-who-might-die-conversations-with-pediatric-residents
#20
Amy E Brown
This essay evolved from observations that pediatric resident physicians' experiences with patient deaths might influence their career paths after completing residency training. The author's journey as a physician led her to wonder whether young pediatricians who gravitated toward careers in primary care had qualitatively different experiences with death and dying during their medical training compared to those who chose fields in which they were more likely to confront death and dying on a regular basis, such as pediatric critical care, neonatology, or pediatric oncology...
2017: Perspectives in Biology and Medicine
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