Selective early medical treatment of the patent ductus arteriosus in extremely low gestational age infants: a pilot randomised controlled trial protocol (SMART-PDA).

Introduction: Patent ductus arteriosus (PDA) is the most common cardiovascular problem that develops in extremely preterm infants and is associated with poor clinical outcomes. Uncertainty exists on whether early pharmacotherapeutic treatment of a clinically symptomatic and echocardiography-confirmed haemodynamically significant PDA in extremely preterm infants improves outcomes. Given the wide variation in the approach to PDA treatment in this gestational age (GA) group, a randomised trial design is essential to address the question.

Targeted Neonatal Echocardiography Performed by Nurse Practitioners in the NICU: Attitudes and Perceptions of the Healthcare Team.

Background: Targeted neonatal echocardiography (TNE) and hemodynamic consultation have typically been performed by physicians. The Stollery Children's Hospital neonatal intensive care unit (NICU) expanded their TNE training program to include neonatal nurse practitioners (NNPs), the first in North America.

Purpose: This study examines the thoughts and perceptions of clinicians about the incorporation of NNPs providing TNE and hemodynamic consultation and investigates key facilitators and challenges for consideration when planning future training, expansion of service in Edmonton, or beyond.

The paradoxical influence of the COVID-19 lockdown period on different types of preterm births in Alberta: a provincial study.

Objectives: The objective of this study was to determine if the COVID-19 pandemic impacted different types of preterm birth rates in Alberta, Canada.

Methods: A population-based, retrospective, cohort study was conducted from March 15, 2015 to December 31, 2020 using provincial data. The primary exposure was the COVID-19 lockdown period, and the primary outcome was the incidence of preterm birth (<37 weeks gestational age).

How a Team Effectiveness Approach to Health Systems Science Can Illuminate Undergraduate Medical Education Outcomes.

Health care delivery requires physicians to operate in teams to successfully navigate complexity in caring for patients and communities. The importance of training physicians early in core concepts of working in teams (i.e.

Clinical Assessment Specialists: A New Faculty Role to Improve Clerkship Assessment.

Introduction: Ambulatory clerkships, including longitudinal integrated clerkships (LICs), face challenges to assessment, including time pressure and clinical demands on preceptors. High-quality clinical assessment is critical to implementing competency-based medical education, generating valid grades, and supporting learning. This importance is further heightened with the new pass/fail scoring for US Medical Licensing Exam Step 1, discontinuation of US Medical Licensing Exam Step 2 Clinical Skills, and the growing concern for bias in assessment.

Acetaminophen versus indomethacin for patent ductus arteriosus management in premature infants: systematic review and meta-analysis of randomized controlled trials.

Objectives: Acetaminophen has gained interest in the neonatal community for its use in the management of hemodynamically significant patent ductus arteriosus (HsPDA) in preterm infants. We conducted a systematic review of randomized controlled trials (RCTs) comparing the efficacy and safety of acetaminophen with indomethacin for the management of HsPDA in preterm infants.

Methods: We searched PROSPERO, OVID Medline, OVID EMBASE, Wiley Cochrane Library (CDSR and Central), EBSCO CINAHL, and SCOPUS from inception to June 15, 2021.

Point-of-care ultrasound (POCUS) protocol for systematic assessment of the crashing neonate-expert consensus statement of the international crashing neonate working group.

Sudden unexpected clinical deterioration or cardiorespiratory instability is common in neonates and is often referred as a "crashing" neonate. The established resuscitation guidelines provide an excellent framework to stabilize and evaluate these infants, but it is primarily based upon clinical assessment only. However, clinical assessment in sick neonates is limited in identifying underlying pathophysiology.

What Are the Minimal Feeds Required for Starting Enteral Ibuprofen in Preterm Infants with PDA?

Ibuprofen is commonly used for the treatment of hemodynamically significant patent ductus arteriosus (PDA) in preterm infants. It seems that the oral formulation incurs a higher closure rate and has a better safety profile in preterm infants born > 26 weeks’ gestation. There is no consensus across Canadian centers regarding the minimum volume of enteral feeds required prior to starting ibuprofen for the treatment of patent ductus arteriosus, and the current practice is comfort-based depending on the centre and the local prevalence of neonatal morbidities.

Multimodal Assessment of Systemic Blood Flow in Infants.

The assessment of systemic blood flow is a complex and comprehensive process with clinical, laboratory, and technological components. Despite recent advancements in technology, there is no perfect bedside tool to quantify systemic blood flow in infants that can be used for clinical decision making. Each option has its own merits and limitations, and evidence on the reliability of these physiology-based assessment processes is evolving.

Fluid and electrolyte management in preterm infants with patent ductus arteriosus.

Optimal fluid management of preterm babies with suspected or confirmed diagnosis of patent ductus arteriosus (PDA) is frequently challenging for neonatal care physician because of paucity of clinical trials. There is wide variation in practice across neonatal units, resulting in significant impact on outcomes in Extremely Low Birth Weight (ELBW) babies with hemodynamically significant PDA. A delicate balance is required in fluid management to reduce mortality and morbidity in this population.

Different approaches for patent ductus arteriosus in premature infants using acetaminophen.

Background: Acetaminophen use for pharmacological treatment of hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants is becoming more popular with emerging evidence that it is effective as well as safe alternative for other agents used to close hsPDA.

Data Sources: We performed a narrative review of literature about pharmacological treatment of PDA using acetaminophen.

Results: Acetaminophen was used as a prophylaxis, symptomatic, targeted, and a rescue approach.

Pulmonary artery dopplers for early prediction of risk for bronchopulmonary dysplasia in extremely low birth weight babies.

Objective: The early abnormal pulmonary vasoreactivity observed in babies at risk of Bronchopulmonary dysplasia (BPD) increases the pulmonary vascular resistance. This can be assessed non-invasively using Time to Peak Velocity:Right Ventricular Ejection Time ratio (TPV:RVET) measured from pulmonary artery Doppler waveform obtained using echocardiogram. We postulate that screening for this early can predict BPD in this cohort.

A Comparison of Patient Outcomes Using Multimodal Analgesia Versus Opioid-Based Pain Management in Total Joint Arthroplasty.

Multimodal analgesia (MMA) pain management following total joint arthroplasty (TJA) is gaining momentum as a best practice. Many forces in healthcare are coming together challenging orthopaedic teams to reevaluate postoperative pain management following surgery including the opioid crisis and pressures to improve patient experience with early discharges following surgery. Measuring the effect of adjustments to pain management is an important step.

Influence of extreme prematurity and bronchopulmonary dysplasia on cardiac function.

Objective: Prematurity and bronchopulmonary dysplasia (BPD) are associated with poorly understood abnormalities of ventricular function. We therefore comprehensively compared biventricular function in infants with and without BPD.

Methods: Prospective observational study in extremely preterm infants with (n = 20) and without (n = 38) BPD using conventional and advanced echocardiography at 28 days (T1) and near-term (T2).

Medical Students' Views on Implementing the Core EPAs: Recommendations From Student Leaders at the Core EPAs Pilot Institutions.

In 2014, the Association of American Medical Colleges recruited 10 institutions across the United States to pilot the 13 Core Entrustable Professional Activities for Entering Residency (Core EPAs). The goal was to establish a competency-based framework to prepare graduating medical students for the transition to residency. Within the Core EPAs pilot, medical students play an influential role in the development and implementation of EPA-related curricula.

Evaluating Core Clerkships: Lessons Learned From Implementing a Student-Driven Feedback System for Clinical Curricula.

Problem: Medical schools have implemented various ways to engage students in improving medical curricula. These systems, however, usually focus on the preclerkship curriculum, perhaps because medical students move through this phase of medical education synchronously, making it easier to collect student input. In contrast, clerkship and postclerkship curricula often lack similar levels of student engagement in program evaluation.

Empowering medical students as agents of curricular change: a value-added approach to student engagement in medical education.

One area in which medical students can add significant value is medical education, and involving them as key stakeholders in their education can have a profound impact on students and the institutions that serve them. However, detailed descriptions of the structure, implementation and quality of programs facilitating student engagement are lacking. We describe the structure of a novel student engagement program at the University of Illinois College of Medicine-Chicago (UICOM-Chicago) known as the Student Curricular Board (SCB).

Can Nonclinician Raters Be Trained to Assess Clinical Reasoning in Postencounter Patient Notes?

Purpose: Clinical reasoning is often assessed through patient notes (PNs) following standardized patient (SP) encounters. While nonclinicians can score PNs using analytic tools such as checklists, these do not sufficiently encompass the holistic judgments of clinician faculty. To better model faculty judgments, the authors developed checklists with faculty-specified scoring formulas embedded in spreadsheets and studied the resulting interrater reliability (IRR) of nonclinician raters (SPs and medics) and student pass/fail status.

Self-Directed and Lifelong Learning: the 5th "S" for TBL™ Application Exercises?

This paper describes a pilot of an innovation to TBL™ as a means to add a fifth "S", self-directed learning (SDL) and life-long learning (LLL), to the 4S application exercise framework. It is important for TBL™ to explicitly address SDL and LLL to enhance student learning and meet accreditation standards.

Development and Evaluation of a Student-Initiated Test Preparation Program for the USMLE Step 1 Examination.

Problem: Studies have documented performance on the United States Medical Licensing Examination® (USMLE) Step 1 exam as an important factor that residency program directors consider when deciding which applicants to interview and rank. Therefore, success on this exam, though only one aspect of applicant evaluation, is important in determining future career prospects for medical students. Unfortunately, mean test scores at the University of Illinois College of Medicine at Chicago (UIC) have historically been below the national average.

Validity Evidence and Scoring Guidelines for Standardized Patient Encounters and Patient Notes From a Multisite Study of Clinical Performance Examinations in Seven Medical Schools.

Purpose: To examine validity evidence of local graduation competency examination scores from seven medical schools using shared cases and to provide rater training protocols and guidelines for scoring patient notes (PNs).

Method: Between May and August 2016, clinical cases were developed, shared, and administered across seven medical schools (990 students participated). Raters were calibrated using training protocols, and guidelines were developed collaboratively across sites to standardize scoring.