bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary Intensivists and Nurses for Long-Stay Patients: A Survey of Practices and Perceptions at Academic PICUs*
Authors: Williams Erin P. , Madrigal Vanessa N. , Leone Tina A. , Aponte-Patel Linda , Baird Jennifer D. , Edwards Jeffrey D. 
Published: February 2023

Objectives:
To determine the prevalence of the utilization of primary intensivists and primary nurses for long-stay patients in large, academic PICU and ascertain how these practices are operationalized and perceived.

Design:
A cross-sectional survey.

Setting:
U.S. PICUs with accredited Pediatric Critical Care Medicine fellowships.

Subjects:
One senior physician and one senior nurse at each institution.

Intervention:
None.

Measurements and Main Results:
Separate but largely analogous questionnaires for intensivists and nurses were created using an iterative process to enhance content/face validity and readability. Sixty-seven intensivists (representing 93% of the 72 institutions with fellowship programs and their PICUs) and 59 nurses (representing 82%) responded. Twenty-four institutions utilize primary intensivists; 30 utilize primary nurses; and 13 utilize both. Most institutions use length of stay and/or other criteria (e.g., medical complexity) for eligibility. Commonly, not all patients that meet eligibility criteria receive primaries. Primary providers are overwhelmingly volunteers, and often only a fraction of providers participate. Primary intensivists at a large majority (>75%) of institutions facilitate information sharing and decision-making, attend family/team meetings, visit patients/families regularly, and are otherwise available upon request. Primary nurses at a similar majority of institutions provide consistent bedside care, facilitate information sharing, and attend family/team meetings. A large majority of respondents thought that primary intensivists increase patient/family satisfaction, reduce their stress, improve provider communication, and reduce conflict, whereas primary nurses similarly increase patient/family satisfaction. More than half of respondents shared that these practices can sometimes require effort (e.g., time and emotion), complicate decision-making, and/or reduce staffing flexibility.

Conclusions:
Primary practices are potential strategies to augment rotating PICU care models and better serve the needs of long-stay and other patients. These practices are being utilized to varying extents and with some operationalization uniformity at large, academic PICUs.
Inter-Rater Reliability of Delirium Screening of Infants in the Cardiac ICU: A Prospective, Observational Study
Authors: Cleveland Melissa , Baute Rebecca , Clindaniel Casey , Hertz Leesa , Pond Rachel , Centers Gabriela I. 
Published: February 2023

OBJECTIVES:
To determine the inter-rater reliability (IRR) of the Cornell Assessment for Pediatric Delirium (CAP-D) in infants admitted to a cardiac ICU (CVICU) and to explore the impact of younger age and mechanical ventilation on IRR.

DESIGN:
Prospective cross-sectional study of delirium screening performed by bedside CVICU nurses. We collected data from September 2020 to April 2021. We evaluated IRR with intraclass correlation coefficient (ICC) one-way random effects and Fleiss kappa for multiple raters.

SETTING:
Eighteen-bed academic pediatric CVICU.

PARTICIPANTS:
Subjects: Infants 1 day to 1 year old admitted to the CVICU, stratified in two age groups (≤ 9 wk and 9 wk to < 1 yr). Exclusion criteria were patients’ immediate postoperative day, State Behavioral Scale score less than or equal to –2, or at risk for hemodynamic instability with assessment. Raters: CVICU nurses working in the unit during study days.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Groups of four raters performed 91 assessments, a total of 364 CAP-D screens. Forty-five of 91 (49%) were in patients less than or equal to 9 weeks old and 43 of 91 (47%) in mechanically ventilated patients. Sixty-eight of 81 nurses (81%) participated. In infants less than or equal to 9 weeks old, ICC was 0.59 (95% CI 0.44–0.71), poor to moderate reliability, significantly lower than the ICC in infants greater than 9 weeks and 0.72 (95% CI 0.61–0.82), moderate to good reliability. In mechanically ventilated infants, ICC was 0.5 (95% CI 0.34–0.65), poor to moderate reliability, significantly lower than the ICC in nonmechanically ventilated infants and 0.69 (95% CI 0.57–0.8), moderate to good reliability. Fleiss kappa for all infants was 0.47 (95% CI 0.34–0.6), slight to fair agreement. Use of anchor points did not improve reliability.

CONCLUSIONS:
In the youngest, most vulnerable infants admitted to the CVICU, further evaluation of the CAP-D tool is needed.
Is HbA1c an Indicator of Diabetic Ketoacidosis Severity in the Pediatric Population?
Authors: Lamsal Riwaaj , Klyachman Leslie , Adeyinka Adebayo , Kondamudi Noah , Pierre Louisdon 
Published: February 2023

Abstract
Glycosylated hemoglobin (HbA1c) reflects how well blood glucose is controlled and is one of the strongest predictors of chronic complications of diabetes mellitus. The degree of acidosis helps determine the severity of diabetic ketoacidosis (DKA) (mild: pH 7.2–7.3; moderate: pH 7.1–7.2; severe: pH <7.1) and guides the level of care and predicts outcome. Many studies have implicated that higher HbA1c levels lead to recurrent DKA. However, there is no description of the association of higher HbA1c with the severity of DKA. One hundred thirty-eight electronic medical records of patients aged 1 to 21 years admitted to the pediatric intensive care unit with DKA between 2011 and 2015 were analyzed. We excluded 50 patients because the HbA1c level was not available. Spearman correlation analyzed the data for 88 patients included in the study. The mean HbA1c was 13.3, with female patients having more admissions compared with male patients (58% vs 42%). The age group from 13 to 21 years accounted for 77.3% of the patients. The duration of type 1 diabetes mellitus did not affect the HbA1c level. Likewise, the blood glucose and serum creatinine level did not show a statistical correlation with blood pH levels. Mean HbA1c for mild, moderate, and severe DKA groups were 11.4%, 12.2%, and 14.8%, respectively. Blood pH and HbA1c returned a negative correlation (correlation coefficient, −0.557; P = 0.005). The HbA1c level correlated positively with the 3 groups of DKA (correlation coefficient, 0.595; P = 0.01). A higher A1c was associated with more severe DKA.
The Effect of 3 Methods (Buzzy, ShotBlocker, and DistrACTION Cards) Used While Taking Blood Samples From Children with Pain and Anxiety
Authors: Sivri Birsen Bilgen , Balci Serap , Dolgun Gülümser 
Published: February 2023

ObjectivesThe aim of this study was to compare the effectiveness of 3 methods (Buzzy, ShotBlocker, and DistrACTION Cards) in reducing pain and anxiety while taking venous blood samples in children.MethodsThe study population consisted of children aged 9 to 12 years admitted to the Child Health and Diseases Department in a Faculty of Medicine in Turkey. The sample of the study consisted of 242 children (Buzzy = 60, ShotBlocker = 61, DistrACTION Cards = 60, control = 61) who met the patient selection criteria and agreed to participate in the study. The data were obtained using an Information Form, the State-Trait Anxiety Inventory for Children, visual analog scale, and the Faces Pain Scale–Revised.DesignThis article is an experimental randomized controlled study.ResultsDuring venous blood collection, the scores of visual analog scale were significantly lower in ShotBlocker, Buzzy, and DistrACTION Cards groups than the control group. It was also observed that the control group experienced more anxiety than the other groups.ConclusionsMethods such as Buzzy, ShotBlocker, and DistrACTION Cards can be used to reduce the anxiety and pain of children during painful procedures such as blood collection and vascular access. Among these methods, “Buzzy” and “DistrACTION Cards” can be preferred as it is equally effective, and then ShotBlocker can be preferred.
Validation of a Clinical Decision Rule for Ultrasound Identification of MRSA Skin Abscesses in Children
Authors: Gutierrez Christie M. , Malia Laurie , Ng Lorraine K. , Dayan Peter S. , Rabiner Joni E. 
Published: February 2023

Objective
The aim of this study was to validate an adult-derived clinical decision rule for ultrasound identification of methicillin-resistant Staphylococcus aureus (MRSA) skin abscesses in a pediatric cohort.

Methods
We conducted a retrospective study of skin and soft tissue infections in patients <21 years presenting to the emergency department who had radiology performed ultrasounds completed and wound cultures obtained. Ultrasound scans were reviewed for edge definition, volume, and shape by 2 pediatric emergency physicians with expertise in point-of-care ultrasound, with approximately 25% of scans reviewed by both experts to evaluate interrater reliability. A third, blinded expert weighed in for discrepancies before analysis. Test performance characteristics were calculated for the clinical decision rule in children.

Results
Two hundred nine patients were enrolled, with mean age of 9.8 (±6.7) years; 87 (42%) were male. Sixty-nine (33%) patients had a wound culture positive for MRSA. The clinical decision rule had a sensitivity of 86% (95% confidence interval [CI], 75%–93%), specificity of 32% (95% CI, 25%–41%), positive predictive value of 38% (95% CI, 35%–42%), negative predictive value of 82% (95% CI, 71%–89%), positive likelihood ratio of 1.26 (95% CI, 1.08–1.46), negative likelihood ratio of 0.45 (95% CI, 0.24–0.84), and an odds ratio of 2.8 (95% CI, 1.31–5.97).

Conclusions
This clinical decision rule for ultrasound identification of MRSA abscesses had moderately high sensitivity and negative predictive value in pediatric patients, with similar sensitivity compared with the original adult validation group. Ultrasound may help identify MRSA abscesses, allowing for improved antibiotic choices and outcomes for children with MRSA abscesses.
Thoracic Imaging in Pediatric Trauma
Authors: Lynch Peter , Samoilov Lucy , Brahm Gary 
Published: January 2023

Objectives
Imaging algorithms for assessment of thoracic trauma in pediatric patients remain controversial, attempting to balance radiation dose and its associated risk with the need for thorough assessment of patients' injuries. This study reviewed the value of chest radiography in detecting traumatic injuries, and the impact that computed tomography (CT) had on clinical management.

Methods
A retrospective review of pediatric trauma patients undergoing chest radiography and thoracic CT over a 2-year period at a level 1 trauma center was performed. The incidence of various traumatic injuries was documented, with measures of sensitivity and specificity on radiography. Clinical notes were reviewed to identify any changes in care based on CT findings.

Results
Eighty-one pediatric trauma patients underwent thoracic CT over a 2-year period, with 60 patients meeting the inclusion criteria. Radiographs identified 47 traumatic injuries out of 117 seen on the subsequent CT examinations for a sensitivity of 41% and specificity of 91%. Radiographs were most sensitive in detecting osseous injuries with a sensitivity of 54%. Additional CT findings changed management in 2 of 60 cases, or 3.3% of the time.

Conclusions
Use of thoracic CT in pediatric trauma patients identifies a significantly greater number of injuries compared with than radiography but significantly increases radiation dose while changing management in only a very small proportion of cases. Despite the relatively small sample size, the findings reflect 2 years of experience at a level 1 trauma center, and this study suggests that it may be reasonable to decrease the frequency of cross-sectional imaging.
Accidental and Abusive Mandible Fractures in Infants and Toddlers
Authors: Koti Ajay S. , Vega Sarah , Johnson Katie L. , Schlatter Adrienne , Ayson Nicole , Menashe Sarah J. , Feldman Kenneth W. 
Published: February 2023

Objective
Mandible fractures are uncommon injuries in infants and young children and may raise concern for nonaccidental trauma. Our study describes several children with mandible fractures to identify features that might differentiate abuse from accident.

Methods
Records and imaging were reviewed for children aged 24 months and younger who were diagnosed with mandible fractures at 2 tertiary pediatric care centers. Twenty-one cases were included, 8 of whom had formal child abuse consultations. Cases were reviewed for mechanisms of injury, physical examination findings, and occult injuries identified, as well as the final abuse determination.

Results
Among children with child abuse consultations, 5 injuries (62.5%) were determined to be accidental, 1 (12.5%) was abusive, and 2 were indeterminate for abuse or accident (25%). In each accidentally injured child, the reported mechanism of injury was a short fall with evidence of facial impact. No accidentally injured child had unexpected occult injuries or noncraniofacial cutaneous injuries.

Conclusions
Infants and young children can sometimes sustain mandible fractures accidentally after well-described short falls with evidence of facial impact. Abuse remains in the differential diagnosis, and children should be evaluated accordingly. We propose that accidental injury be considered when a well-evaluated child with an isolated mandible fracture has a history of a short fall.
Local Health Department Engagement in Access to Mental Health Services and Mental Health Policy or Advocacy Activities
Authors: Ater Abraham Deng , Kurella Sushma , Shah Gulzar H. , Waterfield Kristie C. 
Published: February 2023

Context:
Mental health is a public health concern that requires national attention at the local level. Major issues facing local health departments (LHDs) to actively engage in mental health activities include inadequate surveillance data and limited resources.

Objective:
To examine the levels of engagement in access to mental health services, as well as policy or advocacy activities, by LHDs characteristics.

Design:
The study design is cross-sectional based on the national survey of LHDs. We analyzed the survey data from the National Association of County and City Health Officials' 2019 Profile study. Logistic regression was performed with 6 levels of engagement in mental health activities as the outcome measures.

Results:
LHDs reported that a majority had assessed the gaps in access to mental health (57.69%), followed by other activities—had implemented strategies to increase access to mental health (48.77%), implemented strategies to target underserved populations (40.66%), evaluated strategies to target underserved populations (38.84%), engaged in policy/advocacy to address mental health (32.27%), and finally addressed gaps through provision of mental health (22.31%). LHDs' governance structure was strongly associated with engagement in all 6 mental health activities. LHDs that had performed improvement processes, had behavioral health staff, and had cross-jurisdictional sharing were more likely to be engaged in all 6 of the mental health activities. LHDs were also more likely to be engaged in 5 of the 6 mental health activities if they had some relationships with faith communities and in 4 of the 6 mental health activities if they had some relationships with community health centers.

Conclusions:
Levels of engagement in mental health policy or advocacy activities among LHDs were low and varied by LHD characteristics. Intervention strategies may include encouraging LHDs to actively engage in mental health activities, participating in Public Health Accreditation Board accreditation program, and incentivizing mental health workforce retention.
Benefits and Impacts of Public Health Accreditation for Small Local Health Departments
Authors: Heffernan Megan , Melnick Meghan , Siegfried Alexa L. , Papanikolaou Malina 
Published: February 2023

Objective:
This study sought to identify accreditation benefits and impacts among local health departments (LHDs) stratifying by size of population served to determine differences between small, medium, and large LHDs.

Background:
The Public Health Accreditation Board operates the national accreditation program for public health departments, through which 306 LHDs have been accredited as of August 2022. Benefits of accreditation for LHDs are well documented, despite potential challenges and barriers to seeking accreditation. Research on the benefits of accreditation for small LHDs, specifically, is more limited.

Methods:
All health departments that completed the accreditation process between December 2013 and May 2022 were surveyed following receipt of the accreditation decision. The analytic sample included 266 LHDs (response rate of 93.7%). Data for LHDs were analyzed for specific variables related to experiences, challenges, and benefits, and stratified by size to compare small LHDs with medium and large LHDs. Bivariate analyses were conducted to identify statistical significance.

Results:
Generally, small LHDs reported similar outcomes of accreditation to medium and large LHDs. These included improvements in staff competencies, capacity to provide high-quality services, and relationships with partners. Small LHDs were significantly more likely than medium and large LHDs to report that accreditation increased their use of evidence-based practices. LHDs of all sizes reported an increase in quality improvement activities due to accreditation. Challenges for small LHDs included limited staff time or staff turnover and limited funding.

Conclusions:
The public health accreditation program has offered numerous benefits to LHDs of all sizes, including small LHDs. These accreditation benefits may be particularly important for small LHDs because of their critical role in the public health system and the ongoing need to support performance improvement, strengthen infrastructure, and increase resilience.
Experiences of Health Departments on Community Engagement and Implementation of a COVID-19 Self-testing Program
Authors: Lane-Barlow Christi , Thomas Isabel , Horter Libby , Fleurence Rachael , Green Jamilla , Juluru Krishna , Byrkit Ramona , Weitz Andrew , Ricaldi Jessica N. , Valencia Diana 
Published: February 2023

Context:
Health departments (HDs) work on the front lines to ensure the health of their communities, providing a unique perspective to public health response activities. Say Yes! COVID Test (SYCT) is a US federally funded program providing free COVID-19 self-tests to communities with high COVID-19 transmission, low vaccination rates, and high social vulnerability. The collaboration with 9 HDs was key for the program distribution of 5.8 million COVID-19 self-tests between March 31 and November 30, 2021.

Objective:
The objective of this study was to gather qualitative in-depth information on the experiences of HDs with the SYCT program to better understand the successes and barriers to implementing community-focused self-testing programs.

Design:
Key informant (KI) interviews.

Setting:
Online interviews conducted between November and December 2021.

Participants:
Sixteen program leads representing 9 HDs were purposefully sampled as KIs. KIs completed 60-minute structured interviews conducted by one trained facilitator and recorded.

Main Outcome Measures:
Key themes and lessons learned were identified using grounded theory.

Results:
Based on perceptions of KIs, HDs that maximized community partnerships for test distribution were more certain that populations at a higher risk for COVID-19 were reached. Where the HD relied predominantly on direct-to-consumer distribution, KIs were less certain that communities at higher risk were served. Privacy and anonymity in testing were themes linked to higher perceived community acceptance. KIs reported that self-test demand and distribution levels increased during higher COVID-19 transmission levels.

Conclusion:
HDs that build bridges and engage with community partners and trusted leaders are better prepared to identify and link high-risk populations with health services and resources. When collaborating with trusted community organizations, KIs perceived that the SYCT program overcame barriers such as mistrust of government intervention and desire for privacy and motivated community members to utilize this resource to protect themselves against COVID-19.
Patient Decision Making for Management of Style 410 Anatomic Implants in Breast Reconstruction
Authors: Boyd Carter J. , Salibian Ara A. , Bekisz Jonathan M. , Karp Nolan S. , Choi Mihye 
Published: February 2023

Background:
In July of 2019, the Food and Drug Administration (FDA) recalled the Allergan Natrelle® 410 Highly Cohesive Anatomically Shaped Silicone-Filled Textured Breast Implants (Allergan, Santa Barbara, CA) because of a heightened risk of developing breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The objective of this study was to describe patient decision-making in management of preexisting 410 textured implants.

Methods:
A single-institution retrospective chart review was conducted to determine all patients who received 410 anatomic implants from two surgeons. Patients who received these implants were contacted in July-September of 2019 regarding the FDA recall and requested to schedule a consultation to discuss explant/exchange versus surveillance. Outcomes analyzed included decision of surveillance versus explanation and subsequent reconstructive operations.

Results:
89 patients had received 410 implants from 2013-2017. Of the 147 breasts that were reconstructed, 58.5% were oncologic mastectomies and 41.5% were prophylactic. The majority of patients (71.9%) cited BIA-ALCL as the predominant influencing factor in their decision for management. Others factors included cosmesis, implant concerns unrelated to BIA-ALCL, and other medical conditions. 20 (22.5%) patients underwent explantation of the Style 410 implants. The remaining 77.5% of patients have elected for monitored surveillance. There was a significant association between a history of breast cancer and explantation of the Style 410 implants (p=0.0335).

Conclusions:
The majority of patients with Style 410 textured implants elected to undergo surveillance for BIA-ALCL. When deciding to explant or exchange the Style 410 implants, plastic surgeons should work in conjunction with their patients to carefully outline management options.