Pediatric Palliative Care Simulation Improves Resident Learning Outcomes: An 11-Year Review.

Context: Many general pediatrics residents lack sufficient opportunities to conduct difficult conversations with families, particularly about end-of-life care. Simulation learning is an effective means of practicing professional skills. A pediatric palliative care (PPC) physician is uniquely suited to mentor residents and fellows learning to lead difficult conversations through simulation.

Factors affecting the dwell times of peripheral intravenous catheters inserted by traditional vs. ultrasound-guided methods.

Securing reliable and high-quality peripheral intravenous catheter (PIVC) access is vital for patient-centered care. Factors such as patient condition, catheter type, and insertion method can influence PIVC dwell times. This review examines the differences in dwell times between traditional PIVCs and ultrasound-guided PIVCs (USGPIVCs) and their implications for patient care.

Adverse childhood experiences (ACEs) and mental health by gender identity in the United States, 2019-2021.

Objective: To estimate the prevalence of adverse childhood experiences (ACEs) and their association with mental health outcomes in adulthood by gender identity.

Methods: Data come from 2019 to 2021 US Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System, among 17 states collecting gender identity and ACEs. We estimated the prevalence of ACEs and used Poisson family regression to estimate the association between ACEs and mental health stratified by gender identity.

Learning Curve of Real-Time Imaging with C-Arm Based Tomography for Peripheral Lung Nodule Biopsy.

The number of procedures required to attain proficiency with new bronchoscopic biopsy technologies for peripheral pulmonary lesions (PPLs) is uncertain. A prospective, single-center study evaluated learning curves of two operators performing PPL biopsies using a novel, real-time, intraoperative tomographic imaging system in consecutive procedures in adults with CT-detected PPLs. Operators were considered "proficient" when they asked three or fewer questions of the manufacturer's clinical representative with no subsequent navigations in which they asked more than three questions.

Effects of the affordable care Act's Medicaid expansion on health insurance coverage for individuals in same-sex couples.

Objective: To examine whether the Affordable Care Act's (ACA's) Medicaid expansions affected health insurance coverage for individuals in same-sex couples.

Data Sources And Study Setting: We used data on adults aged 18-64 years in same-sex couples (n = 33,512) from the 2008-2018 American Community Survey (ACS).

Study Design: To estimate the effect of the impact of the state Medicaid expansions under the ACA on health insurance coverage for sexual minorities, we utilize a standard difference-in-differences approach to leverage the variation across geography and time in expanding Medicaid.

Interweaving Adult Fitness Classes Into Community Settings Via Stronger Austin's Community Partnership Model: Increasing Access to Physical Activity and Positive Social Connectedness in Underserved Communities.

The lack of environmental supports for healthy lifestyles is a potent factor in the high prevalence of noncommunicable diseases among communities experiencing economic disadvantage. Stronger Austin aimed to increase access to free physical activity (PA) and fitness programming (eg, Zumba) in underserved communities in Austin, Texas, via a partnership and interweaving into context approach in which classes are interwoven into settings with widespread access for residents, including clinics, city-supported housing, parks, recreation centers, and schools. We aimed to better understand the PA-related benefits and opportunities for improvement when adult fitness classes are interwoven into community settings.

Intrawound Liposomal Bupivacaine in Pediatric Chiari Decompression: A Retrospective Study.

Unlabelled: Intrawound liposomal bupivacaine is a long-acting local anesthetic used to decrease postoperative pain in various procedures. Although it is used in posterior cervical and suboccipital approaches in the adult population, it is currently off-label for pediatrics. This quality improvement (QI) project examines intrawound liposomal bupivacaine for pediatric Chiari decompression and evaluates its role in postoperative opioid consumption.

NCAA Division I American football players with sickle cell trait have altered hematological responses and hydration status.

Sickle cell trait (SCT) is a risk factor of collapse and sudden death in athletes. We conducted a longitudinal study to determine the hematological responses and hydration status in NCAA Division I American football players with SCT. The study took place over 2 years with 6 SCT and 6 position-matched controls (CON) in year 1; and 4 SCT and 4 CON in year 2.

Incentivizing Elimination of Biomass Cooking Fuels with a Reversible Commitment and a Spare LPG Cylinder.

In India, approximately 480,000 deaths occur annually from exposure to household air pollution from the use of biomass cooking fuels. Displacing biomass use with clean fuels, such as liquefied petroleum gas (LPG), can help reduce these deaths. Through government initiatives, most Indian households now own an LPG stove and one LPG cylinder.

Free-living, continuous hypo-hydration, and cardiovascular response to exercise in a heated environment.

Chronic dehydration (DEH) and heat stress combined with poor cardiovascular (CV) health may influence physiological responses to exercise. We examined the effects of free-living induced hypo-hydration on physiological responses to exercise in a heated environment and whether resting CV health is related to these changes. Participants (N = 16, 20.

Abdominal Compartment Syndrome as a Complication of Fluid Resuscitation.

Fluid resuscitation is a primary concern of nurse clinicians. Excessive resuscitation with crystalloids places patients at particular risk for many subsequent complications that carry associated increases in mortality and morbidity. Intra-abdominal hypertension and abdominal compartment syndrome are deadly complications of third spacing and capillary leak that occur secondary to excessive fluid resuscitation.

Analysis of Cricoid Pressure Force and Technique Among Anesthesiologists, Nurse Anesthetists, and Registered Nurses.

Purpose: The purpose of this project was to assess the ability of anesthesiologists, nurse anesthetists, and registered nurses to correctly identify anatomic landmarks of cricoid pressure and apply the correct amount of force.

Design: The project included an educational intervention with one group pretest-post-test design.

Methods: Participants demonstrated cricoid pressure on a laryngotracheal model.

Identifying the association among risk factors and mortality in trauma patients with intra-abdominal hypertension and abdominal compartment syndrome.

Intra-abdominal hypertension and abdominal compartment syndrome (ACS) have become key players in increasing mortality among critically ill trauma patients. Many risk factors place the trauma patient at risk for developing ACS. Very few studies exist to establish a predictive relationship between any one risk factor and mortality among these patients.

Melanocortin receptor expression is associated with reduced CRP in response to resistance training.

The existing paradigm of exercise-induced decreases in chronic inflammation focuses on the expression of inflammatory receptors on systemic monocytes in response to exercise training, with the role of anti-inflammatory receptors largely ignored. Our recent preliminary studies indicate that the anti-inflammatory melanocortin receptors (MCRs) may play a role in modulating exercise-induced decreases in chronic inflammation. Here, we present a study designed to determine the effect of intense, resistance exercise training on systemic monocyte MCR expression.

Robot-assisted laparoscopic ileal bladder augmentation: defining techniques and potential pitfalls.

Purpose: Laparoscopic bladder augmentation has been limited because of the extensive suturing required. The use of robot-assisted laparoscopic (RAL) procedures may circumvent this limitation and allow more efficient suturing. The purpose of the study is to define the techniques and the potential pitfalls in performing RAL bladder augmentation in an animal model.

Unilateral extravesical ureteral reimplantation in children performed on an outpatient basis.

Purpose: Unilateral extravesical ureteral reimplantation is comparable to intravesical procedures for resolution of primary vesicoureteral reflux (VUR). Defining whether this operation can be consistently performed on an outpatient basis is important.

Materials And Methods: A total of 80 patients with unilateral VUR were treated with extravesical ureteral reimplantation, of whom 20 were treated on an inpatient basis and 60 on an outpatient basis.

The Southern Rural Access Program and Alabama's Rural Health Leaders Pipeline: a partnership to develop needed minority health care professionals.

Rural Health Leaders Pipeline programs are intended to increase the number of youth interested in and pursuing health professions in rural communities. This paper presents 2 complementary approaches to Rural Health Leaders Pipeline programs. Two different organizations in Alabama recruit students from 18 specified counties.

Pseudoepidural reverberation artifact: a common ultrasound artifact in fetal cranium.

High-intensity reverberation artifacts frequently occur within the fetal cranium during obstetric ultrasound examinations. One hundred ninety-six static ultrasonograms obtained from 100 consecutive obstetric patients were reviewed to determine the incidence, shape, and location of high-intensity reverberation artifacts within the fetal head. Such artifacts occurred in one-third of the fetuses examined.

Utilization review in nursing homes: making implicit level-of-care judgments explicit.

Comprehensive data on 3,579 patients in Baltimore nursing homes were collected by trained teams of reliable observers. The data included an implicit judgment about the level of care (LOC) deemed most appropriate for each patient. Two different approaches were used to fit the patient data to the LOC judgments: Several versions of an algorithm adapted from a utilization review scheme based on simple clinical criteria and a series of mathematical equations based on logistic regression were each tested.