Simulation-Based Training in Clinical Event Debriefing Improves Leadership Performance.

Objectives: Clinical event debriefing (CED) improves healthcare team performance and patient outcomes. Most pediatric emergency medicine (PEM) physicians do not receive formal training in leading CED. Our objectives were to develop a CED curriculum and evaluate its effect on performance, knowledge, comfort, and clinical practice.

Vitamin D Deficiency and Pediatric Obstructive Sleep Apnea Severity.

Importance: Prior research has demonstrated an association between vitamin D deficiency and obstructive sleep apnea (OSA) in adults; however, its association with pediatric OSA is emerging.

Objective: To evaluate the association of vitamin D levels with obstructive Apnea-Hypopnea Index (AHI) in children with OSA.

Design, Settings, And Participants: This was a cross-sectional study of children aged 2 to 16 years with severe obstructive OSA (AHI ≥20 on polysomnogram) who were undergoing adenotonsillectomy at a tertiary care pediatric otolaryngology clinic from 2017 to 2022.

A Pulse Check on Leadership and Teamwork: An Evaluation of the First 5 Minutes of Emergency Department Resuscitation During Pediatric Cardiopulmonary Arrests.

Objectives: Effective leadership and teamwork are imperative during pediatric cardiopulmonary resuscitations (CPR). The initial phase of pediatric CPR, termed the "first 5 minutes," has significant care delivery gaps in both leadership and team performance. The aim of the study was to describe the performance data of emergency department (ED) teams who performed CPR in a pediatric ED.

An Integrative Review of the Prevalence of Depression among Pediatric Patients with Sickle Cell Disease.

Sickle cell disease (SCD), a common hematological disorder, has received increased interest from researchers who set to discover whether individuals with SCD are at risk for depression. However, the prevalence of depression varies substantially between published studies. Therefore, two aims were identified in this critical review: (1) to summarize the prevalence of depression among children and adolescents diagnosed with SCD and (2) identify if disease severity predicts rates of depression within this population.

Evaluating an Interdisciplinary EEG Initiative on In-Training Examination EEG-Related Item Scores for Anesthesiology Residents.

Purpose: Clinical neurophysiology is an evolving area of medicine with clinical applications in intensive care unit and intraoperative settings, where EEG is used. An interdisciplinary module was implemented over 7 years in one institution to strengthen anesthesiology residents' EEG education. This study researched the module's outcome by evaluating participants' specific performance on EEG-related questions (keywords) through independent testing, i.

Life After an Autism Spectrum Disorder Diagnosis: A Comparison of Stress and Coping Profiles of African American and Euro-American Caregivers.

The purpose of the present study was to understand how caregiver stress and coping behaviors impact African American and Euro-American families differently when caring for a child with autism. This study used discriminate function analysis to contrast the stress and coping profiles of Euro-American caregivers who are more acculturated with the majority culture with African American caregivers who ascribe to more traditional values. A sample of 103 families was recruited (52 Euro-American, 51 African American).

Changes in Transcranial Ultrasound Velocities in Children with Sickle Cell Disease Undergoing Adenotonsillectomy.

Objectives (1) To assess for changes in cerebral blood flow velocity in children with sickle cell disease and obstructive sleep apnea (OSA) following adenotonsillectomy. (2) To determine if clinical factors such as OSA severity affect cerebral blood flow velocity values. Study Design Case series with chart review over 10 years.

The Technology of Processed Electroencephalogram Monitoring Devices for Assessment of Depth of Anesthesia.

Commercial brain function monitors for depth of anesthesia have been available for more than 2 decades; there are currently more than 10 devices on the market. Advances in this field are evidenced by updated versions of existing monitors, development of new monitors, and increasing research unveiling the mechanisms of anesthesia on the brain. Electroencephalography signal processing forms an integral part of the technology supporting the brain function monitors for derivation of a depth-of-anesthesia index.

Feasibility of a worksheet for facilitating self-management in children with asthma.

Background: Few tools exist to facilitate recommended self-management support for children with asthma. We sought to examine the feasibility, acceptance and preliminary results of a novel worksheet designed to provide such support for children and their caregivers presenting for asthma care.

Methods: A 12-topic asthma worksheet was modeled on currently available self-management tools and based on the behavior change theory and motivational interviewing techniques.

Syringe Pump Performance Maintained with IV Filter Use During Low Flow Rate Delivery for Pediatric Patients.

Background: Complex surgical and critically ill pediatric patients rely on syringe infusion pumps for precise delivery of IV medications. Low flow rates and in-line IV filter use may affect drug delivery. To determine the effects of an in-line filter to remove air and/or contaminants on syringe pump performance at low flow rates, we compared the measured rates with the programmed flow rates with and without in-line IV filters.

A 1-Year-Old with Mycobacterium tuberculosis Endocarditis with Mass Spectrometry Analysis of Cardiac Vegetation Composition.

In this study, we report the first case of Mycobacterium tuberculosis endocarditis in an immunocompetent child born in the United States. Mass spectrometry of the vegetation identified coagulation, humoral immune proteins, neutrophil granule proteins, and histones. Few neutrophils on histopathology suggest that neutrophil extracellular traps may contribute to tuberculous endocardiac mass formation.

Expedited Delivery of Pain Medication for Long-Bone Fractures Using an Intranasal Fentanyl Clinical Pathway.

Objective: This study aims to determine whether a pathway designed to facilitate the use of intranasal (IN) fentanyl for long-bone fractures will expedite the delivery of pain medication, decrease the total length of emergency department (ED) stay, and provide faster analgesia compared with intravenous (IV) morphine.

Methods: A pain pathway for IN fentanyl in long-bone fractures was instituted in our ED in July 2011. We performed a retrospective and prospective chart review of patients aged 3 to 21 years who presented to the ED with a clinically suspected long-bone fracture and either received IV morphine or were placed on IN fentanyl pain pathway.

Prior Podcast Experience Moderates Improvement in Electroencephalography Evaluation After Educational Podcast Module.

Background: There is continued interest in using technology to enhance medical education and the variables that may affect its success.

Methods: Anesthesiology residents and fourth-year medical students participated in an electroencephalography (EEG) educational video podcast module. A 25-item evaluation tool was administered before any EEG education was provided (baseline), and the podcast was then viewed.

Hyperglycemia inhibits complement-mediated immunological control of S. aureus in a rat model of peritonitis.

Hyperglycemia from diabetes is associated with increased risk of infection from S. aureus and increased severity of illness. Previous work in our laboratory demonstrated that elevated glucose (>6 mM) dramatically inhibited S.

The impact of an interdisciplinary electroencephalogram educational initiative for critical care trainees.

Purpose: The purpose of this study is to evaluate the effectiveness of an interdisciplinary electroencephalogram (EEG) educational module for critical care training. Electroencephalogram is increasingly used for diagnosis, monitoring, and treatment decisions in critically ill patients with neurologic and nonneurologic disorders. Continuous EEG monitoring has an expanded role in the intensive care unit as an additional evaluation tool for critically ill patients with altered mental status.

Blood culture time to positivity in febrile infants with bacteremia.

Importance: Blood cultures are often obtained as part of the evaluation of infants with fever and these infants are typically observed until their cultures are determined to have no growth. However, the time to positivity of blood culture results in this population is not known.

Objective: To determine the time to positivity of blood culture results in febrile infants admitted to a general inpatient unit.

Complement regulator C4BP binds to Staphylococcus aureus surface proteins SdrE and Bbp inhibiting bacterial opsonization and killing.

Staphylococcus aureus is a premier human pathogen and the most common cause of osteoarticular, wound, and implanted device infections. We recently demonstrated S. aureus efficiently binds the classical complement regulator C4b-binding protein (C4BP) inhibiting antibody-initiated complement-mediated opsonization.

Protease inhibitors decrease IgG shedding from Staphylococcus aureus, increasing complement activation and phagocytosis efficiency.

Staphylococcus aureus is a major pathogen for immunologically intact humans and its pathogenesis is a model system for evasion of host defences. Antibodies and complement are essential elements of the humoral immune system for prevention and control of S. aureus infections.

Hypochlorite killing of community-associated methicillin-resistant Staphylococcus aureus.

We tested in vitro hypochlorite (bleach) killing of community-associated methicillin-resistant Staphylococcus aureus isolates to determine optimal concentration and duration. For all isolates maximal killing, >3-log decrease in colony forming units (CFU), was found after 5 minutes in 2.5 microL/mL bleach.