Implementation of a critical care outreach team in a children's hospital.

Introduction: Proactive surveillance by a critical care outreach team (CCOT) can promote early recognition of deterioration in hospitalized patients but is uncommon in pediatric rapid response systems (RRSs). After our children's hospital introduced a CCOT in 2019, we aimed to characterize early implementation outcomes. We hypothesized that CCOT rounding would identify additional children at risk for deterioration.

Development and evaluation of a writing retreat program to build community and promote productivity in academic hospital medicine.

Background: Scientific writing is a core component of academic hospital medicine, and yet finding time to engage in deeply focused writing is difficult in part due to the highly clinical, 24/7 nature of the specialty that can limit opportunities for writing-focused collaboration and mentorship.

Objective: Our objective was to develop and evaluate an academic writing retreat program.

Methods: We drafted a set of key retreat features to guide implementation of a 3-day, 2-night retreat program held within a 2 h radius of our hospital.

The Need for a Standard Outcome for Clinical Deterioration in Children's Hospitals.

Unrecognized clinical deterioration is a common and significant source of preventable harm to hospitalized children. Yet, unlike other sources of preventable harm, clinical deterioration outside of the ICU lacks a clear, "gold standard" outcome to guide prevention efforts. This gap limits multicenter learning, which is crucial for identifying effective and generalizable interventions for harm prevention.

Opportunities to improve diagnosis in emergency transfers to the pediatric intensive care unit.

Background: Late recognition of in-hospital deterioration is a source of preventable harm. Emergency transfers (ET), when hospitalized patients require intensive care unit (ICU) interventions within 1 h of ICU transfer, are a proximal measure of late recognition associated with increased mortality and length of stay (LOS).

Objective: To apply diagnostic process improvement frameworks to identify missed opportunities for improvement in diagnosis (MOID) in ETs and evaluate their association with outcomes.

Medication Rounds: A Tool to Promote Medication Safety for Children with Medical Complexity.

Children with medical complexity (CMC) often have lengthy medication lists and are at risk of experiencing suboptimal medication management. This tool tutorial describes a novel and pragmatic strategy for the development and implementation of medication rounds, a model that promotes medication safety for hospitalized CMC. An interprofessional group designed and implemented a pharmacy-led medication rounding care model, in which clinicians and pharmacists partner weekly to conduct reviews of all patient medications on a general pediatrics CMC team using a comprehensive checklist.

A Qualitative Study of Resident Experiences With Clinical Event Debriefing.

Objectives: The facilitated discussion of events through clinical event debriefing (CED) can promote learning and wellbeing, but resident involvement is often limited. Although the graduate medical education field supports CED, interventions to promote resident involvement are limited by poor insight into how residents experience CED. The objective of this study was to characterize pediatric resident experiences with CED, with a specific focus on practice barriers and facilitators.

Leveraging EHR Data to Evaluate the Association of Late Recognition of Deterioration With Outcomes.

Objectives: Emergency transfers (ETs), deterioration events with late recognition requiring ICU interventions within 1 hour of transfer, are associated with adverse outcomes. We leveraged electronic health record (EHR) data to assess the association between ETs and outcomes. We also evaluated the association between intervention timing (urgency) and outcomes.

The Goldilocks problem: Healthcare delivery models for children with medical complexity.

Health systems have increasingly adapted elements of the medical home model in designing complex care programs for children with medical complexity (CMC). In recent years, several key complex care program designs have emerged. These programs have been shown to be effective in improving the quality and cost of care for CMC.

From the Frontlines: A Qualitative Study of Staff Experiences With Clinical Event Debriefing.

Objectives: Clinical event debriefing (CED) can improve patient care and outcomes, but little is known about CED across inpatient settings, and participant experiences have not been well described. In this qualitative study, we sought to characterize and compare staff experiences with CED in 2 hospital units, with a goal of generating recommendations for a hospital-wide debriefing program.

Methods: We conducted 32 semistructured interviews with clinical staff who attended a CED in the previous week.

Implementation of a Multidisciplinary Debriefing Process for Pediatric Ward Deterioration Events.

Objectives: Event debriefing has established benefit, but its adoption is poorly characterized among pediatric ward providers. To improve patient safety, our hospital restructured its debriefing process for ward deterioration events culminating in ICU transfer. The aim of this study was to describe this process' implementation.

A Tertiary Care-based Complex Care Program: Improving Care for Children With Medical Complexity.

Objective: Children with medical complexity (CMC) have significant health care costs, but they also experience substantial unmet health care needs, hospitalizations, and medical errors. Their parents often report psychosocial stressors and poor care satisfaction. Complex care programs can improve the care for CMC.

Conceptual models for understanding physician burnout, professional fulfillment, and well-being.

Physician burnout is a highly complex phenomenon whose origins are multifactorial. As the medical profession works to better understand and reduce physician burnout, conceptual models can offer a framework to guide research and practice in the field of physician well-being. Conceptual models represent complex systems in a simplified fashion that facilitates understanding of and communication about those systems.

Interprofessional Team Member Communication Patterns, Teamwork, and Collaboration in Pre-family Meeting Huddles in a Pediatric Cardiac Intensive Care Unit.

Context: Interprofessional teams often develop a care plan before engaging in a family meeting in the pediatric cardiac intensive care unit (CICU)-a process that can affect the course of the family meeting and alter team dynamics but that has not been studied.

Objectives: To characterize the types of interactions that interprofessional team members have in pre-family meeting huddles in the pediatric CICU by 1) evaluating the amount of time each team member speaks; 2) assessing team communication and teamwork using standardized instruments; and 3) measuring team members' perceptions of collaboration and satisfaction with decision making.

Methods: We conducted a prospective observational study in a pediatric CICU.

The Pediatric Aerodigestive Center as a Tertiary Care-Based Medical Home: A Proposed Model.

Children with special healthcare needs have been identified nationally as a population whose health care is associated with unmet needs; increased morbidity; fragmentation of care and medical errors; caregiver dissatisfaction; and disproportionately high costs. A subset of these children are medically fragile, with medical complexity that requires a reliance on tertiary care-based services-including subspecialty appointments, surgical procedures, and care coordination resources. For medically complex patients affected by upper and lower respiratory tract and gastrointestinal disorders, multidisciplinary aerodigestive centers have emerged at tertiary care centers across the United States to facilitate coordinated, high-quality, and high value care.

Identification of , a gene whose constitutive overexpression increases glycinebetaine content in maize and soybean.

Efforts to increase glycinebetaine (GB) levels in plants have been pursued as an approach to improving plant performance under stress conditions. To date, the impact of engineered levels of GB has been limited by metabolic constraints that restrict the achieved increases. We report the identification of a novel gene, that is differentially expressed in high and low GB accumulating maize genotypes.

Shh-proteoglycan interactions regulate maturation of olfactory glomerular circuitry.

The olfactory system relies on precise circuitry connecting olfactory sensory neurons (OSNs) and appropriate relay and processing neurons of the olfactory bulb (OB). In mammals, the exact correspondence between specific olfactory receptor types and individual glomeruli enables a spatially precise map of glomerular activation that corresponds to distinct odors. However, the mechanisms that govern the establishment and maintenance of the glomerular circuitry are largely unknown.

Asperger syndrome and DSM-5: a dilemma for a college freshman.

Angela is an 18-year-old college freshman who made an appointment with her pediatrician because of academic and social difficulties at college. She was diagnosed with Asperger disorder at age 6 based on difficulties relating to adults and peers, perseverative patterns of interest, and normal language development.She received special education services in middle school to help follow directions and complete assignments.

Sequence-based association and selection scans identify drug resistance loci in the Plasmodium falciparum malaria parasite.

Through rapid genetic adaptation and natural selection, the Plasmodium falciparum parasite--the deadliest of those that cause malaria--is able to develop resistance to antimalarial drugs, thwarting present efforts to control it. Genome-wide association studies (GWAS) provide a critical hypothesis-generating tool for understanding how this occurs. However, in P.

Olfactory behavioral testing in the adult mouse.

The rodent olfactory system is of increasing interest to scientists, studied, in part, in systems biology because of its stereotyped, yet accessible circuitry. In addition, this area's unique ability to generate new neurons throughout an organism's lifetime makes it an attractive system for developmental and regenerative biologists alike. Such interest necessitates a means for a quick, yet reliable assessment of olfactory function.