Resilience in Medical Education: Examining the Effects of the COVID-19 Pandemic on Pre-clerkship Curriculum Outcomes and Learner Perceptions at the University of Hawai'i John A. Burns School of Medicine.

The transition to virtual learning formats during the COVID-19 pandemic necessitated substantial curricular adjustments to the University of Hawai'i John A. Burns School of Medicine. This study compares student satisfaction and academic performance between the pre-pandemic (up through March 25, 2020) and pandemic (after March 25, 2020) periods.

Fine Tuning ECG Interpretation for Young Athletes: ECG Screening Using Z-score-based Analysis.

Background: Electrocardiograms (ECGs) in athletes commonly reveal findings related to physiologic adaptations to exercise, that may be difficult to discern from true underlying cardiovascular abnormalities. North American and European societies have published consensus statements for normal, borderline, and abnormal ECG findings for athletes, but these criteria are not based on established correlation with disease states. Additionally, data comparing ECG findings in athletes to non-athlete control subjects are lacking.

Impact of the COVID-19 Pandemic on Inpatient Pediatric Medical Student Education in Hawai'i.

The COVID-19 pandemic has had many effects on medical student education, ranging from safety measures limiting patient exposure to changes in patient diagnoses encountered by medical students in their clerkship experience. This study aimed to identify the impact of the pandemic on the inpatient experiences of third- and fourth-year medical students by assessing patient volumes and diagnoses seen by students. Frequency and types of notes written by medical students on hospital-based pediatric rotations at Kapi'olani Medical Center for Women and Children as well as patient diagnoses and ages were compared between 2 time periods: pre-pandemic (July 2018-February 2020) and pandemic (May 2020-September 2021).

Gout in Native Hawaiian Patients in Hawai'i: Clinical Characteristics and Disparities.

Objective: The purpose of this study was to investigate differences in clinical characteristics and health care use of Native Hawaiian and White patients with gout.

Methods: We performed a retrospective chart review of Native Hawaiian and White patients with gout treated from 2011 to 2017 within a large health care system in Hawai'i. We compared demographic characteristics, clinical outcomes, and risk factors for gout.

Prevalence of invalid ImPACT baseline test results among high school athletes with invalidity and sandbagging indices.

The comparison of baseline neuropsychological test results with post-concussion neuropsychological test results is a common practice to assess the aftermath of a sport-related concussion. The effectiveness of this approach is compromised when invalid baseline test performances occur. The present study was designed to assess the prevalence of invalid baseline test results of high school athletes, using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT).

Heparin Versus Normal Saline: Flushing Effectiveness in Managing Central Venous Catheters in Pediatric Patients With Cancer.

Background: There is insufficient evidence of the effects of intermittent flushing with normal saline versus heparin to prevent occlusion or increased alteplase use in pediatric patients with central venous catheters.

Objectives: The primary objective was to evaluate the effectiveness of a new standard flushing practice in the management of central venous access devices in pediatric patients with cancer. A secondary objective was to assess the cost of heparin flushing supplies to patients and financial impact.

Racial Disparities in Breastmilk Receipt and Extremely Low Gestational Age Neonatal Morbidities in an Asian Pacific Islander Population.

Background: Racial disparities in breastmilk provision and neonatal morbidities of extreme prematurity have been documented in previous studies but are not as well-documented in Asian and Pacific Islander (API) infants. The objectives of this study were to evaluate a predominantly API neonatal intensive care unit (NICU) population for racial disparities in (1) the receipt of breastmilk within 24 h of admission and at discharge and (2) neonatal morbidities among infants ≤ 28 weeks gestational age.

Methods: A retrospective chart review of 2528 infants from 2018 to 2020 born at the largest level 3 NICU in Honolulu, Hawai'i, was conducted.

Paediatric resident workflow observations in a community-based hospital.

Objective: Residency graduates need to demonstrate competence in prioritising safe patient care through appropriate management of multiple competing tasks and workflow interruptions. This pilot study aimed to characterise and correlate interruptions in paediatric resident workflow at an academically affiliated, community-based hospital.

Methods: One of three trained observers followed a resident physician during a convenience sample of 1-2 hour increments, either in the emergency department or on the wards, and recorded all observed activities and interruptions using an established time-motion tool.

Osteoporosis treatment rates after hip fracture 2011-2019 in Hawaii: Undertreatment of men after hip fractures.

Objectives: To investigate trends of osteoporosis treatment rates, and factors affecting osteoporosis treatment after hip fracture admission within a single health care system in Hawaii.

Methods: A retrospective chart review was conducted of patients aged 50 years or older and hospitalized for hip fractures between January 1, 2011 and December 31, 2019 at Hawaii Pacific Health, a large health care system in Hawaii. We collected data on basic demographics and osteoporosis medication prescription from electronic medical records.

Electrocardiogram Standards for Children and Young Adults Using -Scores.

Background: Normative ECG values for children are based on relatively few subjects and are not standardized, resulting in interpersonal variability of interpretation. Recent advances in digital technology allow a more quantitative, reproducible assessment of ECG variables. Our objective was to create the foundation of normative ECG standards in the young utilizing -scores.

Patient Safety Initiative Using Peer Observations and Feedback Inspire Collegial Workplace Culture.

Following Joint Commission recommendations for standardizing patient handoffs, direct peer observations and feedback were utilized in order to improve patient safety related to transitions of care in the Division of Pediatric Hospital Medicine at Kapi'olani Medical Center for Women & Children. All hospitalist attendings were trained in an evidence-based handoff bundle inclusive of team communication and feedback strategies. For the initial project, each hospitalist performed 12 peer observations and feedback sessions using validated tools for verbal and written handoffs over 6 months.

Complications of operative vaginal delivery and provider volume and experience.

Objective: To evaluate associations between operative vaginal delivery complications and provider experience (operative vaginal delivery volume and time since residency).

Methods: We included all operative vaginal deliveries between 2008 and 2014 at a tertiary care teaching hospital, stratified into forceps-assisted and vacuum-assisted deliveries. Complications included severe perineal lacerations (3rd and 4th degree) and neonatal injuries (subgaleal/subdural/cerebral hemorrhage, facial nerve injury, and scalp injury), which were identified by International Classification Diagnosis-9 codes.

Associations Between Maternal Obesity and Race, with Obstetric Anal Sphincter Injury: A Retrospective Cohort Study.

This retrospective cohort study examined associations between maternal body mass index (BMI), race, and obstetric anal sphincter injury (OASI) (3rd/4th degree perineal lacerations). Obstetric anal sphincter injury may lead to significant maternal morbidity, and a more thorough understanding of risk factors for this complication may guide providers in patient counseling and procedures such as episiotomy or operative vaginal delivery. Vaginal deliveries performed at Kapi'olani Medical Center for Women and Children from 2008-2015 were included.

Effects of Walking on Coronary Heart Disease in Elderly Men with Diabetes.

Previous studies have shown that walking is associated with increased longevity and a reduced risk of cardiovascular and age-related diseases. Whether walking benefits individuals with diabetes who are at high risk of coronary heart disease (CHD) remains to be determined. The objective of this study is to examine the association between walking and risk of CHD among elderly men with and without diabetes.

Pediatric Weight Errors and Resultant Medication Dosing Errors in the Emergency Department.

Background: An accurate weight is critical for dosing medications in children. Weight errors can lead to medication-dosing errors.

Objectives: This study examined the frequency and consequences of weight errors occurring at 1 children's hospital and 2 general hospitals.

Discrepancy Between Identification of Early-Term Elective Deliveries by Manual Chart Review and Data Vendor.

Elective delivery from 37 to 39 weeks gestation (early-term deliveries) is a Joint Commission National Quality Measure, and hospitals report on early-term elective delivery rates through Outcome Research Yields Excellence (ORYX) vendors. The objective of this study was to compare early-term elective deliveries, identified through ORYX vendors with those identified through manual chart review, the traditional method of medical record review. We reviewed early-term labor inductions and cesarean deliveries at a single hospital from June 1, 2010 to May 31, 2012.

Restricted episiotomy use and maternal and neonatal injuries: a retrospective cohort study.

Purpose: There is relatively little information on episiotomies in the context of restricted episiotomy use. This study sought to examine maternal and neonatal injuries with restricted episiotomy use.

Methods: We performed a retrospective database analysis of vaginal deliveries at a tertiary care maternity hospital from June 2010 to June 2015.

Surgical site infection: comparing surgeon versus patient self-report.

Background: To compare the rate of surgical site infection (SSI) using surgeon versus patient report.

Materials And Methods: A prospective observational study of surgical patients in four hospitals within one private health-care system was performed. Surgeon report consisted of contacting the surgeon or staff 30 d after procedure to identify infections.

The Electrocardiogram Is a Poor Diagnostic Tool to Detect Left Ventricular Hypertrophy in Children: A Comparison with Echocardiographic Assessment of Left Ventricular Mass.

Objective: The electrocardiogram (ECG) is used to detect left ventricular hypertrophy (LVH) in children and young adults, and it is considered an important screening tool for the most common causes of sudden cardiac arrest in the United States. However, the reliability and accuracy of the ECG in the detection of LVH are poorly understood. This study's objective was to assess the reliability and accuracy of ECG parameters predicting LVH in comparison with echocardiographic two-dimensional left ventricular mass (2D-LVM) assessment.

Induction rates and delivery outcomes after a policy limiting elective inductions.

The purpose of this study was to assess induction rates, maternal, and neonatal outcomes following adoption of a policy prohibiting elective inductions at less than 39 weeks gestation and inductions between 39 and 41 weeks with an unfavorable cervix. A retrospective cohort study of all deliveries greater than or equal to 37 weeks gestation was conducted 1 year prior to through 1 year after implementation of the induction policy. Induction rates before and after the policy were calculated as the primary outcome while maternal and neonatal conditions were assessed as secondary outcomes.

Linking patient-centered medical home and asthma measures reduces hospital readmission rates.

Objective: We sought to achieve 100% compliance with all 3 Children's Asthma Care (CAC; CAC-1, CAC-2, CAC-3) measures and track attendance at follow-up appointments with the patient-centered medical home. The impact of these measures on readmission and emergency department utilization rates was evaluated.

Methods: This quality improvement study evaluated compliance with CAC measures in pediatric patients aged 2 to 18 years old hospitalized with a primary diagnosis of asthma from January 1, 2008, through June 30, 2012.

The impact of healing touch on pediatric oncology patients.

Hypotheses: Healing Touch (HT) is an energy therapy that has been shown to lower stress, pain, and fatigue in adult oncology patients. This study evaluated the feasibility of administering HT in pediatric oncology inpatient and outpatient units at Kapi'olani Medical Center for Women and Children.

Study Design: This study was a 1-year randomized prospective study consisting of 2 study arms.

Clinical and pathologic features of young endometrial cancer patients with loss of mismatch repair expression.

Objective: This study examines premenopausal and early menopause patients in a unique population with endometrial cancer and loss of mismatch repair (MMR) gene expression. The purpose is to compare clinical and pathologic differences in patients with loss of expression (LOE) to those with normal expression (NE).

Methods: Endometrial cancer patients under age 60 in-between 1998 and 2008 were identified from a single tumor registry.

Outcomes of inborn and transported extremely premature very-low-birthweight infants in Hawai'i.

Background: Delivery of premature infants outside tertiary care centers is not always preventable. The aim of this study was to compare rates of survival and common morbidities in extremely premature babies transported to a level III facility versus those born at the level III center.

Methods: Retrospective chart review was performed on all neonates born at ≤ 28 weeks of gestation with birthweight ≤ 1500 g who were admitted to the Newborn Intensive Care Unit at Kapi'olani Medical Center for Women and Children (KMCWC) between 1 January 2000 and 31 December 2005.

Community-acquired Staphylococcus aureus pneumonia among hospitalized children in Hawaii.

Summary Background: Invasive community acquired (CA) Staphylococcus aureus (SA) disease has been endemically observed in Hawaiian children. We wanted to evaluate the clinical, laboratory findings, and outcomes of methicillin-resistant SA (MRSA) and methicillin-susceptible SA (MSSA) associated pneumonia admissions.

Methods: We performed retrospective chart reviews of 38 culture proven SA pneumonia patients admitted to a pediatric tertiary medical center in Hawaii between January 1996 to December 2007.