Developing methods to identify resilience and improve communication about diagnosis in pediatric primary care.

Communication underlies every stage of the diagnostic process. The Dialog Study aims to characterize the pediatric diagnostic journey, focusing on communication as a source of resilience, in order to ultimately develop and test the efficacy of a structured patient-centered communication intervention in improving outpatient diagnostic safety. In this manuscript, we will describe protocols, data collection instruments, methods, analytic approaches, and theoretical frameworks to be used in to characterize the patient journey in the Dialog Study.

Effect of Patient and Family Centered I-PASS on adverse event rates in hospitalized children with complex chronic conditions.

Background: Children with complex chronic conditions (CCCs) are at risk for adverse events (AEs) during hospitalizations.

Objective: We compared the effect of Patient and Family Centered (PFC)I-PASS on AE rates in children with and without CCCs.

Designs, Settings, And Participants: Patients were drawn from the PFCI-PASS study, which included 3106 hospitalized children from seven North American pediatric hospitals between December 2014 and January 2017.

Implementation of the I-PASS handoff program in diverse clinical environments: A multicenter prospective effectiveness implementation study.

Background: Handoff miscommunications are a leading source of medical errors. Harmful medical errors decreased in pediatric academic hospitals following implementation of the I-PASS handoff improvement program. However, implementation across specialties has not been assessed.

Patient and Family-Centered I-PASS SCORE Program: Resident and Advanced Care Provider Training Materials.

Introduction: Patient and family-centered rounds (PFCRs) are an important element of family-centered care often used in the inpatient pediatric setting. However, techniques and best practices vary, and faculty, trainees, nurses, and advanced care providers may not receive formal education in strategies that specifically enhance communication on PFCRs.

Methods: Harnessing the use of structured communication, we developed the Patient and Family-Centered I-PASS Safer Communication on Rounds Every Time (SCORE) Program.

Twelve Tips for Teaching with Virtual Learning Platforms.

This article was migrated. The article was marked as recommended. Met with the challenge of physical distancing during the escalation of the COVID-19 pandemic, medical educators rapidly pivoted their educational repertoires to virtual learning platforms.

Evidence-Based Medicine in the Clinical Learning Environment of Pediatric Hospital Medicine.

The article begins with an overview of evidence-based medicine (EBM), including its history and core principles. Next, the article discusses how the current clinical learning environment has shaped EBM, including the accessibility and portability of technology; the access to electronic search engines and libraries; and the movement toward applying the best evidence through order sets, clinical guidelines, and pathways to work toward standardizing care. The article ends with a focus on how educators can influence a trainee's knowledge, skills, attitudes, and behaviors regarding EBM.

Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study.

Objective: To determine whether medical errors, family experience, and communication processes improved after implementation of an intervention to standardize the structure of healthcare provider-family communication on family centered rounds.

Design: Prospective, multicenter before and after intervention study.

Setting: Pediatric inpatient units in seven North American hospitals, 17 December 2014 to 3 January 2017.

Families as Partners in Hospital Error and Adverse Event Surveillance.

Importance: Medical errors and adverse events (AEs) are common among hospitalized children. While clinician reports are the foundation of operational hospital safety surveillance and a key component of multifaceted research surveillance, patient and family reports are not routinely gathered. We hypothesized that a novel family-reporting mechanism would improve incident detection.

EEG slow waves in traumatic brain injury: Convergent findings in mouse and man.

Objective: Evidence from previous studies suggests that greater sleep pressure, in the form of EEG-based slow waves, accumulates in specific brain regions that are more active during prior waking experience. We sought to quantify the number and coherence of EEG slow waves in subjects with mild traumatic brain injury (mTBI).

Methods: We developed a method to automatically detect individual slow waves in each EEG channel, and validated this method using simulated EEG data.

EEG slow waves in traumatic brain injury: Convergent findings in mouse and man.

Objective: Evidence from previous studies suggests that greater sleep pressure, in the form of EEG-based slow waves, accumulates in specific brain regions that are more active during prior waking experience. We sought to quantify the number and coherence of EEG slow waves in subjects with mild traumatic brain injury (mTBI).

Methods: We developed a method to automatically detect individual slow waves in each EEG channel, and validated this method using simulated EEG data.

Low-temperature dynamic nuclear polarization of gases in Frozen mixtures.

Purpose: To present a new cryogenic technique for preparing gaseous compounds in solid mixtures for polarization using dynamic nuclear polarization (DNP).

Methods: (129) Xe and (15) N2 O samples were prepared using the presented method. Samples were hyperpolarized at 1.

Versatile pulse sequence device to conserve hyperpolarization for NMR and MRI studies.

Purpose: Levitt and co-workers have described the M2S pulse sequence which transfers between longitudinal and singlet spin order. Building on this work, we describe the construction of a portable M2S pulse sequence generator to increase the relaxation time of polarized compounds. Additionally, we investigate the efficiency of spin order transfer under conditions where physical parameters of the system are not known precisely.

Dietary therapy mitigates persistent wake deficits caused by mild traumatic brain injury.

Sleep disorders are highly prevalent in patients with traumatic brain injury (TBI) and can significantly impair cognitive rehabilitation. No proven therapies exist to mitigate the neurocognitive consequences of TBI. We show that mild brain injury in mice causes a persistent inability to maintain wakefulness and decreases orexin neuron activation during wakefulness.

Positive end-expiratory pressure increments during anesthesia in normal lung result in hysteresis and greater numbers of smaller aerated airspaces.

Background: Although it is recognized that pulmonary hysteresis can influence the effects of positive end-expiratory pressure (PEEP), the extent to which expansion of previously opened (vs. newly opening) peripheral airspaces contribute to increased lung volume is unknown.

Methods: Following a recruitment maneuver, rats were ventilated with constant tidal volumes and imaged during ascending and descending ramps of PEEP.

A variability study of regional alveolar oxygen tension measurement in humans using hyperpolarized (3) He MRI.

Purpose: A systematic study of the short-term and long-term variability of regional alveolar partial pressure of oxygen tension (pA O2 ) measurements using (3) He magnetic resonance imaging was presented. Additionally, the repeatability of the average evaluated pA O2 was compared with that of the standard pulmonary function tests.

Methods: Pulmonary function test and pA O2 imaging were performed on 4 nonsmokers (1 M, 3 F, 56 ± 1.

Imaging the interaction of atelectasis and overdistension in surfactant-depleted lungs.

Objective: Atelectasis and surfactant depletion may contribute to greater distension-and thereby injury-of aerated lung regions; recruitment of atelectatic lung may protect these regions by attenuating such overdistension. However, the effects of atelectasis (and recruitment) on aerated airspaces remain elusive. We tested the hypothesis that during mechanical ventilation, surfactant depletion increases the dimensions of aerated airspaces and that lung recruitment reverses these changes.

Determination of the singlet state lifetime of dissolved nitrous oxide from high field relaxation measurements.

Longitudinal spin relaxation due to modulation of dipolar interactions often limits the development of hyperpolarized magnetic tracers. Recently, it has been demonstrated that transferring spin order to a singlet state significantly increases the polarization lifetimes in systems where nitrous oxide is dissolved in a liquid solvent. Additionally, previous studies have suggested that the longitudinal relaxation of nitrous oxide is largely dominated by the spin-rotation interaction.

A multislice single breath-hold scheme for imaging alveolar oxygen tension in humans.

Reliable, noninvasive, and high-resolution imaging of alveolar partial pressure of oxygen (p(A)O(2)) is a potentially valuable tool in the early diagnosis of pulmonary diseases. Several techniques have been proposed for regional measurement of p(A)O(2) based on the increased depolarization rate of hyperpolarized (3) He. In this study, we explore one such technique by applying a multislice p(A)O(2) -imaging scheme that uses interleaved-slice ordering to utilize interslice time-delays more efficiently.

Regional function-structure relationships in lungs of an elastase murine model of emphysema.

Changes in lung function and structure were studied using hyperpolarized (3)He MRI in an elastase-induced murine model of emphysema. The combined analysis of the apparent diffusion coefficient (ADC) and fractional ventilation (R) were used to distinguish emphysematous changes and also to develop a model for classifying sections of the lung into diseased and normal. Twelve healthy male BALB/c mice (26 ± 2 g) were randomized into healthy and elastase-induced mice and studied ∼8-11 wk after model induction.

Cryptophane xenon-129 nuclear magnetic resonance biosensors targeting human carbonic anhydrase.

(129)Xe NMR biosensors are promising agents for early disease detection, especially when their interactions with target biomolecules can perturb (129)Xe chemical shifts well beyond the typical field inhomogeneity of clinical MRI. We introduce human carbonic anhydrase (CA) as a single-binding-site enzyme for studying xenon biosensor-protein interactions. A xenon-binding cryptophane was substituted with linkers of varying lengths to p-benzenesulfonamide to yield nondiastereomeric biosensors with a single (129)Xe NMR resonance.

Designing 129Xe NMR biosensors for matrix metalloproteinase detection.

Xenon-129 biosensors offer an attractive alternative to conventional MRI contrast agents due to the chemical shift sensitivity and large nuclear magnetic signal of hyperpolarized (129)Xe. Here, we report the first enzyme-responsive (129)Xe NMR biosensor. This compound was synthesized in 13 steps by attaching the consensus peptide substrate for matrix metalloproteinase-7 (MMP-7), an enzyme that is upregulated in many cancers, to the xenon-binding organic cage, cryptophane-A.