The impact of clinical result acquisition and interpretation on task performance during a simulated pediatric cardiac arrest: a multicentre observational study.

Purpose: The acquisition and interpretation of clinical results during resuscitations is common; however, this can delay critical clinical tasks, resulting in increased morbidity and mortality. This study aims to determine the impact of clinical result acquisition and interpretation by the team leader on critical task completion during simulated pediatric cardiac arrest before and after team training.

Methods: This is a secondary data analysis of video-recorded simulated resuscitation scenarios conducted during Teams4Kids (T4K) study (June 2011-January 2015); scenarios included cardiac arrest before and after team training.

Adding a dose of empathy to healthcare: What can healthcare systems do?

Rationale, Aims And Objectives: Healthcare practitioners often note system-level barriers to empathy between patients and practitioners. These include burnout-inducing administrative workloads, unfriendly meeting times, burdensome protocols, lack of wellbeing spaces, and undervaluing empathy as a core part of an institution's mission. The need for empathy in healthcare has been magnified with the current SARS-COV-2 outbreak which has limited the expression of interpersonal empathy due to rigid isolation protocols and the use of personal protective equipment.

Death and Dying in Hospitalized Pediatric Patients: A Prospective Multicenter, Multinational Study.

For hospitalized children admitted outside of a critical care unit, the location, mode of death, "do-not-resuscitate" order (DNR) use, and involvement of palliative care teams have not been described across high-income countries. To describe location of death, patient and terminal care plan characteristics of pediatric inpatient deaths inside and outside the pediatric intensive care unit (PICU). Secondary analysis of inpatient deaths in the Evaluating Processes of Care and Outcomes of Children in Hospital (EPOCH) randomized controlled trial.

Improving transparent team communication with the 'Glass Door' decal communication tool: a mixed methods analysis of family and staff perspectives.

Objective: To determine the value and perspectives of intensive care unit (ICU) healthcare professionals (HCPs) and families about the Glass Door (GD) decal team communication tool.

Design: Quality improvement methodology was used to design, test and implement the GD. Uptake was measured through audit.

Effect of a Pediatric Early Warning System on All-Cause Mortality in Hospitalized Pediatric Patients: The EPOCH Randomized Clinical Trial.

Importance: There is limited evidence that the use of severity of illness scores in pediatric patients can facilitate timely admission to the intensive care unit or improve patient outcomes.

Objective: To determine the effect of the Bedside Paediatric Early Warning System (BedsidePEWS) on all-cause hospital mortality and late admission to the intensive care unit (ICU), cardiac arrest, and ICU resource use.

Design, Setting, And Participants: A multicenter cluster randomized trial of 21 hospitals located in 7 countries (Belgium, Canada, England, Ireland, Italy, New Zealand, and the Netherlands) that provided inpatient pediatric care for infants (gestational age ≥37 weeks) to teenagers (aged ≤18 years).

It Takes a Village to Move a Hospital: Simulation Improves Intensive Care Team Preparedness for a Move to a New Site.

Objectives: To evaluate in-situ simulation to prepare a PICU to move to a new, redesigned unit.

Methods: The study setting is an academic PICU. This is a cross-sectional study using in-situ simulations of common PICU admissions.

Comparison of Consent Models in a Randomized Trial of Corticosteroids in Pediatric Septic Shock.

Objectives: To describe the use of deferred and prior informed consent models in the context of a low additional risk to standard of care, placebo-controlled randomized controlled trial of corticosteroids in pediatric septic shock.

Design: An observational substudy of consent processes in a randomized controlled trial of hydrocortisone versus placebo.

Setting: Seven tertiary level PICUs in Canada.

Workload of Team Leaders and Team Members During a Simulated Sepsis Scenario.

Objectives: Crisis resource management principles dictate appropriate distribution of mental and/or physical workload so as not to overwhelm any one team member. Workload during pediatric emergencies is not well studied. The National Aeronautics and Space Administration-Task Load Index is a multidimensional tool designed to assess workload validated in multiple settings.

Biomarkers for Early Acute Kidney Injury Diagnosis and Severity Prediction: A Pilot Multicenter Canadian Study of Children Admitted to the ICU.

Objective: Acute kidney injury occurs early in PICU admission and increases risks for poor outcomes. We evaluated the feasibility of a multicenter acute kidney injury biomarker urine collection protocol and measured diagnostic characteristics of urine neutrophil gelatinase-associated lipocalin, interleukin-18, and liver fatty acid binding protein to predict acute kidney injury and prolonged acute kidney injury.

Design: Prospective observational pilot cohort study.

A Randomized Controlled Trial of Corticosteroids in Pediatric Septic Shock: A Pilot Feasibility Study.

Objective: To determine the feasibility of conducting a randomized controlled trial of corticosteroids in pediatric septic shock.

Design: Randomized, double-blind, placebo controlled trial.

Setting: Seven tertiary level PICUs in Canada.

Improved Clinical Performance and Teamwork of Pediatric Interprofessional Resuscitation Teams With a Simulation-Based Educational Intervention.

Objectives: To measure the effect of a 1-day team training course for pediatric interprofessional resuscitation team members on adherence to Pediatric Advanced Life Support guidelines, team efficiency, and teamwork in a simulated clinical environment.

Design: Multicenter prospective interventional study.

Setting: Four tertiary-care children's hospitals in Canada from June 2011 to January 2015.

An Approach to Confederate Training Within the Context of Simulation-Based Research.

Simulation-based education often relies on confederates, who provide information or perform clinical tasks during simulation scenarios, to play roles. Although there is experience with confederates in their more routine performance within educational programs, there is little literature on the training of confederates in the context of simulation-based research. The CPR CARES multicenter research study design included 2 confederate roles, in which confederates' behavior was tightly scripted to avoid confounding primary outcome measures.

The Development of a Critical Care Resident Research Curriculum: A Needs Assessment.

Background. Conducting research is expected from many clinicians' professional profile, yet many do not have advanced research degrees. Research training during residency is variable amongst institutions and research education needs of trainees are not well understood.

Steroids in fluid and/or vasoactive infusion dependent pediatric shock: study protocol for a randomized controlled trial.

Background: Physicians often administer corticosteroids for the treatment of fluid and vasoactive infusion dependent pediatric shock. This use of corticosteroids is controversial, however, and has never been studied in a pediatric randomized controlled trial (RCT). This pilot trial will determine the feasibility of a larger RCT on the role of corticosteroids in pediatric shock.

Variability in quality of chest compressions provided during simulated cardiac arrest across nine pediatric institutions.

Aim: The variability in quality of CPR provided during cardiac arrest across pediatric institutions is unknown. We aimed to describe the degree of variability in the quality of CPR across 9 pediatric institutions, and determine if variability across sites would be affected by Just-in-Time CPR training and/or visual feedback during simulated cardiac arrest.

Methods: We conducted secondary analyses of data collected from a prospective, multi-center trial.

Evaluating processes of care and outcomes of children in hospital (EPOCH): study protocol for a randomized controlled trial.

Background: The prevention of near and actual cardiopulmonary arrest in hospitalized children is a patient safety imperative. Prevention is contingent upon the timely identification, referral and treatment of children who are deteriorating clinically. We designed and validated a documentation-based system of care to permit identification and referral as well as facilitate provision of timely treatment.

Cystatin C in acute kidney injury diagnosis: early biomarker or alternative to serum creatinine?

Background: Early acute kidney injury (AKI) diagnosis is needed to pursue treatment trials. We evaluated cystatin C (CysC) as an early biomarker of serum creatinine (SCr)-AKI and an alternative to define AKI.

Methods: We studied 160 non-cardiac children in the intensive care unit (ICU).

Inflammatory myofibroblastic tumor of the aortic valves causing sudden cardiac death: a case report and review of the literature.

Cardiac inflammatory myofibroblastic tumor (IMT) is a rare entity affecting predominantly infants, children, and young adults. Although most tumors have a benign clinical course after complete surgical resection, some have significant clinical effects. We report the case of a 9-year-old girl who had sudden cardiac death as a result of occlusion of the left circumflex coronary artery.

The retrospective pre-post: a practical method to evaluate learning from an educational program.

Objectives:   Program evaluation remains a critical but underutilized step in medical education. This study compared traditional and retrospective pre-post self-assessment methods to objective learning measures to assess which correlated better to actual learning.

Methods:   Forty-seven medical students participated in a 4-hour pediatric resuscitation course.

Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: a two-center retrospective cohort study.

Introduction: In adults, small (< 50%) serum creatinine (SCr) increases predict mortality. It is unclear whether different baseline serum creatinine (bSCr) estimation methods affect findings of acute kidney injury (AKI)-outcome associations. We characterized pediatric AKI, evaluated the effect of bSCr estimation approaches on AKI-outcome associations and evaluated the use of small SCr increases to predict AKI development.

Paediatric resuscitation training--do medical students believe it should be a mandatory component of the curriculum?

Background: Resuscitation outcomes are related to care delivered by 'first responders', even for hospitalized patients. Third year medical students (clinical clerks) at McGill University are trained and certified in Advanced Cardiac Life Support (ACLS) for critically ill adult patients, but receive only minimal instruction, in the form of a brief introductory lecture, on paediatric life support.

Methods: We developed an interactive, case-based 4-h Paediatric Resuscitation Course based on the objectives and teaching methods of the Pediatric Advanced Life Support (PALS) course.

Daily estimation of the severity of multiple organ dysfunction syndrome in critically ill children.

Background: Daily evaluation of multiple organ dysfunction syndrome has been performed in critically ill adults. We evaluated the clinical course of multiple organ dysfunction over time in critically ill children using the Pediatric Logistic Organ Dysfunction (PELOD) score and determined the optimal days for measuring scores.

Methods: We prospectively measured daily PELOD scores and calculated the change in scores over time for 1806 consecutive patients admitted to seven pediatric intensive care units (PICUs) between September 1998 and February 2000.