Identifying drivers of cost in pediatric liver transplantation.

Understanding the economics of pediatric liver transplantation (LT) is central to high-value care initiatives. We examined cost and resource utilization in pediatric LT nationally to identify drivers of cost and hospital factors associated with greater total cost of care. We reviewed 3295 children (<21 y) receiving an LT from 2010 to 2020 in the Pediatric Health Information System to study cost, both per LT and service line, and associated mortality, complications, and resource utilization.

Quality and Safety: Learning from the Past and (Re)Imagining the Future.

Optimal quality within health care is no longer narrowly focused on preventing harm and has evolved to include the attainment of best outcomes through an understanding of the features attributed to effectively delivering care in complex work environments. The use of the electronic health record has contributed greatly to creating a repository of data that can be leveraged to comprehend the details associated with health care delivery. Medical knowledge alone is no longer sufficient to guarantee safe care or ensure the best outcomes.

Prophylactic Intravenous Access: Is It Necessary for Renal Transplant Biopsies?

Introduction: Percutaneous renal transplant biopsies have long been a safe and effective procedure with bleeding being the most common significant complication. Only a few studies, however, have addressed the need for intravenous access prior to the procedure.

Objectives: We postulate that the number of patients requiring intravenous resuscitation after a routine renal transplant biopsy is sufficiently low enough to prove that eliminating pre-procedural peripheral IV placement will have no negative impact on patient safety and could improve departmental efficiency.

Complete Genome Sequence of Serratia marcescens Siphophage Serbin.

is an opportunistic human pathogen that is known to cause hospital-acquired respiratory and urinary tract infections. Here, we announce the complete genome sequence and the features of phage Serbin.

Multimodality imaging of small bowel neoplasms.

Although the small intestine accounts for over 90% of the surface area of the alimentary tract, tumors of the small intestine represent less than 5% of all gastrointestinal tract neoplasms. Common small bowel tumors typically are well evaluated with cross-sectional imaging modalities such as CT and MR, but accurate identification and differentiation can be challenging. Differentiating normal bowel from abnormal tumor depends on imaging modality and the particular technique.

Proximal Interruption of the Pulmonary Artery.

Proximal interruption of the pulmonary artery (PIPA) is an uncommon developmental anomaly resulting in underdevelopment of the proximal portion of the pulmonary artery with preservation of the intrapulmonary segments. Clinical presentation ranges between an asymptomatic incidental finding to massive hemoptysis. When findings suggestive of PIPA are present radiographically, the diagnosis of PIPA can be definitively diagnosed with computed tomography or magnetic resonance pulmonary angiography.

"Pimping" in Pharmacy Education: A Survey and Comparison of Student and Faculty Views.

Background: "Pimping" is an informal teaching technique that is widely used in medical education. Pimping is characterized by questioning the learner with the intent of reinforcing clinical hierarchy. To date, there are no studies of the use of pimping in pharmacy education.

American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock.

Objectives: The American College of Critical Care Medicine provided 2002 and 2007 guidelines for hemodynamic support of newborn and pediatric septic shock. Provide the 2014 update of the 2007 American College of Critical Care Medicine "Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock."

Design: Society of Critical Care Medicine members were identified from general solicitation at Society of Critical Care Medicine Educational and Scientific Symposia (2006-2014).

Resuscitation Bundle in Pediatric Shock Decreases Acute Kidney Injury and Improves Outcomes.

Objective: To investigate the impact of an early emergency department (ED) protocol-driven resuscitation (septic shock protocol [SSP]) on the incidence of acute kidney injury (AKI).

Study Design: This was a retrospective pediatric cohort with clinical sepsis admitted to the pediatric intensive care unit (PICU) from the ED before (2009, PRE) and after (2010, POST) implementation of the SSP. AKI was defined by pRIFLE (pediatric version of the Risk of renal dysfunction; Injury to kidney; Failure of kidney function; Loss of kidney function, End-stage renal disease creatinine criteria).

Healthcare Engineering Defined: A White Paper.

Engineering has been playing an important role in serving and advancing healthcare. The term "Healthcare Engineering" has been used by professional societies, universities, scientific authors, and the healthcare industry for decades. However, the definition of "Healthcare Engineering" remains ambiguous.

Implementation of a Standard Verbal Sign-Out Template Improves Sign-Out Process in a Pediatric Intensive Care Unit.

Sign-out of patient data at change of shifts is vulnerable to errors that impact patient safety. Although sign-outs are complex in intensive care units (ICU), a paucity of studies exists evaluating optimal ICU sign-out. Our prospective interventional study investigated the use of a standard verbal template in a Pediatric ICU to improve the sign-out process.

Dose modification factor analysis of multilumen balloon brachytherapy applicator with Monte Carlo simulation.

The Contura brachytherapy applicator is a silicone balloon with five lumens in which a high-dose-rate brachytherapy source can traverse. Multilumen applicators, like the Contura, are used in accelerated partial breast irradiation (APBI) brachytherapy in instances where asymmetric dose distributions are desired; for example, when the applicator surface-to-skin thickness is small (< 7 mm). In these instances, the air outside the patient and the lung act as a poor scattering medium, scattering less dose back into the breast and affecting the dose distribution.

Dimensions of the posterior cerebral circulation: an analysis based on advanced non-invasive imaging.

Background: Our goal was to provide measurements of the posterior cerebral circulation using non-invasive imaging and advanced software analysis tools.

Methods: 100 consecutive patients aged ≥ 40 years (50 men and 50 women) who had undergone CT angiography (CTA) but had no vascular abnormality were analyzed. Specific software was used to make vessel measurements along the center line.

Etiologies of septic shock in a pediatric emergency department population.

Knowledge of pediatric sepsis etiologies is needed to optimize empiric therapy. A retrospective cross-sectional review of 428 children with clinically diagnosed sepsis found that 13% had lobar pneumonia, 12% bacteremia and 10% viral infections. No etiologies were found in 76%.

Prevalence and outcomes of pediatric in-hospital cardiopulmonary resuscitation in the United States: an analysis of the Kids' Inpatient Database*.

Objective: Population-based data on pediatric in-hospital cardiopulmonary resuscitation in the United States are scarce. Single-center studies and voluntary registries may skew the estimated prevalence and outcomes. This study aimed to determine the prevalence and outcomes of pediatric cardiopulmonary resuscitation on a national scale.

Test characteristics of an automated age- and temperature-adjusted tachycardia alert in pediatric septic shock.

Objectives: This study aimed to create and analyze the performance of an automated triage tool alerting triage nursing staff and physicians to an abnormal heart rate consistent with septic shock in a pediatric emergency department.

Methods: A computerized best-practice alert (BPA) triage system corrected heart rate for temperature (5 beats per minute for each 1°F above 100°F or 9.6-10 beats per minute for each 1°C > 36°C) and alarmed on tachycardia.

Evaluation of elution and mechanical properties of two injectable chemotherapeutic bone cements.

Chemotherapeutic bone cements can both stabilize the bone fractures as well as deliver chemotherapy agents directly to the bone metastatic site and adjacent soft tissue tumors. This study evaluated the in vitro elution and flexural properties of Vertebroplastic™ and Confidence Ultra™ bone cements (Depuy Spine Inc., Raynham, Mass.