The article "The survival time of chocolates on hospital wards: covert observational study" studied how long chocolates lasted on hospital wards before being eaten. Researchers covertly placed chocolates in hospital wards and recorded how long they remained. On average, chocolates lasted only 75 minutes before being consumed, with large variations based on ward type and time of day. The study highlights issues around food security and integrity on hospital wards.
Influence of medicare formulary restrictions on evidence based prescribing pr...TÀI LIỆU NGÀNH MAY
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
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HOẶC
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tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
Influence of medicare formulary restrictions on evidence based prescribing pr...TÀI LIỆU NGÀNH MAY
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
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HOẶC
https://www.facebook.com/garmentspace/
https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
Pain Validity Test identifies drug seeking behavior. Stop opioid abuse. Prote...Nelson Hendler
Physician prescribing practices are under constant scrutiny. An Internet questionnaire will predict if a patient will have a medical test abnormality with 95% accuracy, and 100% if the patient will not. This Pain Validity Test can be used to detect drug seeking behavior in patients, at a far high level of accuracy than tests currently in use (34.4%-48.2% accuracy).. The Pain Validity test has been admitted as evidence in 30 cases in 9 states.
SELF MEDICATION PRACTICES FOR ORAL HEALTH PROBLEMS AMONG DENTAL PATIENTS IN B...iosrphr_editor
Introduction: Self‑ medication is commonly practiced all over the world. Self-medication is defined as the use
of medication by a patient on his own initiative or on the advice of a pharmacist or a lay person instead of
consulting a medical practitioner. The present study was aimed to estimate the prevalence of self-medication for
oral health problems among dental patients in Bengaluru city; to identify triggering factors that could influence
self-medication practices; to identify sources of medications used; to identify sources of information about
medications used; and to identify reasons for self-medication.Study Design: A Cross sectional Study.Methods:A
survey was conducted among 175 subjects among dental patients in Bengaluru city. Data were collected
through a specially designed proforma using a closed‑ ended, self‑ administered questionnaire containing 15
questions, in five sections.
Results: The prevalence of
Knowledge, Attitude and Practice of Self-Medication among Medical Studentsiosrjce
Self-medication is a common practice worldwide and the irrational use of the drugs is a major
cause of concern. Self-medication is an issue with serious global implication. The current study aimed to
determine the Knowledge, Attitude and Behavior of self-medication by medical students. A descriptive crosssectional
study was conducted among medical students currently studying first year to assess knowledge,
attitude and practice regarding self-medication in Chitwan Medical College, Bharatpur, Nepal. Seventy five
students studying in first year were selected for the study using stratified random sampling technique and data
was collected using a semi-structured self-administered questionnaire. The study finding revealed, the mean age
of 75 enrolled students was 20 years, 65.3% were in the age group of 17-20 years. Most of them were female
(72%). Seventy three point three percent belong to urban area. Prevalence rate of self-medication of one year
period seems high i.e. 84% and 68.25% in were females. The most common sources of information used by the
respondent were pharmacist (60.31%) and text book (46.03%). More than half of the respondent found to have
a good knowledge about self-medication regarding definition, adverse effect and different types of drug. The
attitude was positive towards self-medication and favored self-medication saying that it was acceptable. The
principal morbidities for seeking self-medication include cold and cough as reported by 85.7% followed by pain
76.2%, fever 73%, diarrhea 47.6% and dysmenorrheal 46%. Drugs / drugs group commonly used for selfmedication
included analgesics 75.8%, and anta-acids 53.2% and antipyretic 46.3%. Among reasons for
seeking self-medication, 79.2% felt that their illness was minor while 61.9% preferred as it is due to previous
experience. This study shows that self-medication is widely practiced among first year students of this medical
institution. There is dire need to make them aware about the pros and cons of self-medication in order to ensure
safe usage of drugs.
Objective: To evaluate the utility of a targeted lecture in improving FP awareness amongst clinicians.
Design: This is a dual institution, prospective survey-based study assessing if an educational lecture can increase the likelihood of FP consideration, discussion, and referral.
Pain Validity Test identifies drug seeking behavior. Stop opioid abuse. Prote...Nelson Hendler
Physician prescribing practices are under constant scrutiny. An Internet questionnaire will predict if a patient will have a medical test abnormality with 95% accuracy, and 100% if the patient will not. This Pain Validity Test can be used to detect drug seeking behavior in patients, at a far high level of accuracy than tests currently in use (34.4%-48.2% accuracy).. The Pain Validity test has been admitted as evidence in 30 cases in 9 states.
SELF MEDICATION PRACTICES FOR ORAL HEALTH PROBLEMS AMONG DENTAL PATIENTS IN B...iosrphr_editor
Introduction: Self‑ medication is commonly practiced all over the world. Self-medication is defined as the use
of medication by a patient on his own initiative or on the advice of a pharmacist or a lay person instead of
consulting a medical practitioner. The present study was aimed to estimate the prevalence of self-medication for
oral health problems among dental patients in Bengaluru city; to identify triggering factors that could influence
self-medication practices; to identify sources of medications used; to identify sources of information about
medications used; and to identify reasons for self-medication.Study Design: A Cross sectional Study.Methods:A
survey was conducted among 175 subjects among dental patients in Bengaluru city. Data were collected
through a specially designed proforma using a closed‑ ended, self‑ administered questionnaire containing 15
questions, in five sections.
Results: The prevalence of
Knowledge, Attitude and Practice of Self-Medication among Medical Studentsiosrjce
Self-medication is a common practice worldwide and the irrational use of the drugs is a major
cause of concern. Self-medication is an issue with serious global implication. The current study aimed to
determine the Knowledge, Attitude and Behavior of self-medication by medical students. A descriptive crosssectional
study was conducted among medical students currently studying first year to assess knowledge,
attitude and practice regarding self-medication in Chitwan Medical College, Bharatpur, Nepal. Seventy five
students studying in first year were selected for the study using stratified random sampling technique and data
was collected using a semi-structured self-administered questionnaire. The study finding revealed, the mean age
of 75 enrolled students was 20 years, 65.3% were in the age group of 17-20 years. Most of them were female
(72%). Seventy three point three percent belong to urban area. Prevalence rate of self-medication of one year
period seems high i.e. 84% and 68.25% in were females. The most common sources of information used by the
respondent were pharmacist (60.31%) and text book (46.03%). More than half of the respondent found to have
a good knowledge about self-medication regarding definition, adverse effect and different types of drug. The
attitude was positive towards self-medication and favored self-medication saying that it was acceptable. The
principal morbidities for seeking self-medication include cold and cough as reported by 85.7% followed by pain
76.2%, fever 73%, diarrhea 47.6% and dysmenorrheal 46%. Drugs / drugs group commonly used for selfmedication
included analgesics 75.8%, and anta-acids 53.2% and antipyretic 46.3%. Among reasons for
seeking self-medication, 79.2% felt that their illness was minor while 61.9% preferred as it is due to previous
experience. This study shows that self-medication is widely practiced among first year students of this medical
institution. There is dire need to make them aware about the pros and cons of self-medication in order to ensure
safe usage of drugs.
Objective: To evaluate the utility of a targeted lecture in improving FP awareness amongst clinicians.
Design: This is a dual institution, prospective survey-based study assessing if an educational lecture can increase the likelihood of FP consideration, discussion, and referral.
The presentation showcases Latest Trends in Healthcare. Featuring start-ups in online healthcare space who are using technology to deliver better healthcare and information to users.
Background of organ transplant infrastructure in the US. Some history. Definitions. Nursing Care of the transplant patient in hospital, and home settings. Intended for senior level nursing students in an ADN program
Running head CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS.docxtodd271
Running head: CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
5
CRITIQUE OF QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
Critiquing Quantitative, Qualitative, or Mixed Methods Studies
Adenike George
Walden University
NURS 6052: Essentials of Evidence-Based Practice
April 11, 2019
Critique of Quantitative, Qualitative, or Mixed Method Design
Both quantitative and qualitative methods play a pivotal role in nursing research. Qualitative research helps nurses and other healthcare workers to understand the experiences of the patients on health and illness. Quantitative data allows researchers to use an accurate approach in data collection and analysis. When using quantitative techniques, data can be analyzed using either descriptive statistics or inferential statistics which allows the researchers to derive important facts like demographics, preference trends, and differences between the groups. The paper comprehensively critiques quantitative and quantitative techniques of research. Furthermore, the author will also give reasons as to why qualitative methods should be regarded as scientific.
The overall value of quantitative and Qualitative Research
Quantitative studies allow the researchers to present data in terms of numbers. Since data is in numeric form, researchers can apply statistical techniques in analyzing it. These include descriptive statistics like mean, mode, median, standard deviation and inferential statistics such as ANOVA, t-tests, correlation and regression analysis. Statistical analysis allows us to derive important facts from data such as preference trends, demographics, and differences between groups. For instance, by conducting a mixed methods study to determine the feeding experiences of infants among teen mothers in North Carolina, Tucker and colleagues were able to compare breastfeeding trends among various population groups. The multiple groups compared were likely to initiate breastfeeding as follows: Hispanic teens 89%, Black American teens 41%, and White teens 52% (Tucker et al., 2011).
The high strength of quantitative analysis lies in providing data that is descriptive. The descriptive statistics helps us to capture a snapshot of the population. When analyzed appropriate, the descriptive data enables us to make general conclusions concerning the population. For instance, through detailed data analysis, Tucker and co-researchers were able to observe that there were a large number of adolescents who ceased breastfeeding within the first month drawing the need for nurses to conduct individualized follow-ups the early days after hospital discharge. These follow-ups would significantly assist in addressing the conventional technical problems and offer support in managing back to school transition (Tucker et al., 2011).
Qualitative research allows researchers to determine the client’s perspective on healthcare. It enables researchers to observe certain behaviors and experiences amo.
Running Head PICOT STATEMENT ON PRESSURE ULCERS1PICOT STA.docxgemaherd
Running Head: PICOT STATEMENT ON PRESSURE ULCERS
1
PICOT STATEMENT ON PRESSURE ULCERS
2
PICOT Question pressure ulcers
Student’s Name: Vladimir Andino
University Affiliation: GCU
PICOT Question
According to a report by CDC, approximately 3 million people develop pressure injuries each year. Pressure ulcers reduce the quality of quality of life. Each year a considerably large number of people are diagnosed with pressure injuries. Various ways can be used to prevent the progression of this phenomenon. This paper evaluates the most effective option that can be applied to prevent pressure injuries. It is framed based on the PICOT statement,
(P) patients with severe pressure injuries.
(I) is the surgical removal of ulcers.
(C) compared with the administration of antibiotics.
(O) more effective in treatment of pressure injuries.
(T) in the short-term medical plan.
Edlich, R., Winters, K. L., Woodard, C. R., Buschbacher, R. M., Long III, W. B., Gebhart, J. H., & Ma, E. K. (2004). Pressure ulcer prevention. Journal of long-term effects of medical implants, 14(4).
This study explicitly analyzes prevention as well as treatment actions that should be taken by nurses who carry the burden of reducing this phenomenon. The study is a qualitative study, in the sense that it does not involve an analysis of data both mathematically and graphically.
The authors use published information to support their arguments hence it is a peer-reviewed secondary study.
After evaluation, the study confirms that nurses should conduct preventative measures to reduce the effects of pressure injuries. This can be achieved by involving various types of treatment and nursing interventions to mention a few.
Bluestein, D., & Javaheri, A. (2008). Pressure ulcers: prevention, evaluation, and management. American family physician, 78(10).
. This study comprehensively evaluates the predominant factors associated with wounds. The study relies on pre-existing data.
The authors conclude that appropriate dressing is important to prevent critical health issues. It is from this point of view that the study advises on thorough check-ups and in case there are no improvement medicals procedures should be taken.
Vanderwee, K., Defloor, T., Beeckman, D., Demarré, L., Verhaeghe, S., Van Durme, T., & Gobert, M. (2011). Assessing the adequacy of pressure ulcer prevention in hospitals: a nationwide prevalence survey. BMJ Quality & Safety, 20(3), 260-267.
The study assesses the efficacy of pressure ulcer prevention in health cares. This is a primary study because the author organizes, collect and analyzes data. Also, this is a quantitative study because it statistically analyzes data.
The study confirmed that there is a limited use of proper preventions measures with respect to pressure injuries and wounds. In other words, the study confirmed that there is a rather low-quality care.
Sving, E., Gunningberg, L., Högman, M., & Mamhidir, A. G. (2012). Registered nurses’ attention t ...
SLC CME- Evidence based medicine 07/27/2007cddirks
Saint Luke's Care, a quality improvement organization within Saint Luke's Health System, presents a CME presentation by Dr. Brent Beasley on Evidence Based Medical Care.
Running Head QUANTITATIVE RESEARCH SUMMARY1QUANTITATIVE RESE.docxtodd581
Running Head: QUANTITATIVE RESEARCH SUMMARY 1
QUANTITATIVE RESEARCH SUMMARY 10
QUANTITATIVE RESEARCH SUMMARY
Student’s Name: Letzy Reyes
Institution: Grand Cayon University
Date: 06/10/2018
Nursing Practice Problem
P-(Problem) – elderly patients aged above 50 years admitted in hospital and having shown blood pressure disease signs. Patients not included in the research were pregnant women.
I-(Intervention) – the patients who are subject in this research will be subjected to therapeutic routine concerning hypertension. The blood pressure of all the patients was tested after administering hypertension medicine to the subjects. The resultant changes were recorded every day to determine the reaction and thus the group will make a conclusion.
C-(Comparison) – institutionalized quality methods will be regulated for hypertension and subjected to the group. The comparison between the groups will be done towards the end of the month in the group.
O-(Outcome) - there will be good relation between the hypertension medication and blood pressure.
T-(Time) – for the next one month the blood pressure will be monitored closely.
The nursing practice portion should be in paragraph form.
PICOT Statement
Elderly patients under hypertension medication together with pharmacological interventions can be maintained in hospitals to improve their blood pressure and with understanding the background and culture of the patients will be of great help in dealing with hypertension. Comment by Doreen Farley: Letzy, I know that this is not the PICOT question that we decided on. What happened to the PICOT?
In patients with hypertension, does the use of meditation along with pharmacological interventions compared to medications alone improve blood pressure? This was the PICOT from out last discussion on 6-1-18
This paper is supposed to be double space only. I am not sure why there is so much space in between concepts.
Introduction
Background of the study
The purpose of the study was to evaluate analyze how patients using hypertension medication along with pharmacological interventions compared to medications alone improve blood pressure. The bottom line of the study was to evaluate how different opinions on hypertension and the treatment of the disease and how such opinions differ from one place to another especially due to the difference in culture or ethnicity of these groups. In addition, the study will be evaluated on what the proposed interventions would do to improve the adherence to these groups. Comment by Doreen Farley: The study evaluated…
The proposed interventions from the research on the two articles will be of importance to the nursing field. There is the need for the nurses to connect, care and convey treatment for various groups of patients in our diverse community. These include taking treatment to patients from different ethnic and racial groups. When it comes to hypertension, nurses have been faced with challenges .
Running head PICOT STATEMENT 1PICOT STATEMENT 2.docxjeanettehully
Running head: PICOT STATEMENT 1
PICOT STATEMENT 2
PICOT Statement
Anna Uka
Grand Canyon University- NRS490
December 1st , 2019
P: Adults on an Acute Care floor
I: Required education on the Braden Scale
C: Standard Practice
O: Decrease in Hospital-Acquired Pressure Ulcers
PICOT QUESTION: Does the required education on the Braden scale increase nursing interventions for Adult patients on an acute care floor at risk of developing pressure ulcers during hospitalization?
Currently, most hospitals are faced with a clinical problem of acquired pressure ulcers. According to Pittman et al (2015), hospital-acquired pressure ulcers remain one of the persistent and relevant issues that need to be addressed in long-term hospital stay patients. Health care is attempting to implement evidence-based protocols, though patients continue to suffer from this prevalent and preventable injury. Health care institutions are facing a big challenge for the patients with this acquired condition because hospital bills continue to balloon and at the same time insurance companies stopped paying for this condition. Research shows that pressure ulcer is preventable; though, in spite of hospitals striving to integrate evidence-based approaches to curb the issue, it continues to remain a serious issue for long-term hospital stay patients. This PICOT statement this research paper is proposing to use is a Braden Scale which can be used by nurses in their practice to reduce hospital-acquired pressure injuries which will reduce the patient stay in the hospital as well as the bills burden in the hospital.
Evidence-Based
Solution
According to Engels et al (2016), “the importance of using evidence-based practice in long-term care hospitals to reduce prevalent pressure ulcers is to promote a safe cost-effective outcome for our patients, families, and the healthcare group. Research needs to be conducted and qualitative data collected when designing an evidence-based solution to hospital-acquired injuries”. Despite a lot of research being conducted from the past years concerning acquired pressure ulcers, many patients continue to get the disease. Evidence-based practice allows the nurse to get pooled in a team of experts where interdisciplinary collaboration becomes the ultimate objective for nurses to practice autonomy that enhances change in the nursing field based on data. “The nursing research utilizes qualitative and quantitative logical methods and an EBP approach aimed at around the study and change of patient consideration, understanding consideration frameworks, and patient results” (Mervis & Phillips, 2019). This PICOT question will effectively apply the Braden Scale to see how it can positively impact long-term hospital in reducing pressure ulcers injuries.
Nursing Intervention
When starting a nursing research project, ...
TEST BANK For Principles of Pediatric Nursing Caring for Children, 8th Editio...rightmanforbloodline
TEST BANK For Principles of Pediatric Nursing Caring for Children, 8th Edition by Kay Cowen; Laura Wisely, Verified Chapters 1 - 31, Complete Newest Version
Impact of health education on tuberculosis drug adherenceSkillet Tony
Adherence is defined as the extent to which patients follow the instructions they are given for prescribed treatments. Until recently, adherence expertise was hard to find, assemble and empower. The study shall solely aim at investigating the influence of patients’ health education on Tuberculosis drug adherence. It will be guided by the following specific objectives; to identify the level of adherence among TB patients at MTRH, to assess the level of patient’s health education on TB drugs, to identify barriers of TB education, to investigate the challenges facing TB patients on treatment and to determine the level of training given to health workers on TB drug adherence. These objectives will enable the researcher to elaborate more on the topic and ensure that those who read through this research shall have a better perspective on the effects of health education on tuberculosis drug adherence. It will take place between the months of July and August. The study will target 17 doctors, 119 nurses and 143 patients of Tuberculosis. The study will employ a case study research design. The case study will enable the researcher be able to collected detailed information as to the influence of patients’ health education on TB drug adherence. The study will employ purposive sampling to sample the doctors and simple random sampling to select both the nurses and the patients who will participate in the study. The researcher will use one research instrument to collect data from the respondents selected to participate in the study which is a questionnaire that will be issued to the respondents on the day of the data collection.
Similar to Pediatric Hospital Medicine Top 10 (ish) 2014 (20)
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1. The Academy of Pediatric Hospital
Medicine Articles and Sciences
Annual Awards Ceremony
July 26, 2014
Orlando, FL
Robert Dudas
Karen Wilson
2. Disclosures
Sadly, neither of us can disclose Hollywood
contacts, significant sources of slightly unethical
funding, or investments in highly profitable
medically-oriented corporations.
Bob is an editor for the Monthly Feature section
of Pediatrics
Karen is deputy editor of Hospital Pediatrics.
We promise these affiliations had nothing to do
with the large number of articles from those
journals, or any subliminal messaging the AAP
may or may not have inserted into the slides.
3. R3 Strategy
Recent, relevant, and reputable…
Wading through XXXX articles
Reviewed articles from August 2013-July 2014
Pediatrics, Hospital Pediatrics, Academic Pediatrics,
JAMAPeds, JAMA, NEJM, Journal of Pediatrics, Pediatric
Infectious Disease, Journal of Hospital Medicine, Pediatric
Emergency Care, and Chest
PubMed searches on common pediatric hospital
medicine topics:
Bronchiolitis, asthma, pneumonia, IV fluid therapy, ALTE,
GERD, osteomyelitis, chocolate, and hyperbilirubinemia
Sought the counsel of leaders in hospital medicine
Selected articles based on quality, general interest, and
potential to impact pediatric hospital medicine practice
4. Choosing wisely, our categories…
We loaded all of the article keywords in to a
database and then used a modified Delphinium
technique to identify emerging concepts for thematic
saturation and used factor analysis to create our final
categories.
Actually, it was a proprietary methodology.
We each read the abstracts of all potentially
hospitalist-related articles and chose the ones we
thought were most relevant.
5. Choosing wisely, our categories…cont.
We each read all of the articles from this list, and
scored from 1 (least relevant) to 3 (most relevant).
These scores were summed.
There were 9 articles that scored a 6, and 5 that
scored a 5; these were included in our Top 10 (ish)
These were placed in to categories with other high
scoring articles on a similar topic, to add suspense.
6. Disclaimers
All literature presented should be independently
evaluated prior to changing practice.
Just because we liked these articles doesn’t mean
you will.
We probably missed the most important pediatric
hospital medicine article of the year…and we are
very sorry.
7. The article most likely to help us Choose Wisely
And the nominees are:
1. Adam Hersh, Brian Lee, Erin Hedican, et al. Linezolid
Use in Hospitalized Children. Peds Inf. Dis. J.
2. Pranita Tamma, Alison Turnbull, Anthony Harris, et al.
Less Is More: Combination Antibiotic Therapy for the
Treatment of Gram-Negative Bacteremia in Pediatric
Patients. JAMA Peds.
3. Choosing Wisely in Pediatric Hospital Medicine.
Ricardo Quinonez, Matthew Garber, Alan Schroeder, and
13 of their friends. Journal of Hospital Medicine.
9. Relevance
Someone, somewhere, said: “Pediatric Hospitalists:
No one does nothing better than us”
Waste accounts for at least 20% of healthcare
expenditures in the US
One way to reduce waste is to eliminate practices of
unproven benefit.
ABIM-F is partnering with medical societies to
identify lists of 5 tests or therapies that physicians
and patients should question.
The Society for Hospital Medicine (SHM) joined the
Choosing Wisely campaign and supported this study.
10. Design
A diverse workgroup of 13 hospitalists was convened
and charged with identifying the tests and therapies
in pediatric hospital medicine that are most
overused.
The group was charged to maintain focus on
overuse practices that had a strong basis in
evidence, and were prevalent in practice.
The group initially proposed candidate
recommendations based on feedback from
colleagues.
Based on consensus the group reduced the list
These were evaluated using:
Exhaustive literature review on each
Input from the Listserv
11. Results
The group initially identified 20 tests and therapies:
The list was narrowed to the top 11 by consensus
A literature review was done on each to determine the
strength of evidence
A modified Delphi technique was used by the group to
score the candidate tests/treatments over two rounds.
The top 5 scoring tests/treatments were highlighted for
publication.
12. The top 5 recommendations:
Do not order chest radiographs in children with
asthma or bronchiolitis
Do not use systemic corticosteroids in children under
2 years of age with a lower respiratory tract infection.
Do not use bronchodilators in children with
bronchiolitis.
Do not treat gastroesophageal reflux routinely in
infants with acid suppression therapy
Do not use continuous pulse oximetry in children
with acute respiratory illness unless they are on
supplemental O2.
13. Category: Best article about the diagnosis that
shall not be named
And the nominees are:
1. Alan Schroeder, Jonathan Mansbach, Michelle
Stevenson, et al. Apnea in Children Hospitalized
with Bronchiolitis. Pediatrics.
2. Kelly Flett, Kristin Breslin, Patricia Braun, and
Simon Hambidge. Outpatient Course and
Complications Associated with Home Oxygen
Therapy for Mild Bronchiolitis. Pediatrics.
3. Kavita Parikh, Matthew Hall, and Stephen Teach.
Bronchiolitis Management Before and After the AAP
Guidelines. Pediatrics.
*
.
*
**
*
15. Importance
In 2006, Guidelines were released to help
standardize the treatment of bronchiolitis.
They told us everything we were doing to treat
bronchiolitis was wrong, and that we should just
stand there, and give oxygen if needed.
Skeptical about the uptake of this advice, a few
intrepid researchers used the PHIS dataset to see if
the guidelines were, in fact, followed, and if there
was a decrease in the rate of use of non-evidence
based care.
16. Design
A retrospective analysis of Pediatric Health
Information Systems (PHIS) administrative data from
41 children’s hospitals.
Data used were from November 1, 2004 to March
31, 2012.
Trends in diagnostic and treatment resource use
were compared before and after publication of the
guidelines
Segmented time-series regression analyses were
used.
Included were children 1 month to 2 years of age
with a primary discharge code for bronchiolitis
Children with CCCs, mechanical ventilation, and
LOS>10 days were excluded.
22. Conclusions and Relevance
The publication of the AAP’s 2006 guidelines on the
treatment of bronchiolitis was associated with a
reduction in diagnostic testing and medication use
that was unsupported by evidence in this sample.
Guidelines can, in fact, help to increase the
likelihood of the delivery of evidence-based care.
23. Category: Best article in Medical Education
And the nominees are:
Amy Starmer, O’Toole J, Rosenbluth G et al:
Development, Implementation, and Dissemination of
the I-PASS Handoff Curriculum: A Multisite
Educational Intervention to Improve Patient
Handoffs.
Brian Drolet, Whittle S, Khokhar M et al: Approval
and Perceived Impact of Duty Hour Regulations:
Survey of Pediatric Program Directors
Amy Starmer, Sectish T, Simon D et al: Rates of
Medical Errors and Preventable Adverse Events
Among Hospitalized Children Following
Implementation of a Resident Handoff Bundle
28. IMPORTANCE
OBJECTIVE To determine whether introduction of a
multifaceted handoff program was associated with
reduced rates of medical errors and preventable
adverse events, fewer omissions of key data in
written handoffs, improved verbal handoffs, and
changes in resident-physician workflow.
29. INTERVENTIONS
Resident handoff bundle: consisting of standardized
communication and handoff training, a verbal mnemonic,
and a new team handoff structure. On one unit, a
computerized handoff tool linked to the electronic medical
record was introduced.
Pre-intervention: separate signouts-intern to intern SAR to
SAR. No structured tool but rely upon a word based document
with synopsis, plan and “to do” list
Intervention 1: 2 hour training, SIGNOUT?, unified signout,
designated space, periodic supervision
Intervention 2: same as above plus-Name, sex, age, weight,
medical record number, location, admission date, diagnosis,
allergies, medications, intravenous access, code status,
laboratories, vital signs, and problem list. It also contained
structured fields entitled “Patient Summary”, “To Do List,” and
“Contingency Planning” with free-text format
30. Horwitz LI, Moin T, Green ML. Development
and implementation of an oral sign-out skills
curriculum. J Gen Intern Med. 2007;22(10):1470-
1474.
31. Prospective intervention study of patient admissions involving pediatric resident
physicians from July-September 2009 and November 2009-January 2010 on 2
inpatient units at Boston Children’s Hospital.
Primary outcomes - rates of medical errors and preventable adverse events
Secondary outcomes - omissions in the printed handoff document and resident
time-motion activity
Design and Outcomes
32. RESULTS
A total of 1255 patient admissions (n = 642 preintervention; n = 613
postintervention) were reviewed for the presence of medical errors.
Medical errors decreased from 33.8 per 100 admissions (95%CI, 27.3-
40.3) to 18.3 per 100 admissions (95%CI, 14.7-21.9; P < .001), and
preventable adverse events decreased from 3.3 per 100 admissions
(95%CI, 1.7-4.8) to 1.5 (95%CI, 0.51-2.4) per 100 admissions (P = .04)
following the intervention.
There were fewer omissions of key handoff elements on printed handoff
documents, especially on the unit that received the computerized handoff
tool (significant reductions of omissions in 11 of 14 categories with
computerized tool; significant reductions in 2 of 14 categories without
computerized tool).
Physicians spent a greater percentage of time in a 24-hour period at the
patient bedside after the intervention 8.3% (95%CI 7.1%-9.8%) vs
10.6%(95%CI, 9.2%-12.2%; P = .03).
The average duration of verbal handoffs per patient did not change. Verbal
handoffs were more likely to occur in a quiet location (33.3%; 95%CI, 14.5%-
52.2%vs 67.9%; 95%CI, 50.6%-85.2%; P = .03) and private location (50.0%;
35. CONCLUSIONS AND RELEVANCE
Implementation of a handoff bundle was associated
with a significant reduction in medical errors and
preventable adverse events among hospitalized
children.
Improvements in verbal and written handoff
processes occurred, and resident workflow did not
change adversely.
37. Category: Best Nursery article
Cora Peterson, Ailes E, Riehle-Colarusso T et al:
Late Detection of Critical Congenital Heart Disease
Among US infants
John Kelleher, Bhat R, Salas A et al:
Oronasopharyngeal suction versus wiping of the
mouth and nose at birth: a randomised equivalency
trial
David Chalmers, Wiedel C Siparsky G et al:
Discovery of Hypospadias during Newborn
Circumcision Should Not Preclude Completion of the
Procedure
41. Importance
Congenital heart defects affect approximately 1% of
live births in the United States; 25% are considered
critical congenital heart disease (CCHD) (defined as
requiring surgery or catheterization at or before age
1 year)
Screening for CCHD was added to the US
Recommended Uniform Screening Panel for
Newborns in 2011.
Screening performed using pulse oximetry.
Screening recommended within 24-48 hours of birth.
42. Study Objectives
To estimate the proportion of US infants with clinically
validated, nonsyndromic, screening-detectable CCHD
whose condition was detected late (>3 days after birth).
To investigate clinical and demographic factors
associated with late detection.
43. Design
Study Design: National Birth Defects Prevention Study
(NBDPS).
Ongoing, population-based, case-control study of >30 major
birth defects.
CCHD confirmed by echocardiography, catheterization,
surgery, or autopsy.
Setting
Infants born from January 1, 1998, through December 31,
2007.
Mothers lived in sampled states (Arkansas, California, Georgia,
Iowa, Massachusetts, New Jersey, New York, North Carolina,
Texas, Utah) at time of delivery.
Outcome: Late CCHD detection.
No evidence of diagnostic echocardiography prenatally or ≤3
days of birth.
47. Implications
Estimated 30% of live-born infants with
nonsyndromic CCHD in the NBDPS were diagnosed
>3 days after birth.
Varied substantially by CCHD type from 8% (pulmonary
atresia) to 62% (coarctation of the aorta).
Many infants with CCHD might benefit from
screening through pulse oximetry before birth
hospital discharge.
Whether these infants are actually detected through
screening is likely to vary by a number of factors,
including CCHD type and the presence of extracardiac
defects.
Future studies of routine screening in practice might
48. Category: Best article about pneumonia
Derek Williams, Hall M, Shah S et al: Narrow vs.
Broad-spectrum Antimicrobial Therapy for Children
Hospitalized with Pneumonia
Rachael Ross, Hersh A, Kronman M, et al: Impact of
Infectious Diseases Society of America/Pediatric
Infectious Diseases Society Guidelines on Treatment
of Community-Acquired Pneumonia in Hospitalized
Children
Queen Mary, Myers A, Hall M, et al: Comparative
Effectiveness of Empiric Antibiotics for Community-
Acquired Pneumonia
50. IMPORTANCE Broad-spectrum antibiotics are
frequently used to empirically treat children
hospitalized with community-acquired pneumonia
despite recent national recommendations to use
narrow-spectrum antibiotics.
OBJECTIVE to compare the effectiveness of empiric
therapy with narrow spectrum antibiotics with empiric
therapy with broad-spectrum antibiotics in children
hospitalized with uncomplicated CAP.
54. Conclusions and Relevance
Compared with broad-spectrum agents, narrow-
spectrum antibiotic coverage is associated with
similar outcomes.
Royalty are an untapped source of potential medical
researchers.
55. Best article about chocolate
Hanks AS, Just DR, Wansink B. Chocolate milk
consequences: a pilot study evaluating the
consequences of banning chocolate milk in school
cafeterias. PLoS One.
Gajendragadkar PR, Moualed DJ, Nicolson PL, et al.
The survival time of chocolates on hospital wards:
covert observational study. BMJ.
Collodel G, Moretti E, Del Vecchio MT, et al. Effect
of chocolate and Propolfenol on rabbit
spermatogenesis and sperm quality following
bacterial lipopolysaccharide treatment. Syst. Biol.
Reprod. Med.
57. Methods
Multicentre prospective covert observational study
Setting: 4 wards at 3 hospitals
Subjects: Boxes of Quality Street and Roses candy
and those eating said candy
Main outcome measure: median survival time of a
chocolate
63. Conclusions
The median survival time of a chocolate on the
wards was 51 minutes.
Frequency of chocolate delivery on the wards should
be increased to account for demand, even in an era
of cost-reduction.
Chocolate box shrinkage should be vigorously fought
.
It is not good to be a chocolate in the hospital.
64. Category: Best article about Serious Bacterial
Infections. Seriously.
And the nominees are:
Tara Greenhow, Hung Y, Herz A et al: The Changing
Epidemiology of Serious Bacterial Infections in
Young Infants
James Laham, Breheny P, gardner B, et al:
Procalcitonin to Predict Bacterial Coinfection in
Infants With Acute Bronchiolitis
Jamie Librizzi, McCulloh, R, Koehn K, et al:
Appropriateness of Testing for Serious Bacterial
Infection in Children Hospitalized With Bronchiolitis
*
66. IMPORTANCE 200,000 annual hospitalizations for
OBJECTIVE to evaluate provider practice patterns
for evaluation of SBI in patients hospitalized with
and to assess the association of SBI testing with
LOS and ABX usage
*
*
*
67. Design
A retrospective chart review of hospitalized patients
<24 months of age with a discharge diagnosis of
from 2 separate study sites (Rhode Island and
Missouri) during 2004 to 2008
Exclusions: lack discharge diagnosis of blitis or was
initially admitted to ICU
*
71. Conclusions and Relevance
SBI is uncommon in children hospitalized for , and
urinary tract infection is the most common diagnosis.
In the evaluation of SBI in , providers more
frequently obtain blood cultures than urinalysis
and/or urine cultures.
Evaluation for SBI is associated with increased
antibiotic use (more than half of them) and increased
LOS.
…since we’re putting in an IV we might as well….
Remember 200,000 annual hospitalizations quickly
adds up to lots of $$
*
*
73. Richard Smith
Editor of the BMJ until 2004
• “The poor quality of much medical research is widely
acknowledged, yet disturbingly the leaders of the
medical profession seem only minimally concerned
about the problem and make no apparent efforts to find a
solution.”
3/10/2014Footer Text
74. "We need to get away from the notion, proven wrong on a daily basis, that peer
review of any kind at any journal means that a work of science is correct. What it
means is that a few (1-4) people read it over and didn't see any major problems.
That's a very low bar in even the best of circumstances.“
Michael Eisen, a biologist at UC Berkeley, is a co-founder of the Public Library of Science
75. Category: Fluid Management
And the nominees are:
1. Jinjing Wang, Erdi Xu, and Yanfeng Xiao. Isotonic
versus Hypotonic Maintenance IV Fluids in
Hospitalized Children: A Meta-Analysis. Pediatrics
2. Francis Carandang, Andrew Anglemyer,
Christopher Longhurst, et al. Association between
Maintenance Fluid Tonicity and Hospital-Acquired
Hyponatremia. J. Pediatr.
3. Ed Oakley, Meredith Borland, Jocelyn Neutze, and
9 other friends from the Paediatric Research in
Emergency Departments International Collaborative
(PREDICT). Nasogastric hydration versus
intravenous hydration for infants with Bronchiolitis: a
Randomised Trial. Lancet.
77. Importance
Maintenance IV fluids maintain homeostasis when
patients are unable to take in water, electrolytes, and
energy.
The Holliday and Segar method has traditionally
been used to calculate fluid and electrolyte needs,
but it may underestimate electrolyte needs for
hospitalized children, especially those prone to
SIADH
There has been increasing concern about the
potential for iatrogenic hyponatremia in patients
receiving hypotonic IV fluids such as ¼ or ½ normal
saline.
This study is a meta-analysis of the most recent
78. Design
Meta-analysis using the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) statement
Multiple databases and reference lists searched for relevant
articles
2 authors independently screened all titles and abstracts
Included: RCTs, hospitalized children 1 month-17 years, and
comparing isotonic (NS or LR), to hypotonic (.45%/.3%/.18%
NS)
Primary outcome was NA<136 mmol/L
Methodologic quality assessed with Cochrane risk-of-bias tool
Relative risks, mean differences, and CIs were pooled
A random-effects model was used
Sensitivity analysis was done where biases were identified
Heterogeneity was determined using I2 statistic
The lower the I2 percent, the less variability between the studies
that can’t be explained by chance
Analyses done in RevMen 5.1
80. Results
The risk of bias tool identified potential issues in all of the
studies, which were addressed in subsequent sensitivity
analyses where possible.
Overall, the RR of hyponatremia with hypotonic fluids vs.
isotonic fluids was 2.24 (95% CI 1.58-3.37; I2=14%).
The RR of severe hyponatremia (Na<130 mmol/L) was
5.29; 95% CI 1.74-16.06; I2=0%.
The fall in pNa was significantly greater in children
receiving hypotonic IV fluids (3.49 mmol/L; 95% CI 5.63-
1.35; p<.001; I2=87%).
There were no differences between the groups in
hypernatremia (RR .73; 95% CI .22-2.48; I2=0%)
These results held up with sensitivity analyses.
81. Conclusions and Relevance
Isotonic fluids are less likely to cause hyponatremia
than hypotonic fluids in hospitalized children.
Isotonic fluids are not more likely to cause
hypernatremia.
However there were still methodological concerns
with most of the included RCTs.
Is there a better way?
83. Importance
Many children admitted with that diagnosis are
unable to take in enough fluids by mouth to stay
hydrated
In many institutions, IV fluid hydration is the default.
However IV fluid is a medication (see last article)
and can have negative effects
Naso-gastric hydration may be a more physiologic
approach.
84. Design
Multi-centre randomized trial of infants 2-12 months
of age in Australia and New Zealand.
Diagnosis of bronchiolitis
Randomly allocated to receive NG or IV hydration
Primary outcome was length of stay
Secondary outcomes included rates of ICU
admission, adverse events, and success of insertion.
750 infants would give 80% power to detect a
difference of 10-14 hours in length of stay between
groups at α=.05.
Intention to treat
T-tests, Kaplan-Meier curves, using Stata 11.1.
89. Conclusions and Relevance
This was a nicely done RCT with sufficient power to
detect differences.
There were no differences in length of stay, ICU
admission, or adverse events between the two
groups
NG insertion was more likely to be successful than
IV insertion.
Parents were equally satisfied.
Consider NG hydration first!
91. Alternatives to the handshake
The familiar hand wave
Right palm over the heart
The bow
The Namaste
The wai gesture
The salaam
Interestingly, no mention of the fist bump or the high
five
92.
93. Best RCT about nebulized saline
1. Wu S, Baker C, Lang M, et al. Nebulized
Hypertonic Saline for Bronchiolitis: A Randomized
Clinical Trial. JAMA Peds.
2. Florin T, Shaw K, Kittick M, et al. Nebulized
Hypertonic Saline for Bronchiolitis in the Emergency
Room: A Randomized Clinical Trial. JAMA Peds.
3. Jonathan Jacobs, Megan Foster, Jim Wan, and
Jay Pershad. 7% Saline in Bronchiolitis. Pediatrics.
94. Best RCT on nebulized saline
3/10/2014Footer Text
*
96. Design
Double-blind randomized clinical trial comparing 3%
saline with .9% saline
Recruited in the ED; treated in the ED and after
admission
Pre-dosed with albuterol
3 bronchiolitis seasons in 2 CA hospitals
Age <24 months, no prior wheeze
Outcome measures:
Hospital admission rate
Respiratory Assessment Change Score:
30 minutes post-treatment
Respiratory Distress Assessment Instrument (RDAI)
Respiratory parameters
Length of stay
97. Analysis
Intention to treat analysis
Χ2 and t-tests used for bivariate comparisons
Logistic and multivariate linear regression for
treatment effects
Controlling for demographic and clinical confounders
Analyses done in SPSS
98.
99. Results
Hospital admission rates were 42.6% for NS vs.
28.9% for HS (p<.01); adjusted OR .49 (.28-.71).
There were no differences in RDAI, RACS, or LOS
No differences in study withdrawal or complications
However there were significant differences by site
Primarily Hispanic population
100. Best other RCT on nebulized saline
3/10/2014Footer Text
*
101. Design
Double-blind randomized clinical trial comparing 3%
saline with .9% saline
Recruited in the ED; treated in the ED
After nasal suctioning and a trial of albuterol
2 bronchiolitis seasons in 1 PA hospital
Age 2 months to <24 months, no prior wheeze
Outcome measures:
Hospital admission rate
Respiratory Assessment Change Score:
1 hour post treatment
Respiratory Distress Assessment Instrument (RDAI)
Respiratory parameters
Clinical parameters
Parent perceptions
102. Analysis
Intention to treat analysis
Χ2 and t-tests used for bivariate comparisons
Median differences analyzed using Mann-Whitney
test.
Analyses done in Stata v.12
106. Take home points
These were both well done RCTs using very similar
methods in similar populations, that found divergent
results.
Editorial
107. Category: NUMBER 1
And the nominees are:
Diana Averbuch, Nir-Paz R, Tenenbaum A et al.
Factors Associated with Bacteremia in young Infants
with Urinary Tract Infection
RIVUR Trial Investigators: Antimicrobial Prophylaxis
for Children with Vesicoureteral Reflux.
Susanna Hernandez-Bou, Trenchs V, Alarcon, et al:
Afebrile Very Young Infants With Urinary Tract
Infection and the Risk for Bacteremia
109. Importance
Children with febrile urinary tract infection commonly
have vesicoureteral reflux (30-40%)
The utility of antimicrobial prophylaxis to prevent
recurrences in children with reflux remains
controversial
110. Design
2 year, 19 site, randomized, double blind, placebo-
controlled
2-71 months of age with grade I-IV vesicoureteral
reflux
Trimethoprim-sulfamethoxazole vs placebo
OUTCOME(S):
Primary: recurrence over 2 years
Secondary:
Renal scarring
Failure of prophylaxis
Antimicrobial resistance
112. Relevance/Importance
Bactrim prophylaxis in children less than 6 years
with VUR diagnosed after UTI is associated with a
decrease in the risk of UTI recurrence
Rates of renal scarring were the SAME in both
groups
113. Final thoughts
A special thanks to the authors and contributors who
have been such great sports through this process.
And huge thank you to our ‘people” Samantha and
Kris for shepherding us through this process.
And a big raspberry to the planning committee who
coerced us into this