bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of Pediatric Residents’ Communication and Interpersonal Skills During Family-Centered Rounds
Authors: Osorio Snezana Nena , Ward Mary J. , Siew Lawrence , Bylund Carma , Konopasek Lyuba 
Published: September 2013

Objectives:
Residency training programs are required to assess and document residents’ competency in communication. Multisource evaluations that include direct resident observations are preferred. Previous studies have often used methods of asking faculty members to evaluate residents on behaviors they did not witness.

Methods:
Twenty first year pediatric residents (interns) were evaluated preand post-FCR introduction by a faculty member, a parent, and a nurse after the encounter with the patients and their families during rounds. All participants used the CAT. Mean CAT scores and associations between the evaluator groups were determined.

Results:
Nurses and faculty were significantly more likely to observe how interns communicated with the parents in the post-FCR period (P &lt; .001). Pre-FCR, compared to parent scores, intern scores were significantly lower (P &lt; .05) and the scores were not correlated (P = .84). Post-FCR, the difference in internparent scores disappeared and their scores were significantly correlated (r18 = 0.73, P &lt; .001). Intern scores did not correlate with faculty and nurse scores. Cronbach a coefficients for the CAT ranged from 0.90 to 0.99.

Conclusions:
Family-centered rounds provide more opportunities for direct observation of residents’ competence in accordance with Accreditation Council for Graduate Medical Education guidelines. This rounds format also encourages a climate that improves residents’ ability to self-assess. Residents’ communication skills can be assessed by using the Communication Assessment Tool in an efficient and timely manner, because all evaluators are present at the bedside during family-centered rounds.
Pediatric Renal Abscess: A 10-year Single-Center Retrospective Analysis
Authors: Seguias Luis , Srinivasan Karthik , Mehta Amit 
Published: September 2013

Objective:The objective of this retrospective series is to describe the demographics and treatment of patients with renal abscesses and to determine if abscess size influences management.Methods:We reviewed all pediatric cases of renal abscesses treated over a 10-year period in our medical center. Clinical, laboratory, imaging data, and treatment modalities were analyzed.Results:Thirty-six patients were evaluated, with renal abscesses found in all age groups. The median age was 9.3 years, and 64% of patients affected were female. Fever and abdominal pain were the most common clinical symptoms. A premorbid genitourinary condition was present in 31% of patients. Previous urinary tract infection was documented in 31% of the cases. Initial elevation of C-reactive protein or erythrocyte sedimentation rate, when obtained, was observed in &gt;80% of cases. Abnormal urinalysis was recognized in two-thirds of encounters. Escherichia coli, the most common microorganism isolated, was found in half the cases. Staphylococcus aureus was isolated in 11%. Ultrasound and computed tomography were the most used diagnostic imaging modalities. Eighty-nine percent of the patients who received intravenous antibiotics alone as an initial treatment regimen did not require percutaneous drainage or surgery.Conclusions:Ten of the 14 patients with an abscess size ≥3 cm had an invasive intervention, but only 1 of these 10 had an initial 48-hour trial of antibiotics alone. In contrast, only 2 of the 22 patients who had an abscess size &lt;3 cm received an invasive intervention (Fisher P= .0002). We conclude that conservative treatment with intravenous antibiotics may be a reasonable initial approach.
A Time-Motion Study of Inpatient Rounds Using a Family-Centered Rounds Model
Authors: Bhansali Priti , Birch Sarah , Campbell Joyce K. , Agrawal Dewesh , Hoffner Wendy , Manicone Paul , Shah Kyle , Krieger Evelina , Ottolini Mary 
Published: September 2013

Objective:
Family-centered rounds (FCR) have become increasingly prevalent in pediatric hospital settings. The objective of our study was to describe time use and discrete events during pediatric inpatient rounds by using a FCR model.

Methods:
We conducted a prospective observational study at Children’s National Medical Center between September 2010 and February 2011. Investigators directly observed rounds on hospitalist and neurology services. Events were timed, and key features were recorded by using a Microsoft Access-based program. Associations with increased time spent during rounds were determined by using regression analyses.

Results:
One hundred fifty-nine rounding encounters were observed. Rounds lasted 7.9 minutes on average per patient. An average of 1.3 minutes was spent between patients during rounds. Eighty-six (54%) encounters occurred outside the patient’s room, 3% of the time because of the family’s request. Infectious isolation was associated with rounds occurring outside the room (P &lt; .0001). Participation of the parent, location of rounds inside or outside the patient’s room, most teaching behaviors, and interruptions were not significantly associated with increased time spent during rounds. Teaching physical examination techniques by allowing multiple trainees to examine the patient was associated with increased rounding time (P = .02).

Conclusions:
The majority of rounds occurred outside the patient’s room, yet rarely at the parent’s request. Patients on infectious isolation were more likely to have rounds occur outside the patient’s room. Neither parental participation nor most teaching behaviors were associated with increased time spent on rounds. These findings will enrich the evidence base needed to establish FCR best practices.
Length of Stay and Readmission Among Late Preterm Infants: An Instrumental Variable Approach
Authors: Goyal Neera , Zubizarreta José R. , Small Dylan S. , Lorch Scott A. 
Published: September 2013

Objective:
Evidence to guide safe discharge for late preterm infants (34–36 weeks’ gestation) is lacking. Previous studies have demonstrated the increased risk of neonatal readmission for these infants compared with those born at term (≥37 weeks’ gestation). The purpose of this study was to estimate the effect of length of stay (LOS) on 7-day readmissions in this population.

Methods:
This was a retrospective study using hospital discharge data linked with vital records for late preterm infants delivered vaginally in California from 1993 to 2005. Exclusion criteria included complications likely requiring neonatal intensive care. The effect of LOS was assessed by using birth hour as an instrumental variable to account for unmeasured confounding. By using a matching algorithm, we created pairs of infants with different LOS based on birth hour but otherwise matched on known confounders for readmission risk, including birth year, hospital, and clinical and demographic covariates such as gestational age, birth weight, race, and insurance.

Results:
We produced 80 600 matched pairs of infants with different LOS based on birth hour. In 122 pairs, both infants were readmitted within 7 days, and in 75 362 pairs, neither infant was readmitted. Of the remaining 5116 matched pairs in which only 1 infant was readmitted, 2456 infants with long LOS and 2660 infants with short LOS were readmitted. We found no evidence that longer LOS reduces the odds of readmission (1-sided P value = .99).

Conclusions:
By using an instrumental variable approach and matching algorithm, longer LOS was not associated with decreased readmission within 7 days of discharge for these late preterm infants.
Simulation Training as a Mechanism for Procedural and Resuscitation Education for Pediatric Residents: A Systematic Review
Authors: Mills David M. , Williams Daniel C. , Dobson Joseph V. 
Published: September 2013

Background:
Pediatric residents often finish their training lacking sufficient procedural proficiency and resuscitation experience in the care of critically ill children. Simulation is gaining favor in pediatric residency programs as a modality for procedural and resuscitation education. We reviewed the literature assessing simulation and its role in pediatric resident training.

Methods:
We conducted a Medline and PubMed search of simulation training in pediatric resident education from January 2007 to July 2012.

Results:
Eight studies were included and divided into simulated procedural assessments and simulated resuscitation scenario assessments. The studies varied widely in their approach and analysis, and they yielded mixed results.

Conclusions:
Although some studies show the merits of simulation in the procedural and resuscitation training of pediatric residents, more research is needed to assess the effectiveness of simulation as an educational tool. Goals of future simulation research should include creation of validated assessment tools and applying skills learned to patient care outcomes.
Care of the Complex Chronically Ill Child by Generalist Pediatricians: Lessons Learned From Pediatric Palliative Care
Authors: Walter Jennifer K. , DeCamp Lisa Ross , Warrier Kavita S. , Murphy Terrance P. , Keefer Patricia M. 
Published: September 2013

Background and Objective:Parents of children with complex chronic conditions report fragmented care, unmet medical needs, and financial strain from health care costs. The aim of this study was to identify both prevalent themes discussed during pediatric palliative care consultation of patients with complex chronic conditions cared for by pediatric generalists and variation in consultation content by age and timing of consultation in disease course.Methods:Forty randomly selected initial inpatient or outpatient consultation notes authored by the pediatric palliative care team at an academic, tertiary care children’s hospital. Inclusion required that patients were primarily cared for by general pediatricians, pediatric hospitalists, or pediatric intensivists, instead of subspecialists. Qualitative analysis by 5 team members utilizing consensus-based findings was used to develop themes. Descriptive statistics were used to describe variations in themes across age and disease course.Results:Common themes included thorough review of patient baseline functioning, current symptoms, assessment of family’s understanding of the prognosis of the patient, coordination of communication with other medical teams and outpatient health care services, consideration of caregiver resources and burdens, and offering a framework for decision-making. Variation in consult themes by age/disease course included more discussion of communication problems and symptom management when patients were at their baseline, but otherwise little variation was found.Conclusions:Common themes covered in initial consultations correspond with documented unmet needs for chronically ill children. There was no significant variation in consultation themes by age/disease course, suggesting that generalists could broadly apply palliative care techniques to improve family-centered care.
Outcomes and Costs Associated With Hospitalist Comanagement of Medically Complex Children Undergoing Spinal Fusion Surgery
Authors: Rappaport David I. , Adelizzi-Delany Judy , Rogers Kenneth J. , Jones Chalanda E. , Petrini Maria E. , Chaplinski Kate , Ostasewski Peter , Sharif Iman , Pressel David M. 
Published: September 2013

Objective:
The goal of this study was to assess outcomes and costs associated with hospitalist comanagement of medically complex children undergoing spinal fusion surgery for neuromuscular scoliosis.

Methods:
A hospitalist comanagement program was implemented at a children’s hospital. We conducted a retrospective case series study of patients during 2003–2008 to compare clinical and cost outcomes for 87 preimplementation patients, 40 patients during a partially implemented program, and 80 patients during a fully implemented program.

Results:
When compared with preimplementation patients, full implementation program patients did not demonstrate a statistically significant difference in median length of stay on the medical/surgical unit after transfer from the PICU (median: 6 vs 8 days; P = .07). Patients in the full implementation group received fewer days of parenteral nutrition (median: 0 vs 6 days; P = .0006) and had fewer planned and unplanned laboratory studies on the inpatient unit. There was no statistically significant change in returns to the operating room (P = .08 between preimplementation and full implementation), other complications, or 30-day readmissions. Median hospital costs increased from preimplementation ($59 372) to partial implementation ($89 302) and remained elevated during full implementation ($81 651) compared with preimplementation (P = .004). Mean physician costs followed a similar trajectory from preimplementation ($18 425) to partial implementation ($24 101) to full implementation ($22 578; P = .0006 [versus preimplementation]).

Conclusions:
A hospitalist comanagement program can significantly affect the care of medically complex children undergoing spinal fusion surgery. Initial program costs may increase.
Pediatric Hospitalists Collaborate to Improve Timeliness of Discharge Communication
Authors: Shen Mark W. , Hershey Daniel , Bergert Lora , Mallory Leah , Fisher Erin Stucky , Cooperberg David 
Published: September 2013

Objectives:
The transition of care from hospital to primary care provider (PCP) at discharge carries the potential for significant information loss. There is evidence that the timeliness and content of discharge communication are often unreliable during this handoff. Suboptimal transitions of care at discharge have been associated with adverse outcomes, and efficient solutions are required to transform the current state. Our specific aim was the achievement 90% documentation of hospitalist-PCP communication within 2 days of hospital discharge in &lt;12 months.

Methods:
As part of a grassroots collaborative improvement organization, pediatric hospitalist groups engaged in parallel quality improvement projects to improve the timeliness and reliability of discharge communication at their local institutions. After an initial face-to-face meeting, e-mail and regular conference calls were used to promote shared effort and learning. The study period lasted 12 months, with &gt;16 weeks of continuous data required for inclusion.

Results:
The mean rate of documentation of timely discharge communication across the collaborative increased from 57% to 85% over the study period. For the 7 hospitals that were able to collect &gt;16 weeks of data before July 2010, the mean rate of communication was &gt;90%. Participants reported that the context of the collaborative contributed to their success.

Conclusions:
Timely hospitalist-PCP communication was inconsistent at the beginning of the study. This low-resource quality improvement collaborative was able to achieve rapid improvement and resulted in improved perceptions of quality improvement knowledge among participants.
Clinical Profile of Children Requiring Early Unplanned Admission to the PICU
Authors: Krmpotic Kristina , Lobos Anna-Theresa 
Published: September 2013

Objective:
The goal of this study was to describe the frequency, characteristics, and outcomes of children who require early unplanned admission to the PICU within 24 hours of hospitalization from the emergency department.

Methods:
This study was a retrospective audit of 24 months of prospectively collected medical emergency team records at a tertiary pediatric hospital in Canada. Our review identified 39 hospitalized children who had an activation that resulted in unplanned admission to the PICU within 24 hours of admission from the ED.

Results:
Forty-six percent of the study subjects were infants aged &lt;1 year, and 64% were male. Respiratory complaints were the most common reason for hospitalization (59%). Preexisting medical conditions (51%), abnormal respiratory rates (46%), abnormal heart rates (33%), abnormal blood gas values (49%), high supplemental oxygen requirement (23%), and treatment with nebulized medications (46%), intravenous fluids (33%), and antibiotics (33%) were common. The median time to medical emergency team activation was 9.4 hours (interquartile range: 4.4–14.5). Nearly one-half (49%) of the patients required a significant intervention after admission to the PICU, with a mean length of stay of 3.4 days and a mortality rate of 5%.

Conclusions:
Male subjects, infants aged &lt;1 year, and children with respiratory complaints accounted for a large proportion of children requiring early unplanned admission to the PICU within 24 hours of hospitalization from the ED. Further studies are required to determine which factors are associated with deterioration after hospitalization.
Phase II Study of Dasatinib (BMS-354825) in Patients With Metastatic Adenocarcinoma of the Pancreas
Authors: Chee Cheng Ean , Krishnamurthi Smitha , Nock Charles J. , Meropol Neal J. , Gibbons Joseph , Fu PingFu , Bokar Joseph , Teston Lois , O'Brien Timothy , Gudena Vinay , Reese Amy , Bergman Mark , Saltzman Joel , Wright John J. , Dowlati Afshin , Brell Joanna 
Published: September 2013

Abstract

Background.
Src, EphA2, and platelet-derived growth factor receptors α and β are dysregulated in pancreatic ductal adenocarcinoma (PDAC). Dasatinib is an oral multitarget tyrosine kinase inhibitor that targets BCR-ABL, c-Src, c-KIT, platelet-derived growth factor receptor β, and EphA2. We conducted a phase II, single-arm study of dasatinib as first-line therapy in patients with metastatic PDAC.

Methods.
Dasatinib (100 mg twice a day, later reduced to 70 mg twice a day because of toxicities) was orally administered continuously on a 28-day cycle. The primary endpoint was overall survival (OS). Response was measured using the Response Evaluation Criteria in Solid Tumors. Circulating tumor cells (CTCs) were also collected.

Results.
Fifty-one patients enrolled in this study. The median OS was 4.7 months (95% confidence interval [CI]: 2.8–6.9 months). Median progression-free survival was 2.1 months (95% CI: 1.6–3.2 months). In 34 evaluable patients, the best response achieved was stable disease in 10 patients (29.4%). One patient had stable disease while on treatment for 20 months. The most common nonhematologic toxicities were fatigue and nausea. Edema and pleural effusions occurred in 29% and 6% of patients, respectively. The number of CTCs did not correlate with survival.

Conclusion.
Single-agent dasatinib does not have clinical activity in metastatic PDAC.
Development and Characterization of Seashore Paspalum SSR Markers
Authors: Harris‐Shultz Karen , Raymer Paul , Scheffler Brian E. , Arias Renée S. 
Published: September 2013

ABSTRACTThe increasing use of secondary water sources for irrigation, which is highly linked to salinization, creates a demand for salt tolerant turf. Seashore paspalum (Paspalum vaginatum Swartz) is a warm‐season turfgrass that survives in sand dunes along coastal sites, brackish ponds, and in estuaries. Some seashore paspalum accessions and cultivars are far more salt tolerant than others. To identify genetic regions that are associated with salt tolerance, molecular tools must be developed. In this study, genomic libraries, enriched for microsatellites, were generated using the salt tolerant accession HI33. High throughput sequencing and subsequent assembling of these libraries resulted in 18,967 contigs and 158,595 singletons. The number of simple sequence repeats (SSR) detected in contigs and in singletons was 3511 and 31,949, respectively, and the number of primer sets designed within each group was 937 and 1667. A total of 80 SSR markers, including five markers previously developed, were used to assess genetic relationships among 18 Paspalum accessions. Two major clusters were identified from the seashore paspalum accessions. Accessions that are likely polyploids, all with coarse leaves, grouped together whereas accessions with fine‐to mid‐fine leaves formed a second group. Furthermore, 33 seashore paspalum SSR markers cross‐amplified in bahiagrass (Paspalum notatum Flugge) and these markers can be a useful tool in this species.
Improved Statistical Inference for Graphical Description and Interpretation of Genotype × Environment Interaction
Authors: Hu Zhiqiu , Yang Rong‐Cai 
Published: September 2013

ABSTRACTNonparametric resampling bootstrapping approach to constructing confidence regions (CR) for genotypic and environmental principal component (PC) scores recently has been used to statistically assess the biplot analysis of genotype × environment interaction (GE). However, it is possible to generate “greater‐than‐expected” CR due to nonunique singular value decomposition (SVD) of two‐way GE data from bootstrap samples. The objective of this study is to improve the current bootstrapping procedure to correct for the “systematic bias” due to the nonuniqueness of SVD through the use of Procrustes rotation. The Procrustes rotation is to compare the genotypic and environmental PC scores from bootstrap samples and original (target) data, with the comparison being done by rotating and then stretching and/or shrinking the PC scores from bootstrap samples such that the sum of squared distances between the corresponding elements of bootstrap and target scores is minimized. The bootstrapping and Procrustes rotation are implemented in an R package, bbplot/R. The analysis of two data sets from wheat (Triticum aestivum L.) and barley (Hordeum vulgare L.) cultivar trials shows that the CR for rotated genotypic and environmental scores are up to 10 times smaller than the CR for the corresponding unrotated scores. The shrunk CR constructed using the rotated scores for the biplot analysis reveal more definite delineations of mega‐environments than the assessment based on mere visual inspection of biplots. Thus, the improved bootstrapping approach will construct the more precise CR for the genotypic and environmental PC scores, thereby facilitating the correct use of biplot analysis for critical decisions on genotype selection or mega‐environment delineation.
Evolutionary ontology — A somewhat sociological analysis
Authors: Binka Bohuslav 
Published: September 2013

Abstract
The main aims of this paper are to establish the position of evolutionary ontology within the Czech environmental debate, to identify why its untapped potential may be an inspiration in other social science disciplines and, finally, to suggest that evolutionary ontology be reconfigured in a particular way so that it can capitalize on its potential. A brief introduction outlines the context and the main ideas of evolutionary ontology and is followed by a discussion of its weaknesses: an emphasis on a confrontational style in addressing other social science disciplines and ignoring the specific nature of the disciplines which represent the main target group of this theory. Consequently, I suggested three main changes as to how evolutionary ontology should be presented.