Propelling the Global Advancement of School Mental Health.

Rates of mental health problems and disorders in children and youth have been increasing for at least three decades, and these have escalated due to the pandemic and multiple other societal stressors. It is increasingly recognized that students and families frequently struggle to receive needed care through traditional locations such as specialty mental health centers. Upstream mental health promotion and prevention strategies are gaining support as a public health approach to supporting overall population well-being, better utilizing a limited specialty workforce, and reducing illness.

A noninvasive hemoglobin monitor in the pediatric intensive care unit.

Background: Critically ill pediatric patients frequently require hemoglobin monitoring. Accurate noninvasive Hb (SpHb) would allow practitioners to decrease anemia from repeated blood draws, traumatic blood draws, and a decreased number of laboratory Hb (LabHb) medical tests. The Food and Drug Administration has approved the Masimo Pronto SpHb and associated Rainbow probes; however, its use in the pediatric intensive care unit (PICU) is controversial.

Management and sequelae of a 41-year-old jehovah's witness with severe anhydrous ammonia inhalation injury.

Anhydrous ammonia is a commonly used chemicals that are found in fertilizer, refrigeration, and in other occupational environments. Lung damage because of inhalation of ammonia can be devastating, producing debilitating lung disease and can ultimately lead to death. This is the case of a 41-year-old male, previously healthy, Jehovah's Witness, who was working at a poultry plant facility when an explosion occurred exposing him to toxic levels of anhydrous ammonia.

Modeling the Mental Health Practice Change Preferences of Educators: A Discrete-Choice Conjoint Experiment.

Schools are sometimes slow to adopt evidence-based strategies for improving the mental health outcomes of students. This study used a discrete-choice conjoint experiment to model factors influencing the decision of educators to adopt strategies for improving children's mental health outcomes. A sample of 1,010 educators made choices between hypothetical mental health practice change strategies composed by systematically varying the four levels of 16 practice change attributes.

Randomized trial of bilevel versus continuous positive airway pressure for acute pulmonary edema.

Background: Studies have shown different clinical outcomes of noninvasive positive pressure ventilation (NPPV) from those of continuous positive airway pressure (CPAP).

Objective: We evaluated whether bilevel positive airway pressure (BPAP) more rapidly improves dyspnea, ventilation, and acidemia without increasing the myocardial infarction (MI) rate compared to continuous positive pressure ventilation (CPAP) in patients with acute cardiogenic pulmonary edema (APE).

Methods: Patients with APE were randomized to either BPAP or CPAP.

Chest high-frequency oscillatory treatment for severe atelectasis in a patient with toxic epidermal necrolysis.

Atelectasis is a significant risk factor for the development of pneumonia, especially in pediatric populations more prone to alveolar collapse or those who may have weakened muscular tone. The Metaneb system is a pneumatic, noninvasive physiotherapy technique that delivers chest high-frequency oscillations. Chest high-frequency oscillations have been shown to enhance mucociliary clearance of secretions and help resolve patchy atelectasis.

Evaluating efforts to optimize TeamSTEPPS implementation in surgical and pediatric intensive care units.

Background: An evidence-based teamwork system, Team-STEPPS, was implemented in an academic medical center's pediatric and surgical ICUs.

Methods: A multidisciplinary change team of unit- and department-based leaders was formed to champion the initiative; develop a customized action plan for implementation; train frontline staff; and identify process, team outcome, and clinical outcome objectives for the intervention. The evaluation consisted of interviews with key staff, teamwork observations, staff surveys, and clinical outcome data.

Tying together research and practice: using ROPE for successful partnerships in school mental health.

There is solid evidence for strategies and programs that, if implemented with fidelity in schools, will enhance the mental health of children and youth. These practices are, however, inconsistently applied and rarely evaluated programmatically in every day practice. In recent years, implementation variables that influence uptake have received attention.

Comparison of three humidifiers during high-frequency percussive ventilation using the VDR-4® Fail-safe Breathing Circuit Hub.

The VDR-4® high-frequency percussive ventilator (HFPV) has been shown to be beneficial in the management of inhalation injury by improving secretion clearance while maintaining oxygenation and ventilation. Delivery of gas flow during HFPV could lack adequate humidification delivered to the patient because a major portion of the delivered gas flow would bypass the humidifier when using the original VDR-4® ventilator circuit. The authors tested a novel inline vaporizing humidifier and two gas-water interface humidifiers during HFPV using the new VDR-4® Fail-safe Breathing Circuit Hub® to determine whether delivered humidification could be improved.

Evaluation of a new circuit configuration for the VDR-4 high-frequency percussive ventilator.

High-frequency percussive ventilation (HFPV) by the VDR-4(R) has been a successful mode of ventilation in the management of inhalation injuries for nearly 20 years. A limitation of the standard VDR-4 ventilator circuit is that the sliding venturi manifold is heavy in weight and is normally connected directly to the patient's endotracheal tube (ETT), resulting in potentially hazardous torque on the ETT. In this study, we evaluate the mechanics of a new circuit for the VDR-4 that relocates the sliding venturi manifold portion of the circuit away from the ETT into the ventilator proper.

Use of a new novel humidification system with high frequency percussive ventilation in a patient with inhalation injury.

Historically, it has been difficult to provide adequate humidification delivery with the high frequency percussive ventilator (HFPV) used in many burn centers. It is possible burn centers have avoided using HFPV because of the risk of mucus plugging, dried secretions, and cast formation. Experiences with HFPV provided doubt that the HFPV ventilator circuit could supply adequate humidification to patients receiving this mode of ventilation.

Modeling the bullying prevention program preferences of educators: a discrete choice conjoint experiment.

We used discrete choice conjoint analysis to model the bullying prevention program preferences of educators. Using themes from computerized decision support lab focus groups (n = 45 educators), we composed 20 three-level bullying prevention program design attributes. Each of 1,176 educators completed 25 choice tasks presenting experimentally varied combinations of the study's attribute levels.

High-frequency percussive ventilation in a pediatric patient with hydrocarbon aspiration.

Introduction: To describe ventilator management using a high-frequency percussive ventilator (HFPV), after other modes of mechanical ventilation failed.

Design: Case series.

Setting: Pediatric intensive care unit.

Utilization of bronchodilators in ventilated patients without obstructive airways disease.

Objective: To examine physician practice in, and the costs of, prescribing inhaled bronchodilators to mechanically ventilated patients who do not have obstructive lung disease.

Methods: This was a prospective cohort study at 2 medical intensive care units at 2 tertiary-care academic medical centers, over a 6-month period. Included were the patients who required > or = 24 hours of mechanical ventilation but did not have obstructive lung disease.

Outcomes of patients with do-not-intubate orders treated with noninvasive ventilation.

Objective: To determine whether diagnosis and bedside observations predict outcomes of patients who have declined intubation but accept noninvasive positive pressure ventilation (NPPV) to treat their respiratory failure.

Design: Prospective multiple-center cohort trial.

Setting: Two teaching hospitals and two community-based hospitals in southeastern New England from January through October 1999.