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By Erich Maul
Beth S Slomine, Faye S Silverstein, James R Christensen, Richard Holubkov, Kent Page, J Michael Dean, Frank W Moler
OBJECTIVE: This study examined 12-month neurobehavioral outcomes in children who survived out-of-hospital cardiac arrest (OH-CA), were comatose after resuscitation, and were enrolled in a clinical trial to evaluate targeted temperature management to hypothermia (33.0°C) or normothermia (36.8°C) (Therapeutic Hypothermia after Pediatric Cardiac Arrest, Out-of-Hopsital [THAPCA-OH]; NCT00878644). METHODS: Baseline functioning was assessed by caregiver responses on the Vineland Adaptive Behavior Scales-Second Edition (VABS-II) soon after OH-CA (based on functioning before OH-CA); children with broadly normal baseline functioning (VABS-II ≥70) were included in the THAPCA-OH primary outcome...
April 2016: Pediatrics
Brittany Mathias, Juan C Mira, Shawn D Larson
PURPOSE OF REVIEW: Sepsis is the leading cause of pediatric death worldwide. In the United States alone, there are 72 000 children hospitalized for sepsis annually with a reported mortality rate of 25% and an economic cost estimated to be $4.8 billion. However, it is only recently that the definition and management of pediatric sepsis has been recognized as being distinct from adult sepsis. RECENT FINDINGS: The definition of pediatric sepsis is currently in a state of evolution, and there is a large disconnect between the clinical and research definitions of sepsis which impacts the application of research findings into clinical practice...
June 2016: Current Opinion in Pediatrics
Xian Zhao, Omar Dughly, Joelle Simpson
PURPOSE OF REVIEW: This article will review current guidelines for decontamination procedures for chemical, biological, and radiologic exposures with a focus on pediatric specific considerations. RECENT FINDINGS: There has been a global increase in terrorist incidents that expose large populations to toxic agents associated with significant morbidity and mortality. The pathophysiology, treatment, and management of these toxic exposures may be unfamiliar to the healthcare provider...
June 2016: Current Opinion in Pediatrics
M Arfan Ikram, Tyler J VanderWeele
Understanding of causal pathways in epidemiology involves the concepts of direct and indirect effects. Recently, causal mediation analysis has been formalized to quantify these direct and indirect effects in the presence of exposure-mediator interaction and even allows for four-way decomposition of the total effect: controlled direct effect, reference interaction, mediated interaction, pure indirect effect. Whereas the other three effects can be intuitively conceptualized, mediated interaction is often considered a nuisance in statistical analysis...
October 2015: European Journal of Epidemiology
Erich Maul, Barbara Latham, Philip M Westgate
BACKGROUND: Resuscitation situations are high risk and high stress, and delays in care can have significant influences on outcomes. Standardization of care protocols and equipment is postulated to decrease some of the stress and risk. The objective of this study was to document increased efficiency in finding resuscitation equipment in a standardized resuscitation cart. METHODS: A new standardized resuscitation cart design was created, and a multimedia education program addressing the new design was launched...
February 2016: Hospital Pediatrics
Michael Auerbach, John W Adamson
It is estimated that one-third of the world's population is anemic, the majority being due to iron deficiency (ID). In adults, ID is associated with fatigue in the absence of anemia, restless legs syndrome, pica and, in neonates, delayed growth and development. In adolescents, ID is associated with decrements in learning and behavioral abnormalities. In the absence of a clear cause, search for a source of bleeding is indicated. No single test is diagnostic of ID unless the serum ferritin is low or the percent transferrin saturation is low with an elevated total iron binding capacity...
January 2016: American Journal of Hematology
Sebastian Straube, Xiangning Fan
Previous publications in the field of Santa studies have not focused on health and safety issues arising from Santa's workplace activities. However, it should be acknowledged that unique occupational hazards exist for Santa Claus. Major occupational health issues affecting Santa are discussed, along with suggestions for future research directions.
2015: Journal of Occupational Medicine and Toxicology
Sander Greenland, Stephen J Senn, Kenneth J Rothman, John B Carlin, Charles Poole, Steven N Goodman, Douglas G Altman
Misinterpretation and abuse of statistical tests, confidence intervals, and statistical power have been decried for decades, yet remain rampant. A key problem is that there are no interpretations of these concepts that are at once simple, intuitive, correct, and foolproof. Instead, correct use and interpretation of these statistics requires an attention to detail which seems to tax the patience of working scientists. This high cognitive demand has led to an epidemic of shortcut definitions and interpretations that are simply wrong, sometimes disastrously so-and yet these misinterpretations dominate much of the scientific literature...
April 2016: European Journal of Epidemiology
Rita V Burke, Kathy Lehman-Huskamp, Rachel E Whitney, Gitanjli Arora, Daniel B Park, Pamela Mar, Mark X Cicero
OBJECTIVE: Disaster preparedness training has a small but growing part in medical education. Various strategies have been used to simulate disaster scenarios to safely provide such training. However, a modality to compare their effectiveness is lacking. The authors propose the use of checklists, which have been a standard in aviation safety for decades. DESIGN: Residents at four different academic pediatric residency programs volunteered to participate in tabletop simulation of a timed, pediatric disaster scenario...
2015: American Journal of Disaster Medicine
Lauren G Solan, Susan N Sherman, Dominick DeBlasio, Jeffrey M Simmons
OBJECTIVE: Primary care providers (PCPs) and hospitalists endorse the importance of effective communication yet studies illustrate critical communication problems between these 2 provider types. Our objective was to develop deeper insight into the dimensions of and underlying reasons for communication issues and determine ways to improve communication and remove barriers by eliciting the perspectives of pediatric PCPs and hospitalists. METHODS: Using qualitative methods, 2 sets of focus groups were held: 1) mix of local PCPs serving diverse populations, and 2) hospitalists from a free-standing, pediatric institution...
July 2016: Academic Pediatrics
Betty Pfefferbaum, Pascal Nitiéma, Anne K Jacobs, Mary A Noffsinger, Leslie H Wind, Sandra F Allen
Evidence-based practice requires the use of data grounded in theory with clear conceptualization and reliable and valid measurement. Unfortunately, developing a knowledge base regarding children's coping in the context of disasters, terrorism, and war has been hampered by a lack of theoretical consensus and a virtual absence of rigorous test construction, implementation, and evaluation. This report presents a comprehensive review of measurement tools assessing child and adolescent coping in the aftermath of mass trauma, with a particular emphasis on coping dimensions identified through factor analytic procedures...
April 2016: Prehospital and Disaster Medicine
Jeanne M Farnan, Sean Gaffney, Jason T Poston, Kris Slawinski, Melissa Cappaert, Barry Kamin, Vineet M Arora
BACKGROUND: Patient safety curricula in undergraduate medical education (UME) are often didactic format with little focus on skills training. Despite recent focus on safety, practical training in residency education is also lacking. Assessments of safety skills in UME and graduate medical education (GME) are generally knowledge, and not application-focused. We aimed to develop and pilot a safety-focused simulation with medical students and interns to assess knowledge regarding hazards of hospitalisation...
March 2016: BMJ Quality & Safety
Kevin J O'Leary, Audrey Killarney, Luke O Hansen, Sasha Jones, Megan Malladi, Kelly Marks, Hiren M Shah
IMPORTANCE: Though interprofessional bedside rounds have been promoted to enhance patient-centred care for hospitalised patients, few studies have been conducted in adult hospital settings and evidence of impact is lacking. OBJECTIVE: To evaluate the effect of patient-centred bedside rounds (PCBRs) on measures of patient-centred care. DESIGN AND SETTING: Cluster randomised controlled trial involving four similar non-teaching hospitalist service units in a large urban hospital...
December 2016: BMJ Quality & Safety
Ravi Rajaram, Lily Saadat, Jeanette Chung, Allison Dahlke, Anthony D Yang, David D Odell, Karl Y Bilimoria
INTRODUCTION: In 2011, the Accreditation Council for Graduate Medical Education (ACGME) expanded restrictions on resident duty hours. While studies have shown no association between these restrictions and improved outcomes, process-of-care and patient experience measures may be more sensitive to resident performance, and thus may be impacted by duty hour policies. The objective of this study was to evaluate the association between the 2011 resident duty hour reform and measures of processes-of-care and patient experience...
December 2016: BMJ Quality & Safety
E Etchells, M Ho, K G Shojania
No abstract text is available yet for this article.
March 2016: BMJ Quality & Safety
Alex Gillespie, Tom W Reader
BACKGROUND: Letters of complaint written by patients and their advocates reporting poor healthcare experiences represent an under-used data source. The lack of a method for extracting reliable data from these heterogeneous letters hinders their use for monitoring and learning. To address this gap, we report on the development and reliability testing of the Healthcare Complaints Analysis Tool (HCAT). METHODS: HCAT was developed from a taxonomy of healthcare complaints reported in a previously published systematic review...
December 2016: BMJ Quality & Safety
Bozena Bonnie Poksinska, Malgorzata Fialkowska-Filipek, Jon Engström
BACKGROUND: Lean healthcare is claimed to contribute to improved patient satisfaction, but there is limited evidence to support this notion. This study investigates how primary-care centres working with Lean define and improve value from the patient's perspective, and how the application of Lean healthcare influences patient satisfaction. METHODS: This paper contains two qualitative case studies and a quantitative study based on results from the Swedish National Patient Survey...
February 2017: BMJ Quality & Safety
C Craig Blackmore, Gary S Kaplan
No abstract text is available yet for this article.
February 2017: BMJ Quality & Safety
Leora I Horwitz
No abstract text is available yet for this article.
January 2017: BMJ Quality & Safety
Claire Lemer, Ronny Cheung, Robert Klaber, Natalie Hibbs
Understanding how to identify and improve clinical pathways has proven a key tool in quality improvement. These techniques originated beyond healthcare, but are increasingly applied to healthcare. This paper outlines the history of the technique transfer and how to use in clinical practice.
February 2016: Archives of Disease in Childhood. Education and Practice Edition
2016-03-14 23:16:50
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