bluuebunny/crossref_metadata_2025 huggingface dataset:
Telehealth and virtual health monitoring in cystic fibrosis
Authors: Vagg Tamara , Shanthikumar Shivanthan , Morrissy David , Chapman Wendy W. , Plant Barry J. , Ranganathan Sarath
Published: August 2021

Purpose of review

At many institutions, the Covid-19 pandemic made it necessary to rapidly change the way services are provided to patients, including those with cystic fibrosis (CF). The purpose of this review is to explore the past, present and future of telehealth and virtual monitoring in CF and to highlight certain challenges/considerations in developing such services.

Recent findings

The Covid-19 pandemic has proven that telehealth and virtual monitoring are a feasible means for safely providing services to CF patients when traditional care is not possible. However, both telehealth and virtual monitoring can also provide further support in the future in a post-covid era through a hybrid-model incorporating traditional care, remote data collection and sophisticated platforms to manage and share data with CF teams.

We provide a detailed overview of telehealth and virtual monitoring including examples of how paediatric and adult CF services adapted to the need for rapid change. Such services have proven popular with people with CF meaning that co-design with stakeholders will likely improve systems further. In the future, telehealth and virtual monitoring will become more sophisticated by harnessing increasingly powerful technologies such as artificial intelligence, connected monitoring devices and wearables. In this review, we harmonise definitions and terminologies before highlighting considerations and limitations for the future of telehealth and virtual monitoring in CF.
Sleep medicine and coronavirus disease 2019
Authors: Gill Cara M. , Piggott Laura M. , Kent Brian D.
Published: August 2021

Purpose of review

To evaluate the impact of the COVID-19 pandemic on the care of people with sleep disorders, to explore relationships between OSA and COVID-19, and to describe current knowledge of the effect of the pandemic on sleep globally.

Recent findings

COVID-19 has led to significant changes in the practice of sleep medicine, including the care of patients with OSA. An OSA diagnosis may portend a worse prognosis with COVID-19, whilst prior COVID-19 may have an impact on sleep breathing.

The pandemic has caused marked difficulties with access to diagnostic sleep studies and reduced capacity for CPAP initiation. Conversely, adherence to CPAP therapy may have improved, and use of remote consultations and telemonitoring has increased. An OSA diagnosis may be associated with increased risk of severe COVID-19, although any apparent relationship may be attributable to confounding factors, such as obesity and metabolic disease. Small studies have reported some increase in CPAP requirements in OSA patients following COVID-19 infection. More generally, the pandemic has been associated with a deterioration in subjective sleep quality across the population; much of this appears because of increased anxiety and stress. Finally, studies assessing putative links between COVID-19 and REM sleep issues are ongoing.
Novel predictors for liver transplantation or death in drug-induced acute liver failure
Authors: Weber Sabine , Woischke Christine , Denk Gerald , Gerbes Alexander L.
Published: August 2021

Objective

Drug-induced liver injury (DILI) is a leading cause of acute liver failure (ALF). Predictors for orthotopic liver transplantation (OLT) or death in drug-induced ALF (DI-ALF) are scarce.

Methods

In total 33 of 346 patients recruited for our prospective study on potentially hepatotoxic drugs had ALF. DILI diagnosis was based on Roussel Uclaf Causality Assessment Method (RUCAM) score and expert opinion. Area under the receiver operating characteristic (AUROC) curve, Youden’s index and positive and negative likelihood ratios were calculated to identify the best performing predictive markers and scores for OLT or death.

Results

Poor outcome was associated with lower baseline platelet counts and cholinesterase (CHE) levels, higher International Normalized Ratio (INR) levels and Model for End-Stage Liver Disease (MELD) scores. Yet, AUROC reached a maximum of only 0.71–0.75 for either of those laboratory markers or the MELD score. Notably however, combinations of those scores were highly discriminatory, in particular INR/(CHE*platelet count) and MELD/(CHE*platelet count), showing an AUROC of 0.91, a positive likelihood ratios of 13.78 and a negative likelihood ratios of 0.08.

Conclusion

While baseline MELD score, INR, CHE, and platelet counts had limited potential to discriminate between DI-ALF with survival or poor outcome, their combinations were highly associated with OLT or death in patients with DI-ALF.
Trends in Cancer Treatment Service Availability Across Critical Access Hospitals and Prospective Payment System Hospitals
Authors: Hung Peiyin , Shi Kewei , Probst Janice C. , Zahnd Whitney E. , Zgodic Anja , Merrell Melinda A. , Crouch Elizabeth , Eberth Jan M.
Published: August 2021

Background:

Rural residents experience worse cancer prognosis and access to cancer care providers than their urban counterparts. Critical access hospitals (CAHs) represent over half of all rural community hospitals. However, research on cancer services provided within CAHs is limited.

Objective:

The objective of this study was to investigate trends in cancer services availability in urban and rural Prospective Payment System (PPS) hospitals and CAHs.

Design:

Retrospective, time-series analysis using data from 2008 to 2017 American Hospital Association Annual Surveys. Multivariable logistic regressions were used to examine differential trends in cancer services between urban PPS, rural PPS, and CAHs, overall and among small (<25 beds) hospitals.

Subjects:

All US acute care and cancer hospitals (4752 in 2008 to 4722 in 2017).

Measures:

Primary outcomes include whether a hospital provided comprehensive oncology services, chemotherapy, and radiation therapy each year.

Results:

In 2008, CAHs were less likely to provide all cancer services, especially chemotherapy (30.4%) and radiation therapy (2.9%), compared with urban (64.4% and 43.8%, respectively) and rural PPS hospitals (42.0% and 23.3%, respectively). During 2008–2017, compared with similarly sized PPS hospitals, CAHs were more likely to provide oncology services and chemotherapy, but with decreasing trends. Radiation therapy availability between small PPS hospitals and CAHs did not differ.

Conclusions:

Compared with all PPS hospitals, CAHs offered fewer cancer treatment services and experienced a decline in service capability over time. These differences in chemotherapy services were mainly driven by hospital size, as small urban and rural PPS hospitals had lower rates of chemotherapy than CAHs. Still, the lower rates of radiotherapy in CAHs highlight disproportionate challenges facing CAHs for some specialty services.
How to assess quality of life in persons with chronic kidney disease
Authors: Lightfoot Courtney J. , Howell Martin , Smith Alice C.
Published: August 2021

Purpose of review

Chronic kidney disease (CKD) significantly impacts many aspects of life, health, and wellbeing. People with CKD have individual priorities for their care which may differ from those valued by clinicians and policy makers. The patient experience is broadly captured by the concept of quality of life (QoL) which is increasing assessed in research and used to guide clinical and policy decision making. Appropriate selection and application of QoL assessment tools are essential for high-quality research and patient care. This article summarises the current approaches to QoL assessment in CKD and outlines aspirations for future improvement.

Recent findings

Commonly used tools for assessment of QoL in CKD include the Short Form-36 and -12 and extended versions adapted for specific use in kidney patients (KD-QoL), and the EQ-5D. However, a wide range of other instruments are also reported, making comparisons between research findings challenging. Few of the tools are adequately validated for use in CKD, and relevance to patient values are unclear. Instruments suitable for use in a routine clinical setting are lacking.

QoL instruments developed and validated with meaningful CKD stakeholder input are required. The Standardised Outcomes in Nephrology initiative is working to address this need.
The Importance of Board Certification
Authors: Marfell Julie A. , McNeely Heidi , Ma Holly , Chappell Kathy
Published: August 2021

The investment to support and obtain board certification demonstrates a nurse leader's commitment to their staff, the organization, and the communities they serve. It is important for nurse leaders to appreciate how organizational support of board certification can positively impact patient care and to be advocates for funding to support board certification for their staff. This month's Magnet® Perspectives column discusses the empirical evidence, as well as the professional value of certification.
An Interview With Judy Davidson
Authors: Reid Ponte Patricia
Published: August 2021

This month's column is an interview with Dr Judy Davidson, nurse scientist, University of California, San Diego Health Sciences Center. Dr Davidson has devoted a large part of her research to the reporting and prevention of nurse suicide.
Using Data from a 360° Leadership Assessment to Enhance Nurse Manager Transformational Leadership Skills
Authors: Heuston Melanie M. , Leaver Cynthia , Harne-Britner Sarah
Published: August 2021

OBJECTIVE

The aim of this study was to compare self-perception of leadership practices among nurse managers (NMs), day shift nurses, and night shift nurses (NSNs).

BACKGROUND

Nurse managers have complex roles in healthcare, with clinical, administrative, and 24-hour accountability for unit activities. Transformational leadership inspires performance beyond expectations, while transcending self-interest for the good of the organization.

METHODS

A comparative, secondary data analysis study of the Leadership Practices Inventory (LPI) 2018.

RESULTS

Day shift nurses' and NSNs' mean scores had lower perceptions of leadership practices than NMs' self-assessment. Day shift nurses, NSNs, and NMs identified the highest mean scores in “enable others to act” (8.57, 8.62, and 8.82, respectively).

CONCLUSIONS

The LPI assessment, the defined observer groups, and unique data visualization informed development of a comprehensive follow-up plan supporting individual and group leadership development. Research examining differences in perceptions of LPI practices across observer groups, particularly direct report staff nurses, is warranted.
The Relationship Between Staff Nurses' Perceptions of Nurse Manager Caring Behaviors and Patient Experience
Authors: Kostich Kelley , Lasiter Sue , Duffy Joanne R. , George Vicki
Published: August 2021

OBJECTIVE

The objective of this study was to explore the relationship between staff nurses' perceptions of nurse manager caring behaviors and patient experience.

BACKGROUND

Despite numerous interventions aimed at changing the provision of patient care to improve care quality, patient experience scores have remained moderate. Little research has been conducted exploring how caring relationships in the professional practice environment might play a role in the patient experience of care.

METHODS

A cross-sectional, correlational design was used to examine the relationship between staff nurses' perceptions of nurse manager caring behaviors as measured by the Caring Assessment Tool–Administration (CAT-Adm) and acute-care patient experience using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.

RESULTS

There was a positive relationship between the staff nurses' perceptions of nurse manager caring behaviors and patients' HCAHPS overall hospital rating. There also was a positive relationship between the CAT-Adm scores and nurse manager visibility.

CONCLUSION

Departments had higher HCAHPS overall hospital rating when the staff nurses perceived their unit manager as caring. In addition, the more staff nurses actually visualized their nurse manager during a shift, the more they perceived their nurse manager as caring.
Peripartum Cardiomyopathy
Authors: Farrell Amanda S. , Kuller Jeffrey A. , Goldstein Sarah A. , Dotters-Katz Sarah K.
Published: August 2021

Importance

Peripartum cardiomyopathy is a rare form of heart failure due to left ventricular systolic dysfunction that affects women late in pregnancy and the postpartum period. A diagnosis of exclusion, peripartum cardiomyopathy can be difficult to diagnose in the context of the normal physiologic changes of pregnancy and requires a high index of suspicion.

Evidence Acquisition

Original research articles, review articles, and guidelines on peripartum cardiomyopathy were reviewed.

Results

The etiology of peripartum cardiomyopathy remains poorly defined, but theories include genetic predisposition, as well as myocardial inflammation and angiogenic dysregulation. Risk factors for this condition include hypertensive disorders of pregnancy, Black race, and maternal age older than 30 years. Patients with peripartum cardiomyopathy are at increased risk of acute clinical decompensation, cardiac arrhythmias, thromboembolic complications, and death. Primary treatment modalities include initiation of a medication regimen aimed at the optimization of preload and reduction of afterload. Maternal clinical status is the primary determinant for timing of delivery.

Conclusions and Relevance

Prompt diagnosis and medical management by an interdisciplinary care team are vital for improving outcomes in patients with peripartum cardiomyopathy.

Target Audience

Obstetricians and gynecologists, family physicians

Learning Objectives

After participating in this activity, the provider should be better able to describe the incidence, proposed etiologies, and risk factors for peripartum cardiomyopathy; outline diagnostic tools and evidence-based clinical management of peripartum cardiomyopathy; and identify the disparities in outcomes and existing knowledge gaps.
COVID-19 in Pregnancy: A Current Review of Global Cases
Authors: Chae Sung Y. , Bhattacharyya Adity , Mendoza Rosa
Published: August 2021

Importance

There is great concern about the impact of COVID-19 in pregnancy due to the high morbidity and mortality associated with prior coronavirus infections.

Objective

The objective of this review is to summarize the current literature on the impact of COVID-19 on pregnant women and their newborns.

Evidence Acquisition

The search terms COVID-19 and pregnancy were used in Medline and Clinical Key databases. Only articles written in English with outcome data on both mothers and their newborns were incorporated.

Results

Pregnant women generally experience COVID-19 as a mild-moderate illness. However, approximately 5% become critically ill. Women with underlying comorbidities seem more likely to experience severe morbidity. Newborns also generally have a favorable course.

Vertical transmission in the intrauterine period is possible but rare. Infection control measures need to be taken to prevent transmission during the peripartum period. There is a paucity of data on infections in the first and second trimesters, but research from those infected in the third trimester indicates a possible link with preterm birth. There is a significant percentage of asymptomatic cases. Racial disparities are also being noted with disproportionate numbers of racial/ethnic minorities being affected.

Conclusions

COVID-19 is generally experienced by pregnant women and their newborns as a mild to moderate illness, although a minority become critically ill and mortality does occur. This is more likely among those with underlying comorbidities, as in the general population. Asymptomatic cases heighten the need for increased testing and infection control measures. Racial disparities highlight underlying vulnerabilities and the need for increased research and policy changes.

Target Audience

Obstetricians and gynecologist, family physicians

Learning Objectives

After completing this activity, the reader should be better able to describe clinical presentations of pregnant women who contract COVID-19; explain the risks associated with maternal morbidity and mortality with COVID-19 infections; outline the risks of vertical transmission and neonatal outcomes of pregnant women with COVID-19 infections; and identify racial/ethnic disparities among pregnant women with COVID-19.
Outcomes of Women Undergoing Excision of the Retained Cervix After Supracervical Hysterectomy
Authors: McHale Melissa P. , Smith Anna Jo B. , Fader Amanda N. , Wethington Stephanie L.
Published: August 2021

(Abstracted from Obstet Gynecol 2021;137(5):831–836)

Supracervical hysterectomy accounted for approximately 7% of all hysterectomies from 2012 to 2016. Supracervical hysterectomy is often desired because of belief that there is superior sexual and urinary function with retention of the cervix as well as decreased operative complexity.
Impact of Cystotomy Location on Cystography Results
Authors: Napoe Gnankang Sarah , Stewart Lauren E. , Myers Deborah L.
Published: August 2021

(Abstracted from Female Pelvic Med Reconstr Surg 2021;27:260–263)

Postcystotomy, cystography is typically performed to determine bladder integrity before the removal of the catheter. Yet, little comparative data are available to support this practice.
Evaluating Progestogens for Preventing Preterm Birth International Collaborative (EPPPIC): Meta-analysis of Individual Participant Data From Randomised Controlled Trials
Authors: Mol B. W. , Wood S. , Rode L. , Tabor A. , Aboulghar M. M. , Porcher R. , Senat M.-V. , Bagga R. , Rajaram S. , Azargoon A. , Bahrami E. , Nassar A. , Schuit E. , van Os M. A. , Crowther C. A. , Alfirevic Z. , Beresford L. , Dietz K. C. , Duley L. , Hodkinson A. , Llewellyn A. , Norman J. E. , Norrie J. , Sharif S. , Simmonds M. , Stewart L. A. , Walker R. A. E. , Walley T. , Wright K. , Blackwell S. C. , Caritis S. N. , Combs C. A. , Croswell J. M. , Das A. F. , Dickersin K. , Elimian A. , Grobman W. A. , Maurel K. A. , McKenna D. S. , Moley K. , Mueller J. , O'Brien J. M. , Rouse D. J. , Sakala C. , Simpson J. L. , Smith K. , Thom E. A. , Whitlock E. P.
Published: August 2021

(Abstracted from Lancet 2021;397:1183–1194)

Preterm birth is the most common cause of neonatal morbidity and mortality. When infants are born preterm, they are at increased risk for having difficulties at birth, health problems throughout infancy, and death during the first year of life.
Evaluation of Hospital Cesarean Delivery–Related Profits and Rates in the United States
Authors: Sakai-Bizmark Rie , Ross Michael G. , Estevez Dennys , Bedel Lauren E. M. , Marr Emily H. , Tsugawa Yusuke
Published: August 2021

(Abstracted from JAMA Netw Open 2021;4:e212235)

Although cesarean delivery (CD) is a commonly performed procedure in the United States, there are significant maternal and fetal risks compared with vaginal delivery. One reason may be related to financial incentives.
Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery: A Retrospective Multicenter Study
Authors: Cashen Katherine , Kwiatkowski David M. , Riley Christine M. , Buckley Jason , Sassalos Peter , Gowda Keshava N. , Iliopoulos Ilias , Bakar Adnan , Chiwane Saurabh , Badheka Aditya , Moser Elizabeth A. S. , Mastropietro Christopher W. ,   the Collaborative Research from the Pediatric Cardiac Intensive Care Society (CoRe-PCICS) Investigators
Published: August 2021

OBJECTIVES:

We aimed to describe characteristics and operative outcomes from a multicenter cohort of infants who underwent repair of anomalous left coronary artery from the pulmonary artery. We also aimed to identify factors associated with major adverse cardiovascular events following anomalous left coronary artery from the pulmonary artery repair.

DESIGN:

Retrospective chart review.

SETTING:

Twenty-one tertiary-care referral centers.

PATIENTS:

Infants less than 365 days old who underwent anomalous left coronary artery from the pulmonary artery repair.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Major adverse cardiovascular events were defined as the occurrence of postoperative extracorporeal membrane oxygenation, cardiopulmonary resuscitation, left ventricular assist device, heart transplantation, or operative mortality. Factors independently associated with major adverse cardiovascular events were identified using multivariable logistic regression analysis. We reviewed 177 infants (< 365 d old) who underwent anomalous left coronary artery from the pulmonary artery repair between January 2009 and March 2018. Major adverse cardiovascular events occurred in 36 patients (20%). Twenty-nine patients (16%) received extracorporeal membrane oxygenation, 14 (8%) received cardiopulmonary resuscitation, four (2%) underwent left ventricular assist device placement, two (1%) underwent heart transplantation, and six (3.4%) suffered operative mortality. In multivariable analysis, preoperative inotropic support (odds ratio, 3.5; 95% CI, 1.4–8.5), cardiopulmonary bypass duration greater than 150 minutes (odds ratio, 6.9 min; 95% CI, 2.9–16.7 min), and preoperative creatinine greater than 0.3 mg/dL (odds ratio, 2.4 mg/dL; 95% CI, 1.1–5.6 mg/dL) were independently associated with major adverse cardiovascular events. In patients with preoperative left ventricular end-diastolic diameter measurements available (n = 116), left ventricular end-diastolic diameter z score greater than 6 was also independently associated with major adverse cardiovascular events (odds ratio, 7.6; 95% CI, 2.0–28.6).

CONCLUSIONS:

In this contemporary multicenter analysis, one in five children who underwent surgical repair of anomalous left coronary artery from the pulmonary artery experienced major adverse cardiovascular events. Preoperative characteristics such as inotropic support, creatinine, and left ventricular end-diastolic diameter z score should be considered when planning for potential postoperative complications.
Diaphragm Activity Pre and Post Extubation in Ventilated Critically Ill Infants and Children Measured With Transcutaneous Electromyography*
Authors: van Leuteren Ruud W. , de Waal Cornelia G. , de Jongh Frans H. , Bem Reinout A. , van Kaam Anton H. , Hutten Gerard
Published: August 2021

OBJECTIVES:

Swift extubation is important to prevent detrimental effects of invasive mechanical ventilation but carries the risk of extubation failure. Accurate tools to assess extubation readiness are lacking. This study aimed to describe the effect of extubation on diaphragm activity in ventilated infants and children. Our secondary aim was to compare diaphragm activity between failed and successfully extubated patients.

DESIGN:

Prospective, observational study.

SETTING:

Single-center tertiary neonatal ICU and PICU.

PATIENTS:

Infants and children receiving invasive mechanical ventilation longer than 24 hours.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Diaphragm activity was measured with transcutaneous electromyography, from 15 minutes before extubation till 180 minutes thereafter. Peak and tonic activity, inspiratory amplitude, inspiratory area under the curve, and respiratory rate were calculated from the diaphragm activity waveform. One hundred forty-seven infants and children were included (median postnatal age, 1.9; interquartile range, 0.9–6.7 wk). Twenty patients (13.6%) failed extubation within 72 hours. Diaphragm activity increased rapidly after extubation and remained higher throughout the measurement period. Pre extubation, peak (end-inspiratory) diaphragm activity and tonic (end-inspiratory) diaphragm activity were significantly higher in failure, compared with success cases (5.6 vs 7.0 μV; p = 0.04 and 2.8 vs 4.1 μV; p = 0.04, respectively). Receiver operator curve analysis showed the highest area under the curve for tonic (end-inspiratory) diaphragm activity (0.65), with a tonic (end-inspiratory) diaphragm activity greater than 3.4 μV having a combined sensitivity and specificity of 55% and 77%, respectively, to predict extubation outcome. After extubation, diaphragm activity remained higher in patients failing extubation.

CONCLUSIONS:

Diaphragm activity rapidly increased after extubation. Patients failing extubation had a higher level of diaphragm activity, both pre and post extubation. The predictive value of the diaphragm activity variables alone was limited. Future studies are warranted to assess the additional value of electromyography of the diaphragm in combined extubation readiness assessment.
Concussion Referral and Practice Patterns by Pediatric Emergency Medicine Providers
Authors: Corwin Daniel J. , Root Jeremy M. , Zonfrillo Mark R. , Thomas Danny G.
Published: August 2021

Objectives

Concussion is a commonly encountered diagnosis for pediatric emergency medicine (PEM) providers, yet little is known regarding referral patterns to specialists. Our goal was to assess PEM providers' referral patterns and current usage of standardized evaluation tools.

Methods

This study was conducted as cross-sectional survey of PEM providers recruited from the American Academy of Pediatrics Section on Emergency Medicine Listserv. Surveys were distributed at 3 time points between December 1, 2020, and February 28, 2021, and included multiple choice, Likert scale, and free text questions. Descriptive statistics and bivariate analyses were used to describe the sample and compare responses between those with variable experience and confidence in concussion management.

Results

In total, 162 of 491 Listserv members (33.0%) completed the survey. The factors most often reported to assist in referral decisions were history of severe (92.6%) or multiple (90.7%) prior concussions, prolonged symptom duration (89.5%), and severity of current symptoms (84.6%). Most providers reported having large experience (63.0%) and confidence (54.9%) in managing concussion. Standardized symptom scales (8.0%), vestibular (11.7%) and balance assessments (13.0%), and prognostic tools (6.8%) were infrequently used. Most (64.2%) providers felt specialty referral was important. More than 80% reported high likelihood to use an accurate risk stratification tool to facilitate referral.

Conclusions

Although most PEM providers reported significant experience and confidence in managing pediatric concussion, standardized assessment tools were infrequently used. Most were likely to use a risk stratification tool to assist in specialty referral. Future studies should assess the ability of targeted referral strategies to improve recovery for concussed youth.
Parent Perspectives Regarding Care Delivery for Children With Idiopathic Toe Walking to Inform an American Physical Therapy Association Clinical Practice Guideline
Authors: Barkocy Marybeth , Muir Nancy , Le Cras Sally , Brausch Shannon , Hoffman Nicole , Bouck Julie , Hendrix Ingrid , Thomas Cecile , Foulk Allison , Quatman-Yates Catherine
Published: August 2021

Purpose:

This study summarizes experiences and perceptions of parents whose children received physical therapy for idiopathic toe walking (ITW) to inform clinical practice guideline development and identify perceived strengths and gaps in care.

Methods:

A US-based survey was distributed to parents of children with ITW. Data from 98 respondents were compiled through descriptive statistics of item responses and review of comments.

Results:

Parents reported variability in timing of diagnosis and intervention, ITW care, and extent they felt educated and involved in decision making. Rates of confidence, satisfaction, and effectiveness of physical therapy care varied.

Conclusions:

A parent-informed clinical practice guideline for physical therapy management of ITW and family-friendly supplemental knowledge translation tools could reduce care variability, optimize shared decision making, and increase satisfaction of outcomes.

Recommendations for Clinical Practice:

Clinicians should be knowledgeable about ITW diagnosis, prognosis, and treatment options, educating families and engaging them in shared decision making around ITW care.
Scootering for Children and Youth Is More Than Fun: Exploration of a Feasible Approach to Improve Function and Fitness
Authors: Wright Marilyn , Twose Donna , Gorter Jan Willem
Published: August 2021

Purpose:

Describe scootering as a physical therapy intervention for children/adolescents with mobility limitations within the “F-Words for Child Development” (fitness, function, family, friends, fun, and future) and through motion analysis.

Methods:

Perspectives of scootering were explored using the holistic “F-words for Child Development” recommendations for pediatric rehabilitation and through 3-dimensional instrumented motion analysis of children/adolescents with cerebral palsy and children/adolescents with typical development.

Results:

Scootering was consistent with the F-words tenets for rehabilitative best practice. Many of the motion characteristics of scootering reflected desirable exercise and gait attributes relevant to children/adolescents with cerebral palsy.

Conclusions:

Scootering is a feasible, functional, and fun activity that has the potential to address many aspects of fitness, function, and gait; meet the needs of families; and provide opportunities for interaction with friends. It is a physical therapy intervention that has the potential to contribute to future health and well-being of children with disabilities.

Video Abstract:

For more insights from the authors, see Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A331.
Complex Care Program Enrollment and Change in ED and Hospital Visits from Medical Device Complications
Authors: Barreda Christina B. , Ehlenbach Mary L. , Nackers Allison , Kelly Michelle M. , Shadman Kristin A. , Sklansky Daniel J. , Edmonson M. Bruce , Zhao Qianqian , Warner Gemma , Coller Ryan J.
Published: August 2021

Introduction:

Medical device-related complications often lead to emergency department (ED) visits and hospitalizations for children with medical complexity (CMC), and pediatric complex care programs may be one way to decrease unnecessary encounters.

Methods:

A retrospective cohort study comparing ED and inpatient encounters due to device complications of 2 cohorts of CMC at a single children’s hospital during 2014–2016; 99 enrolled in a complex care program and 244 in a propensity-matched comparison group. Structured chart reviews identified ED and inpatient encounters due to device complications. The outcome was a change in the frequency of these encounters from the year before to the year after enrollment in the hospital’s complex care program. Program effects were estimated with weighted difference-in-differences (DiDs), comparing the change in mean encounter frequency for CMC enrolled in the program with change for propensity-matched children not enrolled in the program.

Results:

Mean encounters related to device complications decreased for both groups. Complication-related ED encounters per year decreased from a weighted mean (SD) of 0.74 (0.85) to 0.30 (0.44) in enrolled children and 0.26 (0.89) to 0.12 (0.56) in comparison children, a DiD of 0.30 fewer [95% confidence interval (CI) −0.01 to 0.60]. The largest reductions in device complication ED visits were among those with enteral tubes [0.36 fewer (95% CI 0.04–0.68)]. Hospitalizations decreased over time, but DiDs were not significantly different between groups.

Conclusions:

Acute care use from device complications decreased with time. Complex care program enrollment may be associated with more substantial reductions in device complication ED visits, and effects may be most pronounced for CMC with enteral tubes.
Quality Improvement Initiative to Improve Healthcare Providers’ Attitudes towards Mothers with Opioid Use Disorder
Authors: Ford Susan , Clarke Leslie , Walsh Michele C. , Kuhnell Pierce , Macaluso Maurizio , Crowley Moira , McClead Richard , Wexelblatt Scott , Lannon Carole , Kaplan Heather C.
Published: August 2021

Introduction:

Individuals with opioid use disorder often report feelings of shame and describe feeling judged negatively. These feelings are especially true for pregnant women with opioid use disorder. The Ohio Perinatal Quality Collaborative conducted a multimodal quality improvement initiative for infants born with Neonatal Abstinence Syndrome (NAS). An important component of the project was focused on improving staff attitudes toward mothers of infants with NAS.

Methods:

The Ohio Perinatal Quality Collaborative implemented an education program for healthcare providers at 39 participating hospital units regarding opioid use as a chronic disease and principles of nonjudgmental, trauma-informed care. Healthcare providers partnered with the mother of infants with NAS in the care of the infant and connected with local community resources. This work was a subcomponent of an overall multimodal quality improvement project. Healthcare provider attitudes were measured with the “Attitude Measurement: Brief Scales” questionnaire anonymously, at 3 different time points throughout the project. Attitude change was measured by pretraining and posttraining scores. ANOVA methods were used to compare individual items and a summary score across the 3 surveys.

Results:

Summary scores improved significantly from 18.99 at baseline (January–March 2014) to 19.94 (P < 0.0001) in February 2015 and were maintained at 20.05 in July 2016.

Conclusions:

A nonjudgmental attitude toward mothers of infants with NAS is an important component of compassionate care. Improving healthcare provider attitudes can benefit a mother of an infant with NAS and help preserve the mother–infant dyad.
Contextual Factors Affecting Implementation of In-hospital Pediatric CPR Quality Improvement Interventions in a Resuscitation Collaborative
Authors: Dewan Maya , Parsons Allison , Tegtmeyer Ken , Wenger Jesse , Niles Dana , Raymond Tia , Cheng Adam , Skellett Sophie , Roberts Joan , Jani Priti , Nadkarni Vinay , Wolfe Heather
Published: August 2021

Introduction:

Pediatric quality improvement (QI) collaboratives are multisite clinical networks that support cooperative learning. Our goal is to identify the contextual facilitators and barriers to implementing QI resuscitation interventions within a multicenter resuscitation collaborative.

Methods:

A mixed-methods evaluation of the contextual facilitators and barriers to implementation of a resuscitation QI bundle. We administered a quantitative questionnaire, the Model for Understanding Success in Quality (MUSIQ), to the Pediatric Resuscitation Quality (pediRES-Q) Collaborative. Its primary goal is to optimize the care of children who experience in-hospital cardiac arrest through a resuscitation QI bundle. We also conducted semistructured phone interviews with site primary investigators adapted from the Consolidated Framework for Implementation Research qualitative interview guide.

Results:

All 13 actively participating US sites completed the MUSIQ questionnaire. Total MUSIQ scores ranged from 86.0 to 140.5 (median of 118.7, interquartile range 103.6–124.5). Evaluation of the QI team subsection noted a mean score of 5.5 for low implementers and 6.1 for high implementers (P = 0.02). We conducted 8 interviews with the local QI team leadership. Contextual facilitators included a unified institutional approach to QI, a fail forward climate, leadership support, strong microculture, knowledge of other organizations, and prioritization of goals. Contextual barriers included low team tenure, no specific allocation of resources, lack of formalized QI training, and lack of support and buy-in by leaders and staff.

Conclusions:

Using mixed methods, we identified an association between the local QI team’s strength and the successful implementation of the QI interventions.
Culture Ordering for Patients with New-onset Fever: A Survey of Pediatric Intensive Care Unit Clinician Practices
Authors: Booth Lauren D. , Sick-Samuels Anna C. , Milstone Aaron M. , Fackler James C. , Gnazzo Lindsey K. , Stockwell David C.
Published: August 2021

Introduction:

Accurate assessment of infection in critically ill patients is vital to their care. Both indiscretion and under-utilization of diagnostic microbiology testing can contribute to inappropriate antibiotic administration or delays in diagnosis. However, indiscretion in diagnostic microbiology cultures may also lead to unnecessary tests that, if false-positive, would incur additional costs and unhelpful evaluations. This quality improvement project objective was to assess pediatric intensive care unit (PICU) clinicians’ attitudes and practices around the microbiology work-up for patients with new-onset fever.

Methods:

We developed and conducted a self-administered electronic survey of PICU clinicians at a single institution. The survey included 7 common clinical vignettes of PICU patients with new-onset fever and asked participants whether they would obtain central line blood cultures, peripheral blood cultures, respiratory aspirate cultures, cerebrospinal fluid cultures, urine cultures, and/or urinalyses.

Results:

Forty-seven of 54 clinicians (87%) completed the survey. Diagnostic specimen ordering practices were notably heterogeneous. Respondents unanimously favored a decision-support algorithm to guide culture specimen ordering practices for PICU patients with fever (100%, N = 47). A majority (91.5%, N = 43) indicated that a decision-support algorithm would be a means to align PICU and consulting care teams when ordering culture specimens for patients with fever.

Conclusion:

This survey revealed variability of diagnostic specimen ordering practices for patients with new fever, supporting an opportunity to standardize practices. Clinicians favored a decision-support tool and thought that it would help align patient management between clinical team members. The results will be used to inform future diagnostic stewardship efforts.
A Prospective Study of Family Engagement for Prevention of Central Line-associated Blood Stream Infections
Authors: Chamblee Tracy B. , Miles Darryl K.
Published: August 2021

Introduction:

We sought to determine if a family-centered care (FCC) handout intervention designed to encourage family engagement (FE) in the prevention of central line-associated bloodstream infections (CLABSIs) would alter parental perceptions of FCC and improve staff compliance with CLABSI bundle components.

Methods:

A prospective quasiexperimental study of 121 legal guardians of children with a central venous catheter (CVC) admitted to the pediatric intensive care unit (PICU). Baseline (n = 59) and intervention (n = 62) groups of parents completed an 18-question online survey assessing basic CLABSI care practices and FCC principles. The intervention group received an FE handout before completing the survey with information about CLABSI prevention practices designed to encourage active participation in their child’s CVC care.

Results:

Independent sample t-tests found significant improvements in the intervention parents responses compared to the baseline group (no handout) on survey items assessing CLABSI knowledge (P < 0.001) and on parental perceptions of FCC in the domains of dignity and respect, information sharing, participation, and partnership (all with a P < 0.001). An improvement was observed in staff CLABSI maintenance bundle compliance in the postintervention period, increasing from 89% to 94%.

Conclusions:

Educating parents on CLABSI prevention strategies and encouraging family participation in CVC care was associated with improved parental perceptions of participation in their child’s care, medical team’s listening, attention, honesty, and explanation of treatment plans and was associated with an increase in staff compliance with CLABSI maintenance bundle practices.
Three-Dimensional Anatomy of the Palatopharyngeus and Its Relation to the Levator Veli Palatini Based on Micro–Computed Tomography
Authors: Di Wu , Zhao Jiuli , Ma Hengyuan , Song Tao , Wang Yongqian , Yin Ningbei
Published: August 2021

Background:

Although multiple studies have been reported on the palatopharyngeus and levator veli palatini, their subtle anatomy and functions remain unclear. The authors elucidated the relationship between these muscles and their functional implications based on three-dimensional digital techniques.

Methods:

Cadaveric specimens were stained with iodine–potassium iodide and scanned using micro–computed tomography. The muscle fibers were drawn on the exported Imaging and Communications in Medicine images to reconstruct a three-dimensional model and further simplified.

Results:

In the soft palate, the palatopharyngeus was divided into three bundles. The largest inferior head was found to attach to the palatine aponeurosis, soft palate, and the hard palate on the oral side, which occupied approximately the anterior 28.4 to 36.2 percent of the soft palate in the midline. The superior head was thin and attached to the palatine aponeurosis and the surrounding mucosa on the nasal side. The posterior head was located posterior to the levator veli palatini with fibers attaching to the levator veli palatini and the median portion of the uvula. The levator veli palatini was clasped by the three heads of the palatopharyngeus. The fasciculi of the palatopharyngeus converged into a bundle of muscles at the pharynx and inserted into the lateral and posterior pharyngeal wall.

Conclusions:

The palatopharyngeus is the largest muscle that connects the soft palate and pharyngeal wall; it closely coordinates with the levator veli palatini to control levator veli palatini overlifting, narrow the velopharyngeal port with the help of the superior constrictor, and elevate the pharynx. The palatopharyngeus and levator veli palatini help each other in velopharyngeal closure through coordination from other muscles.
Short- and Long-Term Outcomes following Severe Traumatic Lower Extremity Reconstruction: The Value of an Orthoplastic Limb Salvage Center to Racially Underserved Communities
Authors: Naga Hani I. , Azoury Saïd C. , Othman Sammy , Couto Javier A. , Mehta Samir , Levin L. Scott , Butler Paris D. , Kovach Stephen J.
Published: August 2021

Background:

Previous studies have demonstrated that nonwhite race and disadvantaged socioeconomic status negatively impact outcomes following lower extremity reconstruction. The authors sought to characterize differences in outcomes between racial groups in patients necessitating traumatic lower extremity reconstruction at an orthoplastic limb salvage center.

Methods:

A retrospective review between 2002 and 2019 was conducted of patients who underwent free flap lower extremity reconstruction at an orthoplastic limb salvage center. Patient demographics were identified, and permanent addresses were used to collect census data. Short-term complications and long-term functional status were recorded.

Results:

One hundred seventy-three patients underwent lower extremity reconstruction and met inclusion criteria. Among all three groups, African American patients were more likely to be single (80 percent African American versus 49 percent Caucasian and 29.4 percent other; p < 0.05) and had significantly lower rates of private insurance compared with Caucasian patients (25 percent versus 56.7 percent; p < 0.05). African American patients demonstrated no significant differences in total flap failure (4.9 percent versus 8 percent and 5.6 percent; p = 0.794), reoperations (10 percent versus 5.8 percent and 16.7 percent; p = 0.259), and number of readmissions (2.4 versus 2.0 and 2.1; p = 0.624). Chronic pain management (53.3 percent versus 44.2 percent and 50 percent; p = 0.82), full weight-bearing status (84.2 percent versus 92.7 percent and 100 percent; p = 0.507), and ambulation status (92.7 percent versus 100 percent and 100 percent; p = 0.352) were similar among groups.

Conclusions:

Outcomes are equivalent between racial groups presenting to an orthoplastic limb salvage center for lower extremity reconstruction. The postoperative rehabilitation strategies, follow-up, and overall support that an orthoplastic limb salvage center ensures may lessen the impact of socioeconomic disparities in traumatic lower extremity reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
The Effects of the COVID-19 Pandemic on Resident Education and Wellness: A National Survey of Plastic Surgery Residents
Authors: Crowe Christopher S. , Lopez Joseph , Morrison Shane D. , Drolet Brian C. , Janis Jeffrey E. ,   On behalf of the Resident Council Wellness and Education Study Group
Published: August 2021

Background:

The coronavirus disease of 2019 (COVID-19) pandemic has had a profound effect on surgical training programs, reflecting decreases in elective surgical cases and emergency restructuring of clinical teams. The effect of these measures on U.S. plastic surgery resident education and wellness has not been characterized.

Methods:

An institutional review board–exempted anonymous survey was developed through expert panel discussion and pilot testing. All current U.S. plastic surgery trainees were invited to complete a cross-sectional 28-question survey in April of 2020. Respondents were queried regarding demographic information, educational experiences, and wellness during the COVID-19 pandemic.

Results:

A total of 668 residents responded to the survey, corresponding to a 56.1 percent response rate. Sex, training program type, postgraduate year, and region were well represented within the sample. Nearly all trainees (97.1 percent) reported restructuring of their clinical teams. One-sixth of respondents were personally redeployed to assist with the care of COVID-19 patients. A considerable proportion of residents felt that the COVID-19 pandemic had a negative impact on their education (58.1 percent) and wellness (84.8 percent). Residents found virtual curriculum effective and meaningful, and viewed an average of 4.2 lectures weekly. Although most residents did not anticipate a change in career path, some reported negative consequences on job prospects or fellowship.

Conclusions:

The COVID-19 pandemic had a considerable impact on U.S. plastic surgery education and wellness. Although reductions in case volume may be temporary, this may represent a loss of critical, supervised clinical experience. Some effects may be positive, such as the development of impactful virtual lectures that allow for cross-institutional curriculum.
Long-Term Effectiveness of Ear Molding in Infants Using the EarWell Infant Correction System in China
Authors: Zhong Zhen , Zhang Junbo , Xiao Shuifang , Liu Yuhe , Zhang Yanmei
Published: August 2021

Background:

Ear molding is a safe and effective way to treat babies born with ear deformities. In this study, the authors explored the long-term effectiveness of ear molding and determined the factors that relate to recurrence.

Methods:

A retrospective review of 200 consecutive infants treated with the EarWell System from March of 2018 to August of 2019 was performed. Immediate and long-term effectiveness was evaluated and compared.

Results:

A total of 190 children (314 ears) were included. The mean age at presentation was 16.2 days (range, 0 to 100 days). The most common deformity was constricted ear [172 ears (54.8 percent)], and the rarest deformity was cryptotia [four ears (1.3 percent)]. At the completion of treatment, 10 constricted ears were evaluated to be unsuccessful. The immediate success rates of mild and severe constricted ears were 95.7 percent and 93.1 percent, respectively. The average long-term follow-up was 336 days (range, 180 to 660 days) after completion of treatment. Twenty-two ears (7.2 percent) reverted to their original shape. The long-term success rates of severe constricted ears and prominent ears decreased most significantly, 83.3 percent (p = 0.030) and 66.7 percent (p = 0.042), respectively. Family history led to a decrease of long-term effectiveness of prominent ears. Age at application, sex, duration of molding, and retention taping were not correlated to the long-term outcome.

Conclusions:

Long-term follow-up demonstrated that in a percentage of babies, the ear deformities did recur after an initially successful treatment. Severe constricted ears and prominent ears are most likely to relapse.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.