bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.