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Spence MC, Sugarman A, Uong A, Bhuiyan M, Neugut YD, Asas KD, Fernandes DM, Broder M, Hametz PA, McCabe ME. Academic Half Day Improves Resident Perception of Education Without Compromising Patient Safety. Acad Pediatr 2024:S1876-2859(24)00060-3. [PMID: 38373579 DOI: 10.1016/j.acap.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Residency programs are required to offer a didactic curriculum and protect resident time for education. Our institution implemented an academic half day (AHD) in the 2021-2022 academic year to address issues related to the standard noon conference series. OBJECTIVE Determine the impact of AHD implementation on education, patient safety, and workflow. METHODS This was a prospective, single-site educational intervention study. Pre- and post-implementation surveys and Accreditation Council for Graduate Medical Education (ACGME) surveys assessed changes in trainee and faculty attitudes and behaviors. Patient safety and workflow were evaluated by comparing the number of safety event reports, rapid response team activations, time to admission from the ED, and time of discharge on AHD days compared to other weekdays. RESULTS Survey response rates were: residents 68%/48%, fellows 42%/35%, and faculty 59%/29%. AHD was associated with a significant, positive change in resident attitudes and experiences and on ACGME survey items. On AHDs compared with other weekdays, there were no significant differences in safety event report rates (P = .98), nor in rapid response team activation rates (P = .99). There was not a clinically meaningful difference in median admission time from the ED on AHD weekdays (125 minutes) compared to other weekdays (130 minutes, P = .04). There was no significant difference in median discharge time on AHD vs other weekdays (P = .13). CONCLUSIONS This study suggests that there is no significant difference in patient safety or workflow with the implementation of AHD. This study supports prior studies that residents strongly prefer AHD. AHD may be a useful framework for resident education without compromising patient care.
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Affiliation(s)
- Matthew C Spence
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, NY.
| | - Ariel Sugarman
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, NY
| | - Audrey Uong
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, NY
| | - Mariam Bhuiyan
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, NY
| | - Y Dana Neugut
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, NY
| | - Kathleen D Asas
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, NY
| | - Danielle M Fernandes
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, NY
| | - Molly Broder
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, NY
| | - Patricia A Hametz
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, NY
| | - Megan E McCabe
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, NY
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Shah SH, Woolf AD, Manning K, Holder-Niles F, Tully B, Flanagan S, Spence MC, Hauptman M. The more you know: Insights from integrated pre-visit surveys in a pediatric environmental health center. Int Public Health J 2023; 15:297-306. [PMID: 38362063 PMCID: PMC10868725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
The Pediatric Environmental Health Center (PEHC) at Boston Children's Hospital is a specialty referral clinic that provides consultation for approximately 250 patients annually. Identifying environmental hazards is key for clinical management. Exposure concerns include lead, mold, pesticides, perfluoroalkyl substances (PFAS), impaired air quality, and more. Our goal was to identify concerns and visit priorities of our patient population to guide visits. A 47-question pre-visit survey was created exploring potential environmental hazards and administered prior to visits using a platform integrated into the electronic medical record (EMR). The study group was a convenience sample of patients from June 2021 to June 2022. Of 204 total visits, 101 surveys were submitted, yielding a response rate of 49.5%. 66/101 (65.3%) were surveys from initial consultations used for descriptive analysis. The majority of patients were seen for a chief complaint of lead exposure (90.1%). Most respondents had concerns about peeling paint (40.0%), and those reporting peeling paint were more likely to report additional concerns [75.0%, p < 0.001]. Other concerns highlighted were mold (15.2%), pests (15.2%), asbestos (10.6%), air pollution (9.1%), temperature regulation (7.6%), pesticides (6.1%), PFAS (4.5%), and formaldehyde (4.5%). A knowledge gap was identified; 45.5% (30/66) respondents responded "no" to the question asking if the Poison Control Center phone number was stored in their phone. This study illustrates how the implementation of a pre-visit EMR integrated survey engages families, informs clinical care, and serves as a point-of-care education tool for specific knowledge gaps. Findings will guide development of future environmental health screeners.
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Affiliation(s)
- Shalini H Shah
- Pediatric Environmental Health Center, Boston Children’s Hospital, Boston, Massachusetts, USA
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Alan D Woolf
- Pediatric Environmental Health Center, Boston Children’s Hospital, Boston, Massachusetts, USA
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly Manning
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts, USA
| | - Faye Holder-Niles
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Bridget Tully
- Pediatric Environmental Health Center, Boston Children’s Hospital, Boston, Massachusetts, USA
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Shelby Flanagan
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew C Spence
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts, USA
| | - Marissa Hauptman
- Pediatric Environmental Health Center, Boston Children’s Hospital, Boston, Massachusetts, USA
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Fill JA, Brandt JT, Wiedemann HP, Rinehart BL, Lindemann CF, Komara JJ, Bowsher RR, Spence MC, Zeiher BG. Urinary desmosine as a biomarker in acute lung injury. Biomarkers 2006; 11:85-96. [PMID: 16484139 DOI: 10.1080/13547500500343225] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Acute lung injury (ALI) is a complex disorder associated with an acute inflammatory response thought to contribute to tissue injury. Desmosine, a cross-linking amino acid present in elastin, is released during matrix degradation and cleared by the kidney. Results from animal models and human disease studies have suggested that ALI is associated with the release of desmosine, resulting in increased urinary desmosine. A radioimmunoassay was used to monitor urinary desmosine levels over 10 days in ten patients with ALI. The concentration of desmosine was measured with and without acid hydrolysis. Baseline urinary desmosine was increased in two of ten patients. The concentration of desmosine at baseline did not appear to be related to age, gender, neutrophil elastase (NE)/alpha(1)-antiprotease complex concentration or P(a)O(2)/F(i)O(2) ratio. No meaningful changes in desmosine levels were noted after removal from mechanical ventilation. Baseline desmosine concentrations did not appear to correlate with the risk of death. The limited sensitivity, predictive correlations and dynamic modulation would suggest that urine desmosine has a limited role as a biomarker for ALI. Hydrolysis of urine samples appears necessary for optimal measurement of urine desmosine.
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Affiliation(s)
- J A Fill
- Eli Lilly and Co, Lilly Corporate Center, Indianapolis, IN 46285, USA.
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Main ML, Foltz D, Firstenberg MS, Bobinsky E, Bailey D, Frantz B, Pleva D, Baldizzi M, Meyers DP, Jones K, Spence MC, Freeman K, Morehead A, Thomas JD. Real-time transmission of full-motion echocardiography over a high-speed data network: impact of data rate and network quality of service. J Am Soc Echocardiogr 2000; 13:764-70. [PMID: 10936820 DOI: 10.1067/mje.2000.106075] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
UNLABELLED With high-resolution network transmission required for telemedicine, education, and guided-image acquisition, the impact of errors and transmission rates on image quality needs evaluation. METHODS We transmitted clinical echocardiograms from 2 National Aeronautics and Space Administration (NASA) research centers with the use of Motion Picture Expert Group-2 (MPEG-2) encoding and asynchronous transmission mode (ATM) network protocol over the NASA Research and Education Network. Data rates and network quality (cell losses [CLR], errors [CER], and delay variability [CVD]) were altered and image quality was judged. RESULTS At speeds of 3 to 5 megabits per second (Mbps), digital images were superior to those on videotape; at 2 Mbps, images were equivalent. Increasing CLR caused occasional, brief pauses. Extreme CER and CDV increases still yielded high-quality images. CONCLUSIONS Real-time echocardiographic acquisition, guidance, and transmission is feasible with the use of MPEG-2 and ATM with broadcast quality seen above 3 Mbps, even with severe network quality degradation. These techniques can be applied to telemedicine and used for planned echocardiography aboard the International Space Station.
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Affiliation(s)
- M L Main
- Cardiovascular Imaging Center, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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