bluuebunny/crossref_metadata_2025_split huggingface dataset:
An International Survey Comparing Different Physician Models for Health Care Delivery to Critically Ill Children With Heart Disease
Authors: Bhaskar Priya , Rettiganti Mallikarjuna , Sadot Efraim , Paul Thomas , Garros Daniel , Frankel Lorry R. , Reemtsen Brian , Butt Warwick , Gupta Punkaj 
Published: March 2020

Objectives:
To explore relationships between the training background of cardiac critical care attending physicians and self-reported perceived strengths and weaknesses in their ability to provide clinical care.

Design:
Cross-sectional observational survey sent worldwide to ~550 practicing cardiac ICU attending physicians.

Setting:
Hospitals providing cardiac critical care.

Subjects:
Practicing cardiac critical care physicians.

Interventions:
None.

Measurements and Main Results:
We received responses from 243 ICU attending physicians from 82 centers (14 countries). The primary training background of the respondents included critical care (62%), dual training in critical care and cardiology (16%), cardiology (14%), and other (8%). We received 49 responses from medical directors in nine countries, who reported that the predominant training background for attending physicians who provide cardiac intensive care at their institutions were critical care (58%), dual trained (18%), cardiology (12%), and other (11%). A greater proportion of physicians trained in either critical care or dual-training reported feeling confident managing multiple organ failure, neurologic conditions, brain death, cardiac arrest, and performing procedures like advanced airway placement and inserting chest- and abdominal-drains. In contrast, physicians with cardiology and dual-training reported feeling more confident managing intractable arrhythmias, understanding cardiopulmonary interactions, and interpreting echocardiogram, electrocardiogram, and cardiac catheterization. Overall, only 57% of the respondents felt comfortable based on their current training background to manage patients with complex cardiac issues without collaboration with other specialists.

Conclusions:
Our survey demonstrates that intensivists trained in critical care are more comfortable with critical care skills, cardiology-trained intensivists are more comfortable with cardiology skills, and dual-trained physicians are comfortable with both critical care skills and cardiology skills. These findings may help inform future efforts to optimize the educational curriculum and training pathways for future cardiac intensivists. These data may also be used to shape continuing medical education activities for cardiac intensivists who have already completed their training.
Readiness for Hospital Discharge, Stress, and Coping in Mothers of Children Undergoing Cardiac Surgeries: A Single-Center Prospective Study
Authors: Poh Pei-Fen , Lee Jan Hau , Loh Yee Jim , Tan Teng Hong , Cheng Karis Kin Fong 
Published: March 2020

Objectives:
To examine the relationship between stress, coping, and discharge readiness in mothers of children undergoing congenital heart surgeries.

Design:
Quantitative descriptive study at three time points: pre surgery (time point I), day of hospital discharge (time point II) and 2 weeks following discharge (time point III).

Setting:
Tertiary care pediatric hospital in Singapore.

Participants:
One hundred mothers whose children had undergone congenital heart surgeries.

Measurements and Main Results:
Data collection included self-reported questionnaires of the Pediatric Inventory for Parents and the Coping Health Inventory for Parents across three time points. Readiness for Hospital Discharge Scale was administered at hospital discharge (time point II). The utilization of health services and support was reported at post discharge (time point III). One-hundred mothers participated in this study between May 2016 and July 2017. Their mean age was 35.8 years (sd = 7.0), and the mean age of their children was 3.7 years (sd = 4.6). There was significant reduction in mean stress difficulty (Pediatric Inventory for Parents) of mothers (F = 4.58; p = 0.013) from time point I to III. No significant changes were found in the overall mean coping score (Coping Health Inventory for Parents) of mothers across time. The mean overall score for the readiness for discharge (Readiness for Hospital Discharge Scale) of mothers at hospital discharge was 207.34 (sd = 29.22). Coping through family integration subscale and communication stress predicted discharge readiness of mothers (adjusted R
2 = 0.11; p = 0.034). Mothers who reported higher overall stress (Pediatric Inventory for Parents) 2 weeks post discharge were more likely to call a friend or family member, visit the emergency department, or have their child readmitted to hospital following hospital discharge.

Conclusions:
We identified coping by family integration and communication-related stress as predictors of readiness for discharge. Strategies targeted at communication and family integration for discharge preparation may improve caregivers’ readiness for hospital discharge.
Methylene Blue for Refractory Shock in Children: A Systematic Review and Survey Practice Analysis
Authors: Otero Luna Andrea V. , Johnson Rachel , Funaro Melissa , Canarie Michael F. , Pierce Richard W. 
Published: March 2020

Objectives:
Shock refractory to fluid and catecholamine therapy has significant morbidity and mortality in children. The use of methylene blue to treat refractory shock in children is not well described. We aim to collect and summarize the literature and define physicians’ practice patterns regarding the use of methylene blue to treat shock in children.

Design:
We conducted a systematic search of MEDLINE, Embase, PubMed, Web of Science, Cochrane for studies involving the use of methylene blue for catecholamine-refractory shock from database inception to 2019. Collected studies were analyzed qualitatively. To describe practice patterns of methylene blue use, we electronically distributed a survey to U.S.-based pediatric critical care physicians. We assessed physician knowledge and experience with methylene blue. Survey responses were quantitatively and qualitatively evaluated.

Setting:
Pediatric critical and cardiac care units.

Patients or Subjects:
Patients less than or equal to 25 years old with refractory shock treated with methylene blue.

Interventions:
None.

Measurements and Main Results:
One-thousand two-hundred ninety-three abstracts met search criteria, 139 articles underwent full-text review, and 24 studies were included. Studies investigated refractory shock induced by a variety of etiologies and found that methylene blue was generally safe and increased mean arterial blood pressure. There is overall lack of studies, low number of study patients, and low quality of studies identified. Our survey had a 22.5% response rate, representing 125 institutions. Similar proportions of physicians reported using (40%) or never even considering (43%) methylene blue for shock. The most common reasons for not using methylene blue were unfamiliarity with this drug, its proper dosing, and lack of evidentiary support.

Conclusions:
Methylene blue appears safe and may benefit children with refractory shock. There is a stark divide in familiarity and practice patterns regarding its use among physicians. Studies to formally assess safety and efficacy of methylene blue in treating pediatric shock are warranted.
Spontaneous Breathing and Imposed Work During Pediatric Mechanical Ventilation: A Bench Study*
Authors: van Dijk Jefta , Blokpoel Robert G. T. , Koopman Alette A. , Brandsema Ruben , Newth Christopher J. L. , Kneyber Martin C. J. 
Published: March 2020

Objectives:
To calculate imposed work of breathing during simulated spontaneous breathing at a given tidal volume across the range of normal length or shortened pediatric endotracheal tube sizes and endotracheal tubes with an intraluminal catheter in situ.

Design:
In vitro study.

Setting:
Research laboratory.

Interventions:
A bench model (normal compliance, no airway resistance) simulating sinusoid flow spontaneous breathing used to calculate imposed work of breathing for various endotracheal tube sizes (3.0–7.5 mm). Imposed work of breathing was calculated by integrating inspiratory tidal volume over the end-expiratory difference between the positive end-expiratory pressure and the tracheal pressure. Measurements were taken at different combinations of set spontaneous tidal volume (2.5, 5.0, 7.5, and 10 mL/kg), age-appropriate inspiratory times, length of endotracheal tube, and presence of intraluminal catheter.

Measurements and Main Results:
Overall median imposed work of breathing (Joules/L) was not significantly different between the four age groups: 0.047 Joules/L (interquartile range, 0.020–0.074 Joules/L) for newborns, 0.077 Joules/L (interquartile range, 0.032–0.127 Joules/L) for infants, 0.109 Joules/L (interquartile range, 0.0399–0.193 Joules/L) for small children, and 0.077 Joules/L (interquartile range, 0.032–0.132 Joules/L) for adolescents. Shortening the endotracheal tubes resulted in a significant difference in reduction in overall imposed work of breathing, but the absolute reduction was most notable in small children (0.030 Joules/L) and the least effect in neonates (0.016 Joules/L). Overall imposed work of breathing increased in each age group when an intraluminal catheter was in situ: 91.09% increase in imposed work of breathing in neonates to 0.168 Joules/L, 84.98% in infants to 0.142 Joules/L, 81.98% in small children to 0.219 Joules/L, and 55.45% in adolescents to 0.140 Joules/L.

Conclusions:
Calculated imposed work of breathing were not different across the range of endotracheal tube sizes. The low imposed work of breathing values found in this study might be appreciated as clinically irrelevant. Our findings add to the change in reasoning that it is appropriate to perform spontaneous breathing trials without pressure support. Nonetheless, our findings on the measured imposed work of breathing values need to be confirmed in a clinical study.
Extracorporeal Membrane Oxygenation for Group B Streptococcal Sepsis in Neonates: A Retrospective Study of the Extracorporeal Life Support Organization Registry
Authors: Schlapbach Luregn J. , Chatfield Mark D. , Rycus Peter , MacLaren Graeme 
Published: March 2020

Objectives:
Neonatal group B streptococcal sepsis remains a leading cause of neonatal sepsis globally and is characterized by unique epidemiologic features. Extracorporeal membrane oxygenation has been recommended for neonatal septic shock refractory to conventional management, but data on extracorporeal membrane oxygenation in group B streptococcal sepsis are scarce. We aimed to assess outcomes of extracorporeal membrane oxygenation in neonates with group B streptococcal sepsis.

Design:
Retrospective study of the international registry of the Extracorporeal Life Support Organization.

Setting:
Extracorporeal membrane oxygenation centers contributing to Extracorporeal Life Support Organization registry.

Patients:
Patients less than or equal to 30 days treated with extracorporeal membrane oxygenation and a diagnostic code of group B streptococcal sepsis between January 1, 2007, and December 31, 2016.

Interventions:
None.

Measurements and Main Results:
In-hospital mortality was the primary outcome. Univariable and multivariable logistic regression models to predict mortality were established. One hundred ninety-two runs in 191 neonates were identified meeting eligibility criteria, of which 55 of 191 (29%) died. One hundred thirty-seven (71%) were treated with venoarterial extracorporeal membrane oxygenation. One hundred sixty-nine runs (88%) occurred during the first week of life for early-onset sepsis and 23 (12%) after 7 days of life. The in-hospital mortality for extracorporeal membrane oxygenation used after 7 days of life was significantly higher compared with early-onset sepsis (65% vs 24%; p < 0.01). In addition, lower weight, lower pH, lower bicarbonate, and surfactant administration precannulation were significantly associated with mortality (p < 0.05). Adjusted analyses confirmed that age greater than 7 days, lower weight, and lower pH were associated with higher mortality (p < 0.05). One hundred fifty-one of 192 runs (79%) experienced a major complication. The number of major complications during extracorporeal membrane oxygenation was associated significantly with mortality (p < 0.001; adjusted odds ratio, 1.27 [1.08–1.49; p = 0.004]).

Conclusions:
This large registry-based study indicates that treatment with extracorporeal membrane oxygenation for neonatal group B streptococcal sepsis is associated with survival in the majority of patients. Future quality improvement interventions should aim to reduce the burden of major extracorporeal membrane oxygenation–associated complications which affected four out of five neonatal group B streptococcal sepsis extracorporeal membrane oxygenation patients.
Population Pharmacokinetics of Vancomycin in the Pediatric Ventricular Assist Device Population
Authors: Moffett Brady S. , Humlicek Timothy J. , Akcan-Arikan Ayse , Anders Marc , Tume Sebastian 
Published: March 2020

Objectives:
Determine the pharmacokinetic disposition of vancomycin in the pediatric ventricular assist device population.

Design:
A retrospective, population pharmacokinetic study.

Setting:
Large, quaternary care children’s hospital.

Patients:
Less than 19 years old initiated on vancomycin while undergoing ventricular assist device therapy from 2011 to 2018 in our institution.

Interventions:
Patient data were summarized by using descriptive statistical methods, and population pharmacokinetic analysis was performed by using NONMEM (Icon, PLC, Dublin, Ireland). Simulation was performed to identify a vancomycin dosing strategy that resulted in a trough concentration less than 15 mg/L and an area under the curve0–24:minimum inhibitory concentration ratio of greater than 400.

Measurements and Main Results:
A total of 69 patients (male 50.7%, median age 7.1 years [interquartile range, 2.4–11.9]) met study criteria (HeartWare [Framingham, MA] = 37, Berlin Heart [Berlin, Germany] = 22, Impella [Abiomed, Danvers, MA] = 4, RotaFlow [Maquet, Hirrlingen, Germany] right ventricular assist device = 3, HeartMate II [Abbott Laboratories, Abbott Park, IL] = 2, Berlin Heart biventricular assist device = 1). Patients received a median of 21 doses (interquartile range, 13–44 doses) of IV vancomycin (14.8 ± 1.8 mg/kg/dose) along with vancomycin as an intrathoracic irrigation (n = 48; 69.6%). The mean serum concentration was 12.2 ± 5.2 mg/L at 11.2 ± 6.9 hours after a dose. A one-compartment pharmacokinetic model best fit the data with allometric scaling on clearance and volume of distribution. Clearance was characterized by total body weight and serum creatinine, and volume of distribution was characterized by total body weight. Simulation identified doses greater than 15 mg/kg/dose with extended intervals were necessary to achieve endpoints.

Conclusions:
Vancomycin dosing in pediatric ventricular assist device patients should be altered in comparison to nonventricular assist device patients and should be accompanied with frequent serum concentration monitoring.
Economic Evaluation: Onsite HSV PCR Capabilities for Pediatric Care
Authors: Weber Zachary , Sutter Deena , Baltensperger Austin , Carr Nicholas 
Published: March 2020

Objective:
Herpes simplex virus (HSV) encephalitis has an overall mortality rate of 11%–29% with treatment. Although rare, HSV encephalitis is frequently tested for and empirically treated, especially in the neonatal population. HSV infection can be diagnosed with polymerase chain reaction (PCR) testing, although this frequently requires sending samples to reference laboratories. The inherent delay in results may lead to prolonging empiric treatment and hospital stay, resulting in increased costs. This study investigates whether onsite HSV PCR testing decreases hospitalization duration, acyclovir treatment duration, and financial cost on an institution.

Project design:
This single-center project utilized the IHI model for improvement to evaluate third-party HSV PCR processing versus an implemented onsite PCR-based meningitis–encephalitis panel for HSV central nervous system evaluation. The primary outcome was hospital cost differential with secondary outcomes, including duration of acyclovir administration and time to result.

Results:
We identified 96 children age 0–18 from 2010 to 2016, 74 patients utilizing offsite third-party testing, and 22 patients utilizing onsite. We observed a per-patient cost savings of $428 ($618.43–$190.43, P = 0.029) upon the implementation of onsite testing. The mean duration of acyclovir therapy decreased from 3.7 to 0.26 days per patient (P < 0.001). Time to result decreased from 4.6 to 0.13 days (P < 0.001).

Conclusions:
Acquisition of real-time local HSV PCR capabilities significantly decreased time to result and empiric medication use while significantly reducing hospital costs in a military treatment facility.
ED RAPID: A Novel Children’s Hospital Direct Admission Process Utilizing the Emergency Department
Authors: Louie Jeffrey P. , Furnival Ronald A. , Roback Mark G. , Jacob Abraham K. , Marmet Jordan , Nerheim Daniel , Hendrickson Marissa A. 
Published: March 2020

Introduction:
Direct hospital admission of children without evaluation in the emergency department (ED) is common, but few guidelines exist to maximize safety by assessing patient stability. This report describes a novel approach to support patient safety.

Methods:
An interdisciplinary children’s hospital team developed a brief ED-based evaluation process called the ED Rapid Assessment of Patients Intended for Inpatient Disposition (ED RAPID). It entails a brief evaluation of vital signs and clinical stability by the ED attending physician and nurse. Children deemed stable are admitted to inpatient wards, whereas those requiring immediate intervention undergo full ED evaluation and disposition. We assessed outcomes for all children evaluated through this process from March 2013 through February 2015.

Results:
During the study period, we identified 715 patients undergoing ED RAPID evaluation. Of these, we directly admitted 691 (96.4%) to the hospital ward after ED RAPID evaluation; median ED treatment time was 4.0 minutes. We transitioned 24 (3.4%) to full ED evaluation, 14 (2.0%) because a ward bed was unavailable, and 10 (1.4%) for clinical reasons identified in the evaluation. We admitted four of the 10 stopped (40% of stops, 0.6% of total) to an intensive care unit, and 6 (60% of stops, 0.8% of total) to the hospital ward after ED care. Eight children (1.1%) admitted to the hospital ward after ED RAPID evaluation required a transfer to an intensive care unit within 12 hours.

Conclusion:
The ED RAPID evaluation process for children directly admitted to the hospital was feasible and effective in this setting.
Evaluation of Communication Skills Among Physicians: A Systematic Review of Existing Assessment Tools
Authors: Boucher Vincent Gosselin , Gemme Claudia , Dragomir Anda I. , Bacon Simon L. , Larue Florent , Lavoie Kim L. 
Published: March 2020

ABSTRACT

Objective
The importance of physician training in communication skills for motivating patients to adopt a healthy life-style and optimize clinical outcomes is increasingly recognized. This study inventoried and systematically reviewed the psychometric properties of, and the skills assessed by, existing assessment tools used to evaluate communication skills among physicians.

Methods
This review was conducted in accordance with the PRISMA guidelines (PROSPERO: CRD42018091932). Four databases (PUBMED, EMBASE, PsychINFO, and SCOPUS) were searched up to December 2018, generating 3902 unique articles, which were screened by two authors. A total of 57 articles met the inclusion criteria and underwent full data extraction.

Results
Forty-five different assessment tools were identified. Only 47% of the studies mentioned underlying theories or models for designing the tool. Fifteen communication skills were assessed across the tools, the five most prevalent were information giving (46%) or gathering (40%), eliciting patients’ perspectives (44%), planning/goal setting (37%), and closing the session (32%). Most tools (93%) assessed communication skills using in-person role play exercises with standardized (61%) or real (32%) patients, but only 54% described the expertise of the raters who performed the evaluations. Overall, reporting of the psychometric properties of the assessment tools was poor-moderate (4.5 ± 1.3 out of 9).

Conclusions
Despite identifying several existing physician communication assessment tools, a high degree of heterogeneity between these tools, in terms of skills assessed and study quality, was observed, and most have been poorly validated. Research is needed to rigorously develop and validate accessible, convenient, “user-friendly,” and easy to administer and score communication assessment tools.
Interobserver Variability in the Computed Tomography Assessment of Pulmonary Injury and Tumor Recurrence After Stereotactic Body Radiotherapy
Authors: Guerreiro Nicolau F.C. , Araujo-Filho Jose A.B. , Horvat Natally , Lee Hye Ju , Oliveira Bernardo S.P. , Ynoe de Moraes Fabio , Castro Isac , Miranda Degrande Fabiana Accioli , Abreu Carlos E.V. , Giassi Karina de S. 
Published: March 2020

Purpose:
To evaluate the interobserver agreement of chest computed tomography (CT) findings in the diagnosis of expected changes and local recurrence after stereotactic body radiation therapy (SBRT) in patients with early-stage lung cancer or a single pulmonary metastasis.

Materials and Methods:
A total of 54 patients with early-stage lung cancer or pulmonary metastasis who were treated with SBRT from 2007 to 2015 were included. The exclusion criteria were patients who presented with pulmonary infection during follow-up and patients who underwent a single CT during follow-up. The imaging features on CT were assessed by 3 blinded radiologists at the following 2 time points after SBRT: (a) early follow-up and (b) late follow-up (≥6 mo). The radiologists classified the findings as expected changes after SBRT or recurrence. Interobserver agreement was assessed by kappa and Wilcoxon statistics.

Results:
A total of 13 women and 41 men with a mean age of 75.3 (±8.9) years were selected. The total and per fraction SBRT doses were 54 Gy (interquartile range: 45 to 54) and 18 Gy (interquartile range: 15 to 18), respectively. All expected changes and findings suggestive of recurrence had an almost perfect agreement (κ>0.85) among readers, except for diffuse consolidation in the early period (κ=0.65).

Conclusion:
CT findings demonstrate high interobserver agreement for expected changes and for findings indicating recurrence after SBRT.