Work system barriers and facilitators of a team health information technology.

Designing health IT aimed at supporting team-based care and improving patient safety is difficult. This requires a work system (i.e.

Management of Critically Ill Patients With Spinal Muscular Atrophy Admitted With Acute Respiratory Failure.

Background: Spinal muscular atrophy (SMA) is a neurodegenerative disease that results in progressive muscular atrophy and weakness. The primary cause of morbidity and mortality in these children is pulmonary disease due to poor airway clearance that leads to acute respiratory failure. There is a paucity of literature on the treatment of children with SMA and acute respiratory failure.

Managing multiple perspectives in the collaborative design process of a team health information technology.

We need to design technologies that support the work of health care teams; designing such solutions should integrate different clinical roles. However, we know little about the actual collaboration that occurs in the design process for a team-based care solution. This study examines how multiple perspectives were managed in the design of a team health IT solution aimed at supporting clinician information needs during pediatric trauma care transitions.

Team Cognition in Handoffs: Relating System Factors, Team Cognition Functions and Outcomes in Two Handoff Processes.

Objective: This study investigates how team cognition occurs in care transitions from operating room (OR) to intensive care unit (ICU). We then seek to understand how the sociotechnical system and team cognition are related.

Background: Effective handoffs are critical to ensuring patient safety and have been the subject of many improvement efforts.

Scenario-Based Evaluation of Team Health Information Technology to Support Pediatric Trauma Care Transitions.

Background: Clinicians need health information technology (IT) that better supports their work. Currently, most health IT is designed to support individuals; however, more and more often, clinicians work in cross-functional teams. Trauma is one of the leading preventable causes of children's death.

Care transition of trauma patients: Processes with articulation work before and after handoff.

While care transitions influence quality of care, less work studies transitions between hospital units. We studied care transitions from the operating room (OR) to pediatric and adult intensive critical care units (ICU) using Systems Engineering Initiative for Patient Safety (SEIPS)-based process modeling. We interviewed twenty-nine physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) and administered the AHRQ Hospital Survey on Patient Safety Culture items about handoffs, care transitions and teamwork.

Use of Point-of-Care Ultrasound in the Pediatric and Neonatal Emergency Transport Realm.

Point-of-care ultrasound (POCUS) is a tool often used by clinical providers in the care of critically ill or acutely injured patients. POCUS can be used to evaluate for potentially harmful conditions during transport and to optimize downstream management. Although available literature primarily focuses on adults in the prehospital, critical care, and austere environment realm, more literature supporting POCUS use during pediatric and neonatal transport has emerged over the last few years.

Paramedic student encounters with patients during clinical placements: A multi-institutional cohort study.

Objective: Paramedic students in the US are required to complete clinical placements to gain supervised experience with real patient encounters. Given wide variation in clinical placement practices, an evidence-based approach is needed to guide programs in setting realistic and attainable goals for students. This study's goal was to describe patient encounters and hours logged by paramedic students during clinical placements.

Early infant behavioural correlates of social skills in adolescents.

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder typically diagnosed after the second year of life; however, differences in brain structure and function associated with ASD have been ascertained in early infancy. Identifying behavioural markers of ASD risk in early infancy has the potential to facilitate early detection and intervention.

Objectives: We examined associations between infant behaviour and adolescent behaviours associated with ASD.

Work system barriers and facilitators in inpatient care transitions of pediatric trauma patients.

Hospital-based care of pediatric trauma patients includes transitions between units that are critical for quality of care and patient safety. Using a macroergonomics approach, we identify work system barriers and facilitators in care transitions. We interviewed eighteen healthcare professionals involved in transitions from emergency department (ED) to operating room (OR), OR to pediatric intensive care unit (PICU) and ED to PICU.

Complexity of the pediatric trauma care process: Implications for multi-level awareness.

Trauma is the leading cause of disability and death in children and young adults in the US. While much is known about the medical aspects of inpatient pediatric trauma care, not much is known about the processes and roles involved in in-hospital care. Using human factors engineering (HFE) methods, we combine interview, archival document and trauma registry data to describe how intra-hospital care transitions affect process and team complexity.

Information flow during pediatric trauma care transitions: things falling through the cracks.

Pediatric trauma is one of the leading causes of morbidity and mortality in children in the USA. Every year, nearly 10 million children are evaluated in emergency departments (EDs) for traumatic injuries, resulting in 250,000 hospital admissions and 10,000 deaths. Pediatric trauma care in hospitals is distributed across time and space, and particularly complex with involvement of large and fluid care teams.

Prevalence of Unique Pediatric Pathologies Encountered by Paramedic Students Across Age Groups.

Unlabelled: Introduction Traditionally, Emergency Medical Services (EMS) educators have divided the pediatric population into age groups to assist in targeting their clinical and didactic curriculum. Currently, the accrediting body for paramedic training programs requires student exposure to pediatric patients based entirely on age without specifying exposure to specific pathologies within each age stratification. Identifying which pathologies are most common within the different pediatric age groups would allow educators to design curriculum targeting the most prevalent pathologies in each age group and incorporating the physiologic and psychological developmental milestones commonly seen at that age.

A Comparison of Costs Between Medical and Surgical Patients in an Academic Pediatric Intensive Care Unit.

Objective: To estimate the impact of patient type on costs incurred during a pediatric intensive care unit (PICU) hospitalization.

Patients And Methods: Retrospective cohort study at an academic PICU located in the United States that examined 850 patients admitted to the PICU from January 1 to December 31, 2009. Forty-eight patients were excluded due to lack of financial data.

Relationship Between Severity of Illness and Length of Stay on Costs Incurred During a Pediatric Critical Care Hospitalization.

Objective: To estimate the impact of severity of illness and length of stay on costs incurred during a pediatric intensive care unit (PICU) hospitalization.

Study Design: This is a retrospective cohort study at an academic PICU located in the U.S.

Life-Long Transgene Expression in Skeletal Muscle Without Transduction of Satellite Cells Following Embryonic Myogenic Progenitor Transduction by Lentivirus Administered in Utero.

Embryologic events in mammalian myogenesis remain to be fully defined. Recent evidence supports the presence of a common progenitor arising in the dermomyotome that gives rise to both embryologic and adult muscle and postnatal myogenic stem cells (satellite cells). In this study, we utilize the technique of early intra-amniotic gene transfer to target nascent muscle progenitors as they traverse the primitive streak before formation of the dermomyotome.

Developmental stage determines efficiency of gene transfer to muscle satellite cells by in utero delivery of adeno-associated virus vector serotype 2/9.

Efficient gene transfer to muscle stem cells (satellite cells) has not been achieved despite broad transduction of skeletal muscle by systemically administered adeno-associated virus serotype 2/9 (AAV-9) in mice. We hypothesized that cellular migration during fetal development would make satellite cells accessible for gene transfer following in utero intravascular injection. We injected AAV-9 encoding green fluorescent protein (GFP) marker gene into the vascular space of mice ranging in ages from post-coital day 12 (E12) to postnatal day 1 (P1).

Extensive mandibular ameloblastoma in a pediatric patient.

Ameloblastoma is an infrequent tumor of the jaw with peak incidence generally in the third and fourth decade of life. Treatment commonly involves resection although recurrence rates remain high despite this modality. We present a unique case of a 6.

Robust in vivo transduction of nervous system and neural stem cells by early gestational intra amniotic gene transfer using lentiviral vector.

Presently, in vivo methods to efficiently and broadly transduce all major cell types throughout both the central (CNS) and peripheral adult nervous system (PNS) are lacking. In this study, we hypothesized that during early fetal development neural cell populations, including neural stem cells (NSCs), may be accessible for gene transfer via the open neural groove. To test this hypothesis, we injected lentiviral vectors encoding a green fluorescent protein (GFP) marker gene into the murine amniotic cavity at embryonic day 8.

Off-label medication use in an academic hospital pediatric critical care unit.

Objective: The objective of this study was to analyze medication use in a medium-sized academic hospital pediatric intensive care unit over a 1-year period and identify medications, medication classes, and age categories that would benefit most from pediatric drug trials.

Methods: The patient population included all pediatric patients < 18 years of age (n = 677) admitted to the pediatric intensive care unit from January 1, 2005 to December 31, 2005. The main outcomes assessed were medications and classes of medications most prevalent in each age category in comparison to currently available prescribing guidelines based on Food and drug Administration (FDA) approval as shown in the PDR and research as shown by Lexi-Comp.