Diagnosing, assessing and managing cellulitis.

Cellulitis is an acute bacterial infection that affects the deep dermis and surrounding subcutaneous tissue. Although it is a common condition, it is often misdiagnosed because it can mimic a range of conditions that also cause inflamed, red, irritated and painful skin. Such misdiagnoses may lead to unnecessary hospital admissions and antibiotic overuse, with most alternative diagnoses being non-infectious.

Physician Burnout Through the Female Lens: A Silent Crisis.

Physician burnout, the emotional exhaustion and depersonalization that arises from job fatigue and dissatisfaction, is a rapidly growing problem. Although burnout has been a recognized problem for decades, our healthcare system has yet to devise a sustainable solution. Additionally, burnout does not affect all physicians in the same way- women physicians have disproportionately higher rates of burnout than male physicians.

Implementation of a Clinical Leadership Curriculum for Pediatric Residents.

Introduction: Clinical leadership is an essential skill for physicians, empowering them to lead and coordinate teams, communicate clearly under various conditions, model positive behaviors, display emotional intelligence, and ultimately improve patient care outcomes. However, there are currently no standardized residency curricula or competency-based assessments for clinical leadership, as residents often assimilate leadership skills through trial-and-error or observation of their clinical faculty. By utilizing a comprehensive needs assessment and synthesizing evidence-based practices, we developed and implemented a longitudinal and skills-based clinical leadership curriculum for pediatric residents.

Association of end-tidal carbon dioxide levels during cardiopulmonary resuscitation with survival in a large paediatric cohort.

Aim: To examine the associations between ETCO, ROSC, and chest compression quality markers in paediatric patients during active resuscitation.

Methods: This was a single-centre cohort study of data collected as part of an institutional prospective quality initiative improvement program that included all paediatric patients who received chest compressions of any duration from January 1, 2013, through July 10, 2018, in the Johns Hopkins Children's Center. Data was collected from Zoll R Series® defibrillators.

Using emollients to promote safe and effective skin care for patients.

The role of emollients in the treatment of dry skin conditions is often underestimated. Emollients promote optimal skin health and prevent skin breakdown, and their use can improve patients' quality of life. However, when advising patients on emollient use, nurses must consider the challenges involved such as the extensive choice of products and the necessity of regular applications.

Assessment of Clinical Leadership Training Needs in Senior Pediatric Residents.

Introduction: Although clinical leadership in physicians is associated with improved healthcare, leadership training is rarely integrated into residency training. Our objective was to perform a comprehensive needs assessment of our pediatric residents' existing leadership experiences and knowledge and to identify training gaps within our program.

Methods: First, we held focus groups with senior pediatric residents to understand their clinical leadership experiences and identify training needs.

Advancing Advocacy: Implementation of a Child Health Advocacy Curriculum in a Pediatrics Residency Program.

Introduction: ACGME program requirements for graduate medical education state that pediatric residency programs should include elements of child advocacy education. Finding readily available, easily implementable advocacy curricula for pediatric residency programs is challenging. We conducted a generalized curricular needs assessment via literature review and a targeted needs assessment with health care providers and advocacy leaders and developed and implemented a child health advocacy curriculum in a pediatrics residency program.

Improved Cardiopulmonary Resuscitation Performance With CODE ACES: A Resuscitation Quality Bundle.

Background Over 6000 children have an in-hospital cardiac arrest in the United States annually. Most will not survive to discharge, with significant variability in survival across hospitals suggesting improvement in resuscitation performance can save lives. Methods and Results A prospective observational study of quality of chest compressions ( CC ) during pediatric in-hospital cardiac arrest associated with development and implementation of a resuscitation quality bundle.

Prevention of medical errors and malpractice: Is creating resilience in physicians part of the answer?

In this article, we present key concepts regarding physician and resident resilience and burnout, the legal and educational context for these distinctions, and the effects of improved physician resilience through self-care on a reduction in medical errors and malpractice. Resilience here indicates the mental processes and behaviors that enable an individual to overcome the potential negative effects of stressors. In order to explore the multiple factors that contribute to physician resilience, the authors approached the topic from a variety of perspectives, including the current ways of thinking about medical malpractice in the United States, physician resilience and medical errors, and building resilience during postgraduate medical education.

Design and Deployment of a Pediatric Cardiac Arrest Surveillance System.

Objective: We aimed to increase detection of pediatric cardiopulmonary resuscitation (CPR) events and collection of physiologic and performance data for use in quality improvement (QI) efforts.

Materials And Methods: We developed a workflow-driven surveillance system that leveraged organizational information technology systems to trigger CPR detection and analysis processes. We characterized detection by notification source, type, location, and year, and compared it to previous methods of detection.

Intensivist Presence at Code Events Is Associated with High Survival and Increased Documentation Rates.

To better support the highest function of the Johns Hopkins Hospital adult code and rapid response teams, a team leadership role was created for a faculty intensivist, with the intention to integrate improve processes of care delivery, documentation, and decision-making. This article examines process and outcomes associated with the introduction of this role. It demonstrates that an intensivist has the potential to improve patient care while offsetting costs through improved billing capture.

Role of slough and biofilm in delaying healing in chronic wounds.

The management of biofilms with maintenance desloughing and antimicrobial therapy is fast becoming the accepted treatment strategy for chronic wounds.

Cost-effective wound management: a survey of 1717 nurses.

Delivering high-quality wound care requires a mix of knowledge and skills, which nurses aim to update by attending educational events such as conferences and study days. This article describes the data obtained from 30 educational study days, which took place across England, Scotland and Wales. It will explore nurses' knowledge in relation to the cost-effectiveness and clinical efficacy of current wound care practices, based on the answers of 1717 delegates that attended the events.

A 6 month evaluation of a non-powered hybrid mattress replacement system.

In 2013, the Royal Cornwall Hospitals NHS Trust undertook a 6-week evaluation of the AtmosAir 4000 non-powered reactive pressure redistribution mattress replacement system to determine its suitability in supporting the prevention of pressure ulcers in high-risk patients (phase one). The results demonstrated that the AtmosAir 4000 mattress system, together with skin assessment and repositioning regimes, met the pressure ulcer preventative needs of patients at high and very high risk of developing pressure ulcers. It also resulted in a notable reduction in the use of dynamic air mattresses.

Evaluating a pressure-redistribution mattress replacement system.

Pressure ulcer prevention is high on the quality agenda and provision of pressure-relieving equipment to meet patients' needs is an essential part of this process. This can be challenging in today's NHS and this article explores the evaluation process that supported the procurement of the AtmosAir™ 4000 pressure-redistributing mattress replacement system. Outcomes suggest that, when combined with a robust repositioning and skin assessment regime, the AtmosAir 4000 performed well and dynamic mattress usage was reduced.

Management of a black leopard (Panthera pardus) with seasonal atopy and cutaneous adverse food reaction by using transmucosal immunotherapy.

An 11-yr-old female black leopard (Panthera pardus) was presented with pruritus and intermittent gastrointestinal distress for a duration of 18 mo. Dietary elimination trial and challenge confirmed food hypersensitivity. Milder and persistent pruritus, while consuming a strict elimination diet, confirmed atopic dermatitis also was related to airborne environmental triggers identified by intradermal allergy testing.

The economics of pain management.

Using castration and dehorning as the test base, this article evaluates whether pain management is associated with increased production and whether this motivates producers. The literature supporting increased production parameters is limited. Studies have evaluated short periods and often use few animals.

The Excite Trial: relationship of intensity of constraint induced movement therapy to improvement in the wolf motor function test.

Purpose: To examine the relationship between change scores on the log mean Wolf Motor Function Test (lmWMFT) and the intensity of supervised Constraint Induced Movement Therapy (CIMT) in participants with subacute and chronic stroke.

Methods: A retrospective analysis of data from 169 EXCITE participants who received CIMT either immediately after randomization or one year later was undertaken. During waking hours, participants wore a restraining mitt on the less affected extremity.

Telemedicine in educational settings.

The use of telemedicine to enhance patient care is well documented in the literature (Currell et al 2001); however, its use in educational settings requires further exploration. Technological advances in electronic communication have been the catalyst for enabling the transmission and storage of large volumes of data. This, in turn, has allowed still and video images to be used for clinical consultation and the advancement of healthcare professionals' knowledge and skills.