Science of health care delivery milestones for undergraduate medical education.

Background: The changing healthcare landscape requires physicians to develop new knowledge and skills such as high-value care, systems improvement, population health, and team-based care, which together may be referred to as the Science of Health Care Delivery (SHCD). To engender public trust and confidence, educators must be able to meaningfully assess physicians' abilities in SHCD. We aimed to develop a novel set of SHCD milestones based on published Accreditation Council for Graduate Medical Education (ACGME) milestones that can be used by medical schools to assess medical students' competence in SHCD.

Ways to Write a Milestone: Approaches to Operationalizing the Development of Competence in Graduate Medical Education.

Purpose: To identify approaches to operationalizing the development of competence in Accreditation Council for Graduate Medical Education (ACGME) milestones.

Method: The authors reviewed all 25 "Milestone Project" documents available on the ACGME Web site on September 11, 2013, using an iterative process to identify approaches to operationalizing the development of competence in the milestones associated with each of 601 subcompetencies.

Results: Fifteen approaches were identified.

Emergency Video Telemedicine Consultation for Newborn Resuscitations: The Mayo Clinic Experience.

Objective: To describe the Mayo Clinic experience with emergency video telemedicine consultations for high-risk newborn deliveries.

Patients And Methods: From March 26, 2013, through December 31, 2015, the Division of Neonatal Medicine offered newborn telemedicine consultations to 6 health system sites. A wireless tablet running secure video conferencing software was used by the local care teams.

Clinical data needs in the neonatal intensive care unit electronic medical record.

Background: The amount of clinical information that providers encounter daily creates an environment for information overload and medical error. To create a more efficient EMR human-computer interface, we aimed to understand clinical information needs among NICU providers.

Methods: A web-based survey to evaluate 98 data items was created and distributed to NICU providers.

Real-time video communication improves provider performance in a simulated neonatal resuscitation.

Aim: To determine if a real-time audiovisual link with a neonatologist, termed video-assisted resuscitation or VAR, improves provider performance during a simulated neonatal resuscitation scenario.

Methods: Using high-fidelity simulation, 46 study participants were presented with a neonatal resuscitation scenario. The control group performed independently, while the intervention group utilized VAR.

Emergent thrombectomy in a neonate with an upper extremity arterial thrombus.

Case This case report is of a 39 (4/7)weeks infant who presented at the time of birth with an immobile, cyanotic right upper extremity consistent with ischemia but without evidence of gangrene. Doppler examination identified pulses in the axillary but not the brachial or radial arteries. Extremity arterial ultrasound confirmed the diagnosis of an arterial thrombosis extending from the right axillary artery to the brachial artery bifurcation.

Technology-enhanced simulation and pediatric education: a meta-analysis.

Background And Objective: Pediatrics has embraced technology-enhanced simulation (TES) as an educational modality, but its effectiveness for pediatric education remains unclear. The objective of this study was to describe the characteristics and evaluate the effectiveness of TES for pediatric education.

Methods: This review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards.

Identification of latent safety threats using high-fidelity simulation-based training with multidisciplinary neonatology teams.

Background: Latent safety threats (LSTs) are errors in design, organization, training, or maintenance that may contribute to medical errors and have a significant impact on patient safety. The investigation described in this article was conducted as part of a larger prospective, longitudinal evaluation using laboratory- and in situ simulation-based training sessions to improve technical and nontechnical skills of neonatal ICU (NICU) providers at a Level III academic NICU.

Methods: Simulations were performed in laboratory (4 scenarios per session) and in situ (1 scenario per session) settings with multidisciplinary neonatology teams.

Perceptions and practices of therapeutic hypothermia in American neonatal intensive care units.

Objective: In 2005, therapeutic hypothermia (TH) was used in few American neonatal intensive care units (NICUs) with great variability in practices. We hypothesized that TH would be used with greater frequency and uniformity today.

Study Design: We surveyed directors of 797 NICUs queried in our prior study to determine attitudes toward and practices of TH.

Maternal microchimerism in Hirschsprung's disease.

Hirschsprung's disease (HD) presents with severe constipation due to absent ganglion cells in the distal rectum. We sought to determine whether maternal chimeric cells are present in aganglionic bowel. We hypothesize that chimeric cells are part of the unfavorable microenvironment that leads to the destruction of enteric neurons in HD.

Congenital heart disease associated with selective serotonin reuptake inhibitor use during pregnancy.

Objective: To determine the risk of congenital cardiac abnormalities associated with use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy.

Patients And Methods: We conducted a retrospective review of the medical records of all pregnant women presenting at Mayo Clinic's site in Rochester, MN, from January 1, 1993, to July 15, 2005, and identified 25,214 deliveries. A total of 808 mothers were treated with SSRIs at some point during their pregnancy.

Hypothermia for the treatment of neonatal ischemic encephalopathy: is the genie out of the bottle?

Evidence suggests that hypothermia for hypoxic ischemic encephalopathy in the term neonate may decrease the risk of death or neurodevelopmental impairment. The objective of this study was to determine how hypothermia has been incorporated into practice. An anonymous survey was sent to medical directors of United States neonatal intensive care units (NICUs) in October 2005.