Nursing Care at End of Life in Pediatric Intensive Care Unit Patients Requiring Mechanical Ventilation.

Background: Parents' perceptions of critical care during the final days of their child's life shape their grief for decades. Little is known about nursing care needs of children actively dying in the pediatric intensive care unit (PICU).

Objectives: To examine associations between patient characteristics, circumstances of death, and nursing care requirements for children who died in the PICU.

A mixed-methods evaluation on the efficacy and perceptions of needleless connector disinfectants.

Objective: Optimizing needleless connector hub disinfection practice is a key strategy in central-line-associated bloodstream infection (CLABSI) prevention. In this mixed-methods evaluation, 3 products with varying scrub times were tested for experimental disinfection followed by a qualitative nursing assessment of each.

Methods: Needleless connectors were inoculated with varying concentrations of and followed by disinfection with a 70% isopropyl alcohol (IPA) wipe (a 15-second scrub time and a 15-second dry time), a 70% IPA cap (a 10-second scrub time and a 5-second dry time), or a 3.

Patient-perceived barriers to surgical treatment of cleft lip and palate in Brazil: A multi-region study.

Introduction: Many patients worldwide are unable to access timely primary repair of cleft lip and palate. The aim of this study was to assess patient-perceived barriers to accessing timely cleft lip and palate repair across Brazil.

Methods: A 29-item questionnaire was applied to patients undergoing surgery for cleft lip and/or palate across five contrasting sites in Brazil from February 2016 to November 2017.

Point-of-Care Ultrasound Curriculum for Endotracheal Tube Confirmation for Pediatric Critical Care Transport Team Through Remote Learning and Teleguidance.

Objective: Point-of-care ultrasound (POCUS) is used to manage patients in real time. This study aimed to teach pediatric critical care team members to use POCUS for endotracheal tube (ETT) placement confirmation. A secondary aim was to assess the feasibility of a remote curriculum for this purpose.

Presentation and outcomes of post-transplant lymphoproliferative disorder at a single institution pediatric transplant center.

Background: This study aimed to characterize features present at the time of diagnosis and describe outcomes in patients with post-transplant lymphoproliferative disorder (PTLD) following pediatric solid organ transplantation.

Methods: We performed a retrospective review of solid organ transplant patients who developed pathologically confirmed PTLD at our center from 2006 to 2016.

Results: Of 594 patients included in this study, 41(6.

High-Powered Magnet Exposures in Children: A Multi-Center Cohort Study.

Background And Objectives: High-powered magnets were effectively removed from the US market by the Consumer Product Safety Commission (CPSC) in 2012 but returned in 2016 after federal court decisions. The United States Court of Appeals for the 10th Circuit cited imprecise data among other reasons as justification for overturning CPSC protections. Since then, incidence of high-powered magnet exposure has increased markedly, but outcome data are limited.

Addressing Mistreatment of Providers by Patients and Family Members as a Patient Safety Event.

Objective: Mistreatment of health care providers (HCPs) is associated with burnout and lower-quality patient care, but mistreatment by patients and family members is underreported. We hypothesized that an organizational strategy that includes training, safety incident reporting, and a response protocol would increase HCP knowledge, self-efficacy, and reporting of mistreatment.

Methods: In this single-center, serial, cross-sectional study, we sent an anonymous survey to HCPs before and after the intervention at a 213-bed tertiary care university children's hospital between 2018 and 2019.

Improving Guidance and Maternal Knowledge Retention After Well-Newborn Unit Discharge.

Background And Objectives: In 2015, the American Academy of Pediatrics published a policy statement to provide best practices on mother-infant discharge criteria, including the delivery of anticipatory guidance to mothers of healthy newborns. In our large health system with a mix of hospital types, no standard approach to or measurement of the effectiveness of newborn discharge guidance exists. At one community well-newborn unit, we aimed to increase maternal knowledge retention of newborn guidance from 69% to 90%.

Improving Quality and Efficiency in Pediatric Emergency Department Behavioral Health Care.

Introduction: Many children with behavioral health concerns increasingly utilize the emergency department for assessment and care. These visits are increasing in frequency, length, and cost, further stressing already limited resources. To improve the quality of care in this population, we developed a multidisciplinary improvement initiative to decrease the length of stay by 10% (from 5.

A Guide to Establishing a Pediatric Neurogastroenterology and Motility Program.

The purpose of this document is to provide guidance for establishing a pediatric neurogastroenterology and motility (PNGM) program, including considerations for personnel, equipment, and physical space requirements, and business planning, from members of the neurogastroenterology and motility (NGM) Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) who have developed PNGM programs at various institutions. A business plan defining the needs for required personnel, dedicated physical space, procedures, clinical care, and equipment storage is a prerequisite. Thoughtful logistical planning should address provider schedules, clinical visits, procedure coordination, and prior authorization processes.

Current Practices in Treating Cardiomyopathy and Heart Failure in Duchenne Muscular Dystrophy (DMD): Understanding Care Practices in Order to Optimize DMD Heart Failure Through ACTION.

Cardiac disease has emerged as a leading cause of mortality in Duchenne muscular dystrophy in the current era. This survey sought to identify the diagnostic and therapeutic approach to DMD among pediatric cardiologists in Advanced Cardiac Therapies Improving Outcomes Network. Pediatric cardiology providers within ACTION (a multi-center pediatric heart failure learning network) were surveyed regarding their approaches to cardiac care in DMD.

Moving Beyond Implicit Bias in Antiracist Academic Medicine Initiatives.

The concept of implicit bias has arguably laid the groundwork for uncomfortable discussions surrounding race in academic medicine, but its effectiveness in changing racist behavior and systems remains unclear. Terms like implicit bias, while perhaps more palatable than other concepts to some, may result in confusion and divert time from meaningful reconceptualization and creation of effective antiracism initiatives. This Invited Commentary contends that the term implicit bias is inadequate for addressing racism because it is too broad; does not necessarily lead to a change in racist behaviors; assumes that racism is unconscious, aggressor-centered, and individual-focused; and implies that everyone suffers equally in a racist system.

Pediatric Web-based Video Capsule Endoscopy Curriculum: A Pilot Study to Determine the Ability to Implement a Standardized Educational Curriculum.

Unlabelled: Video capsule endoscopy (VCE) is a noninvasive modality to broadly image the gastrointestinal tract. Previously, the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition and its endoscopy committee noted a lack of standardized pediatric VCE training. It was hypothesized that a web-based curriculum could be broadly implemented and help to enhance comfort and develop VCE skills.

National Needs Assessment for a Pediatric Trauma Toolkit: General Requirements for Moderate- and High-Volume Hospitals.

Background: Optimal outcomes have been reported for children treated at pediatric trauma centers; however, most children are treated at nonpediatric trauma centers or nonpediatric general hospitals. Hospitals that are not verified or designated pediatric trauma centers may lack the training and level of comfort and skill when treating severely injured children.

Objective: This study focused on identifying common pediatric guidelines for standardization across all trauma centers to inform a pediatric trauma toolkit.

Validation of risk assessment models for venous thromboembolism and bleeding in critically ill adolescents.

Objective: To determine the performance of risk assessment models that were developed for adults, in predicting venous thromboembolism (VTE) and bleeding in critically ill adolescents.

Study Design: We conducted a retrospective cohort study of adolescents 12 to 17 years old admitted to the pediatric intensive care unit who received cardiopulmonary support but did not have VTE on admission nor received anticoagulation. Discrimination, using areas under the receiver operating characteristic (AUROC) and precision-recall (AUPRC) curves, and calibration, using Hosmer-Lemeshow test, of the Geneva, Padua, IMPROVE VTE and IMPROVE Bleed models were calculated.

Lower Gastrointestinal Functional and Motility Disorders in Children.

Functional and motility gastrointestinal disorders are the most common complaints to the pediatric gastroenterologist. Disorders affecting the small intestine carry a significant morbidity and mortality due to the severe limitation of therapeutic interventions available and the complications associated with such interventions. Congenital colorectal disorders are rare but also carry significant morbidity and poor quality of life plus the social stigma associated with its complications.

Upper Gastrointestinal Functional and Motility Disorders in Children.

Children with disorders affecting the sensory and motor functions of the esophagus will present primarily with swallowing dysfunction, dysphagia, and chest pain, and those with disorders affecting the normal function of the stomach will present with symptoms like abdominal pain, nausea, and vomiting. Recent advances in the mechanisms of disease and technology have increased our understanding of gastrointestinal physiology and that knowledge has been applied to develop new diagnostic studies and therapeutic interventions. We present an overview of the clinical presentation, diagnosis, and treatment of common primary and secondary functional and motility disorders affecting the upper gastrointestinal tract in children.

Virtual Interviewing for Pediatric Emergency Medicine Fellowship-A National Survey.

Objective: This study aimed to evaluate both applicant and interviewer satisfaction with the virtual interviewing process for pediatric emergency medicine (PEM) fellowship in hopes to improve the fellowship interviewing process. It was proposed that fellowship programs and applicants would prefer virtual interviews over traditional interviews.

Methods: A survey developed in collaboration with UT Southwestern PEM fellowship leaders and national PEM leaders was sent to all PEM fellowship applicants and programs at the conclusion of the 2020 interview season and rank list submission.

Pediatric solid tumors and associated cancer predisposition syndromes: Workup, management, and surveillance. A summary from the APSA Cancer Committee.

Background/purpose: Cancer predisposition syndromes (CPS) are a heterogeneous group of inherited disorders that greatly increase the risk of developing malignancies. CPS are particularly relevant to pediatric surgeons since nearly 10% of cancer diagnoses are due to inherited genetic traits, and CPS often contribute to cancer development during childhood.

Materials/methods: The English language literature was searched for manuscripts, practice guidelines, and society statements on "cancer predisposition syndromes in children".