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Ponnapakkam A, Krick J, Brink H, Koslow E, Cervero R, Martin PC. Conceptualizing and Developing Competence in Newborn Medicine Among Military Pediatricians. Mil Med 2024:usae318. [PMID: 38894667 DOI: 10.1093/milmed/usae318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/25/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION Competence in neonatal care is especially important for military pediatricians because military pediatricians can be asked to serve in remote duty locations with limited resources. We sought to understand how this competence is defined, developed, and assessed by military pediatric training programs. MATERIALS AND METHODS After Institutional Review Board approval was obtained, we interviewed educators and recent graduates from every pediatric military training program to construct a shared definition of competence. We then used Kern's Six Steps for curriculum development to understand how competence is taught and assessed. RESULTS Participants felt that competence for military pediatricians in the neonatal setting meant that learners should be able to provide a full spectrum of newborn care in any military setting. Participants confirmed that this competence was particularly important for military pediatricians because of the possibility of remote duty locations. Participants felt that specific knowledge, skills, and attitudes supported competence. Knowledge domains include distinguishing normal newborns from abnormal newborns, managing normal newborn care, managing common newborn abnormalities, and creating a safe escalation plan for complicated or uncommon newborn abnormalities. Specific skills that support competence are newborn resuscitation, delivery of effective ventilation, and neonatal circumcision. Specific attitudes that support competence are, understanding the personal limits of knowledge and understanding the resources for escalation of care. Educators use a variety of modalities to teach toward competence, including the structured curricula, bedside teaching, and simulation. According to participants, the assessment of learners occurs primarily through narrative assessment and feedback but would ideally occur through direct observation. CONCLUSIONS Competence in the neonatal setting is particularly important for military pediatricians. Essential skills undergo differential assessment and current assessment methods differ from ideal assessment methods. Future work should focus on how these facets can support a unified curriculum in newborn medicine.
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Affiliation(s)
- Adharsh Ponnapakkam
- Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Jeanne Krick
- Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Hannah Brink
- Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Elizabeth Koslow
- Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Ronald Cervero
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Paolo C Martin
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Hadfield BR, Sawyer T, Moreira AG, Farner R, Vasquez MM. Rapid cycle deliberate practice improves resident performance during ELBW resuscitation. J Neonatal Perinatal Med 2024; 17:31-40. [PMID: 38217617 DOI: 10.3233/npm-230102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
BACKGROUND Neonatal Resuscitation is a required competency for pediatric and family medicine residency programs. Simulation-based training can be used to supplement clinical experience. Rapid Cycle Deliberate Practice (RCDP) has been validated as an effective education model and is gaining favor over traditional simulation models. The aim of this study was to evaluate the effectiveness of a simulation-based rapid cycle deliberate practice (RCDP) intervention on extremely low birth weight (ELBW) infant resuscitation. METHODS Pediatric and family practice residents were randomized to control and intervention groups and participated in pre- and post-NICU rotation simulations. The intervention group received one RCDP session. Simulations were scored by blinded video review for overall performance, positive pressure ventilation (PPV), endotracheal intubation and behavioral skills. Surveys assessed confidence in ELBW resuscitation. RESULTS Forty-one residents participated in the study. The RCDP group performed better than the control group at post-rotation evaluation for overall resuscitation performance (65% vs 87%, p = 0.004), administering PPV (63% vs 88%, p = 0.006), and validated behavior skills (1.4 vs 2.0, p = 0.019). Residents in the RCDP group reported greater confidence with ELBW resuscitation. CONCLUSION An educational intervention using RCDP was associated with improved resident performance and confidence in ELBW resuscitation. RCDP should be considered for NRP and ELBW resuscitation training.
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Affiliation(s)
- B R Hadfield
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - T Sawyer
- Department of Pediatrics, Division of Neonatology, Seattle Children's Hospital, Seattle, WA, USA
| | - A G Moreira
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - R Farner
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - M M Vasquez
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Haviland C, Lucas A, Chen YC, Paolino J, Dzara K, Frey-Vogel AS. Simulated Umbilical Venous Catheter Placement Improves Resident Competence and Confidence. Cureus 2020; 12:e10810. [PMID: 33163314 PMCID: PMC7641490 DOI: 10.7759/cureus.10810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/05/2020] [Indexed: 11/05/2022] Open
Abstract
Background Pediatric ACGME (Accreditation Council for Graduate Medical Education) requirements include demonstrated competence in umbilical line placement. Given a waning number of these procedures clinically available to residents, new methods of procedural teaching must be employed. We developed a simulation-based strategy, using adult-learning principles, to teach umbilical venous catheter (UVC) placement to pediatric residents. We also determined whether procedural teaching via simulation increased confidence and competence among pediatric residents in performing the procedure. Methods Out of 23 first-year pediatric residents, eight participated in the study. Participants completed a survey evaluating their self-perceived competence and confidence in umbilical line placement. Their simulated umbilical line placement was assessed using a standardized checklist. Residents were then trained on simulated line placement in small groups by neonatologists. Six months later, residents completed a post-training survey and were assessed while placing simulated lines. Statistical analysis was completed using a paired t-test for parametric data, Wilcoxon signed-rank sum test for non-parametric data, and McNemar's chi-squared test for categorical data. Spearman's correlation was used for ordinal variables and Pearson's correlation was used for continuous variables. Results Nine PGY-1 (post-graduate year-1) residents completed the pre-training survey and simulation, while eight residents completed the post-training survey and simulation. There was an increase in resident confidence in placing umbilical lines six months after completion of the training session (p = 0.015) even though there was no difference in the number of umbilical lines that residents had placed in the intervening time. The residents performed a greater number of steps correctly after the training compared to their performance before the training (p=0.001). There was a statistically significant positive correlation between resident confidence and the number of steps performed correctly (rs(14)= 0.649, p = 0.006). There was no correlation between confidence and the number of umbilical lines placed on live subjects. Conclusion A teaching strategy that allows pediatric residents to struggle to perform UVC placement in a simulated setting, before receiving expert instruction, is effective at increasing their confidence and competence, even in the absence of exposure to human subjects.
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Affiliation(s)
| | | | - Yih-Chieh Chen
- Division of Allergy and Clinical Immunology, Jeff and Penny Vinik Center for Allergic Diseases Research, Brigham and Women's Hospital, Boston, USA
| | - Jonathan Paolino
- Cancer and Blood Disorders Center, Dana-Farber/Boston Children's Hospital, Boston, USA
| | - Kristina Dzara
- Brigham Education Institute, Brigham and Women's Hospital, Boston, USA
- Pediatrics and Obstetrics and Gynecology, Massachusetts General Hospital, Boston, USA
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Kane SK, Lorant DE. Creation and Validation of Tool to Assess Resident Competence in Neonatal Resuscitation. Acad Pediatr 2019; 19:394-398. [PMID: 30273690 DOI: 10.1016/j.acap.2018.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 08/12/2018] [Accepted: 09/10/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND The American Board of Pediatrics requires that pediatricians be able to initiate stabilization of a newborn. After residency, 45% of general pediatricians routinely attend deliveries. However, there is no standard approach or tool to measure resident proficiency in newborn resuscitation across training programs. In a national survey, we found a large variability in faculty assessment of the amount of supervision trainees need for various resuscitation scenarios. Objective documentation of trainee performance would permit competency-based decisions on the level of supervision required and facilitate feedback on trainee performance. METHODS A simplified tool was created following the Neonatal Resuscitation Program (NRP) algorithm, with emphasis on communication, leadership, knowledge of equipment, and initial stabilization. To achieve content validity, the tool was evaluated by the NRP steering committee. To assess internal structure of the tool, we filmed 10 simulated resuscitation scenarios, 9 of which contained errors. Experienced resuscitation team members used the tool to assess performance of the team leader in the videos. To evaluate the response process, the tool was used to assess experienced resuscitators in real time at academic and non-academic sites. RESULTS The NRP steering committee approved the tool, providing evidence of content validity. Performance of the team leader in the simulated videos was assessed by 16 evaluators using the tool. There was an intraclass coefficient of 0.86, showing excellent agreement. There was no statistical difference in scores between 102 resuscitations led by experienced resuscitators at academic and nonacademic hospitals (P = .98), which demonstrates generalizability. CONCLUSIONS The tool we have developed to assess performance in initiating newborn resuscitation shows evidence of construct validity based on assessment of content and internal structure (interobserver agreement, response processes, and generalizability).
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Affiliation(s)
- Sara K Kane
- Department of Pediatrics/Neonatology, Indiana University School of Medicine, Indianapolis, Ind.
| | - Diane E Lorant
- Department of Pediatrics/Neonatology, Indiana University School of Medicine, Indianapolis, Ind
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Nease EK, Narumanchi J, Nield OE, Nield LS. Breastfeeding Concerns and Their Management: One-Year Experience in a Physician-Run Lactation Clinic. Glob Pediatr Health 2018; 5:2333794X18775890. [PMID: 29796408 PMCID: PMC5960850 DOI: 10.1177/2333794x18775890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/09/2018] [Indexed: 11/22/2022] Open
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Petersen R. A 2017 Update: Centers for Disease Control and Prevention's Contributions and Investments in Breastfeeding. Breastfeed Med 2017; 12:465-467. [PMID: 28817308 PMCID: PMC6402809 DOI: 10.1089/bfm.2017.0093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Given that breastfeeding is important to the health of infants and their mothers, the Centers for Disease Control and Prevention's (CDC) goal is to ensure that new mothers understand the benefits of breastfeeding and, when they choose to breastfeed, have the supports they need to successfully initiate and continue breastfeeding until they reach their goals. This report summarizes CDC's current contributions and investments in breastfeeding.
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Affiliation(s)
- Ruth Petersen
- Director, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC) , Atlanta, Georgia
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Mind the gap: can videolaryngoscopy bridge the competency gap in neonatal endotracheal intubation among pediatric trainees? a randomized controlled study. J Perinatol 2017; 37:979-983. [PMID: 28518132 DOI: 10.1038/jp.2017.72] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/13/2017] [Accepted: 03/21/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND To study the impact of videolaryngoscopy (VL) on intubation success among pediatric trainees compared with direct laryngoscopy (DL). METHODS One hundred pediatric residents were enrolled in a randomized, crossover, simulation study comparing VL to DL. Following a didactic session on neonatal intubation, residents intubated a standard neonatal mannequin. Three Neonatal Resuscitation Program (NRP) scenarios were then conducted, followed by a mannequin intubation with the alternate device. Number of attempts and time to intubation were recorded for all intubations. RESULTS Proportion of successful intubations on first attempt was greater with VL compared with DL (88% versus 63%; P=0.008). The DL group increased success after crossover with VL (63% versus 89%; P=0.008). Exposure to VL also reduced intubation time after device crossover (median intubation time: 31 versus 17 s; P=0.048). CONCLUSIONS VL increased the success of endotracheal intubation by pediatric residents in simulation, with skills transferrable to DL.
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Chung EK, Gable EK, Golden WC, Hudson JA, Hackman NM, Andrews JP, Jackson DS, Beavers JB, Mirchandani DR, Kellams A, Krevitsky ME, Monroe K, Madlon-Kay DJ, Stratbucker W, Campbell D, Collins J, Rauch D. Current Scope of Practice for Newborn Care in Non-Intensive Hospital Settings. Hosp Pediatr 2017; 7:471-482. [PMID: 28694290 DOI: 10.1542/hpeds.2016-0206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Esther K Chung
- Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania and Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware;
| | - E Kaye Gable
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina and Cone Health, Greensboro, North Carolina
| | - W Christopher Golden
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer A Hudson
- Department of Pediatrics, Greenville Health System, Greenville, South Carolina
| | - Nicole M Hackman
- Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Jennifer P Andrews
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - DeeAnne S Jackson
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jessica B Beavers
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Dipti R Mirchandani
- Department of Pediatrics, Hofstra Northwell School of Medicine at Hofstra University, Hempstead, New York and Cohen Children's Medical Center of New York, New Hyde Park, New York
| | - Ann Kellams
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Meredith E Krevitsky
- Department of Pediatrics, Hofstra Northwell School of Medicine at Hofstra University, Hempstead, New York and Cohen Children's Medical Center of New York, New Hyde Park, New York
| | - Kimberly Monroe
- Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital and University of Michigan, Ann Arbor, Michigan
| | - Diane J Madlon-Kay
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - William Stratbucker
- Department of Pediatrics, Michigan State University and Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Deborah Campbell
- Department of Pediatrics, Albert Einstein College of Medicine, New York, New York and Children's Hospital at Montefiore, Bronx, New York
| | - Jolene Collins
- Department of Pediatrics, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, California; and
| | - Daniel Rauch
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Elmhurst, New York
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Palmquist AE, Doehler K. Contextualizing online human milk sharing: Structural factors and lactation disparity among middle income women in the U.S. Soc Sci Med 2014; 122:140-7. [DOI: 10.1016/j.socscimed.2014.10.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 10/15/2014] [Accepted: 10/17/2014] [Indexed: 10/24/2022]
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DeLaroche A, Riggs T, Maisels MJ. Impact of the new 16-hour duty period on pediatric interns' neonatal education. Clin Pediatr (Phila) 2014; 53:51-9. [PMID: 24002047 DOI: 10.1177/0009922813500847] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To assess the impact of the 16-duty hour restriction on pediatric interns' neonatal education. METHOD Survey of interns clinical and educational experiences during their neonatal rotations. RESULTS A total of 316 respondents in 2011, who worked >16 hours, were compared with 509 respondents in 2012, who worked ≤16 hours. The average work week decreased from 67.3 ± 9.6 to 59.3 ± 8.1 hours (P < .0001). The 2012 cohort attended fewer didactic lectures (-16%, P < .0001), grand rounds (-27%, P < .0001), and mock resuscitations (-16%, P < .005). There were no significant differences in the number of (1) patients on service, (2) deliveries attended, or (3) procedures. There was no significant difference in the median number of correct responses (4) on 10 knowledge-based multiple-choice questions. CONCLUSIONS The decrease in duty hours was achieved without significantly affecting interns' knowledge or clinical experience.
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Affiliation(s)
- Amy DeLaroche
- 1Department of Pediatrics, Beaumont Children's Hospital
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Abstract
Best postpartum breastfeeding practices must address the caloric needs of all infants, including vulnerable infants, while enabling long-term, exclusive breastfeeding. An adequate subsequent milk supply depends on early, frequent and effective colostrum removal. A combination of hand expression of colostrum, spoon-feeding and unrestricted breastfeeding provide more milk for infants and more stimulation for subsequent breast milk production. A sustainable, preventive practice model for low- and high-risk infants depends on elevating staff expertise and shifting the focus of lactation educators to address staff learning needs. We propose a five-step implementation program to achieve this.
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Cordero L, Hart BJ, Hardin R, Mahan JD, Giannone PJ, Nankervis CA. Pediatrics residents' preparedness for neonatal resuscitation assessed using high-fidelity simulation. J Grad Med Educ 2013; 5:399-404. [PMID: 24404302 PMCID: PMC3771168 DOI: 10.4300/jgme-d-12-00192.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 10/18/2012] [Accepted: 11/29/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Pediatrics residents are expected to demonstrate preparedness for neonatal resuscitation, yet research has shown gaps in residents' readiness to perform this skill. OBJECTIVE To evaluate procedural skills and team performance of pediatrics residents during neonatal resuscitation (NR) using a high-fidelity mannequin, and to assess residents' confidence in their NR skills before and after training. METHODS Two teams of residents (all had completed NR program training) participated in 2 separate, 90-minute sessions (2 to 3 weeks apart) in an off-site delivery room during their neonatal intensive care rotation. Residents' confidence in assisting and leading NR was surveyed before each session. Teams participated in a scenario (adapted from the NR program), which required 5 skills (positive pressure ventilation, chest compressions, endotracheal intubation, umbilical vein catheterization, and epinephrine administration). Video recording was used for debriefing and scoring. Skills were scored for technique and timeliness, and team behaviors were scored for communication, management, and leadership. RESULTS Twenty-six residents (11 teams) completed 2 paired sessions. Self-confidence scores increased between the 2 sessions but were not correlated with performance. Gaps in procedural skill performance were observed, and timeliness for most skills did not meet expectations. Significant improvement in team communication was noted. CONCLUSIONS Important gaps in procedural skill performance, particularly timeliness, were detected by NR simulation training; residents' improvements in self-confidence did not reflect gains in actual performance. Their relative unpreparedness for NR (despite prior certification) highlights the need for deliberate practice and specific team training before and during neonatal intensive care delivery room rotations.
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Clayton HB, Li R, Perrine CG, Scanlon KS. Prevalence and reasons for introducing infants early to solid foods: variations by milk feeding type. Pediatrics 2013; 131:e1108-14. [PMID: 23530169 PMCID: PMC3608486 DOI: 10.1542/peds.2012-2265] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2012] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the prevalence of, and mothers' self-reported reasons for, introducing solid foods to infants earlier than recommended (aged <4 months) and the variation in reasons for early introduction by milk feeding type. METHODS The study included 1334 mothers who participated in the national longitudinal Infant Feeding Practices Study II (2005-2007). Monthly 7-day food-frequency questions throughout infancy were used to determine infant age at solid food introduction and to classify infant's milk feeding at introduction as breast milk only, formula only, or mixed. Reasons for introducing solid foods at age <4 months were assessed through maternal responses to a list of 12 potential reasons. Analyses included descriptive statistics and multivariable logistic regression. RESULTS Overall, 40.4% of mothers introduced solid foods before age 4 months. Prevalence varied by milk feeding type (24.3%, 52.7%, and 50.2% for breastfed, formula-fed, and mixed-fed infants, respectively). The most commonly cited reasons for early introduction of solid food were as follows: "My baby was old enough," "My baby seemed hungry," "I wanted to feed my baby something in addition to breast milk or formula," "My baby wanted the food I ate," "A doctor or other health care professional said my baby should begin eating solid food," and "It would help my baby sleep longer at night." Four of these reasons varied by milk feeding type. CONCLUSIONS Our findings highlight the high prevalence of early introduction of solids and provide details on why mothers introduced solid foods early.
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Affiliation(s)
- Heather B Clayton
- Epidemic Intelligence Service, Office of Workforce Development, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Patel J, Posencheg M, Ades A. Proficiency and retention of neonatal resuscitation skills by pediatric residents. Pediatrics 2012; 130:515-21. [PMID: 22926169 DOI: 10.1542/peds.2012-0149] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The basic knowledge and skill base to resuscitate a newborn infant is taught in the Neonatal Resuscitation Program (NRP). We hypothesize that caregivers will perform below current acceptable standards before the recertification period of two years. METHODS This is a prospective descriptive study evaluating performance of pediatric residents' NRP knowledge and skills over time. NRP scores are used as baseline data. Follow-up is performed before the resident's first NICU rotation. Differences in the mean scores are analyzed for degree of retention. Subset score analysis is also performed. RESULTS Eighty-eight subjects completed both evaluations. Knowledge scores maintained close to passing throughout the academic year. Subset evaluation revealed significant deficits within the intubation lesson. Alarming deficits were seen in skills evaluation starting at initial NRP certification with 39.1% residents having failing scores. Mean scores were below passing for every group on follow-up testing. Subgroup analysis of skills revealed deficits in the initial phases of resuscitation (lessons 1-3). CONCLUSIONS Deterioration of skills is seen shortly after training. It appears that knowledge is generally better retained. Discrepancies between areas of knowledge and skill deterioration indicate that proficiency in one does not necessarily indicate proficiency of the other.
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Affiliation(s)
- Jay Patel
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia PA 19104, USA.
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Lewin LO, O'Connor ME. "BreastfeedingBasics": web-based education that meets current knowledge competencies. J Hum Lact 2012; 28:407-13. [PMID: 22550095 DOI: 10.1177/0890334411435990] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The United States has not met the majority of the Centers for Disease Control and Prevention goals for breastfeeding duration. Studies have shown a lack of knowledge about breastfeeding by health care professionals and students (HCP/S). Web-based education can be a cost-effective manner of education for HCP/S. "BreastfeedingBasics" is an online free educational program available for use. AIMS This study compares information in "BreastfeedingBasics" to the breastfeeding knowledge competencies recommended by the US Breastfeeding Committee (USBC). It also evaluates usage of "BreastfeedingBasics" by users and health care professional faculty. METHODS Using anonymous information from Web site users, the authors compared mean pre-test and post-test scores of the modules as a measure of the knowledge gained by HCP/S users. They evaluated usage by demographic information and used a Web-based survey to assess benefits of usage of "BreastfeedingBasics" to faculty. RESULTS Overall, 15 020 HCP/S used the Web site between April 1999 and December 2009. "BreastfeedingBasics" meets 8 of the 11 USBC knowledge competencies. Mean post-test scores increased (P < .001) for all modules. Faculty reported its benefits to be free, broad scope, and the ability to be completed on the students' own time; 84% of the faculty combined the use of "BreastfeedingBasics" with clinical work. CONCLUSIONS Use of "BreastfeedingBasics" can help HCP/S meet the USBC core breastfeeding knowledge competencies and gain knowledge. Faculty are satisfied with its use. Wider use of "BreastfeedingBasics" to help improve the knowledge of HCP/S may help in improving breastfeeding outcomes.
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Affiliation(s)
- Linda Orkin Lewin
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
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O'Connor ME, Brown EW, Lewin LO. An Internet-based education program improves breastfeeding knowledge of maternal-child healthcare providers. Breastfeed Med 2011; 6:421-7. [PMID: 21029021 DOI: 10.1089/bfm.2010.0061] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Breastfeeding rates in the United States remain below the Surgeon General's Healthy People 2010 goals. Encouragement of breastfeeding and education by maternal-child healthcare (MCH) providers (physicians, residents, and midlevel providers) improves breastfeeding initiation and duration. Surveys of MCH providers show lack of knowledge about breastfeeding. This study evaluated the effect of usage of "BreastfeedingBasics," a free Internet-based educational course, on the knowledge of MCH providers and evaluation of the baseline knowledge of course users. METHODS A before and after intervention study was done of MCH providers using the "BreastfeedingBasics" website between 1999 and 2008. Baseline knowledge and change in knowledge were assessed by computer-scored pretests and posttests. RESULTS Of 3,456 MCH providers enrolled, 2,237 (65%) completed one or more pretest. Total mean pretest/posttest scores were as follows: midlevel providers, 81%/89%; residents, 84%/93%; and physicians, 85%/92% (p < 0.001 among groups and between pretests and posttests). Mean pretest/posttest scores of the modules were as follows: Anatomy/Physiology, 79%/93%; Growth/Development, 72%/91%; Mother-Infant Couple (normal newborn), 82%/92%; and Breastfed Infant with Problems, 77%/91% (p < 0.001 for all). Specific topics with the lowest pretest scores and subsequent posttest scores were as follows (pretest/posttest): supplementation with vitamin D, 61%/93%; breastfeeding physiology, 38%/65%; growth of breastfed infants at 10 days, 80%/95%, 14 days, 72%/91%, and 3-4 months, 39%/84%; and stopping breastfeeding for maternal problems when not indicated, 69%/93% (p < 0.001 for all). CONCLUSIONS Use of an Internet-based educational program improved knowledge of MCH providers as measured by pretest and posttest scores. Knowledge of the growth of breastfed infants is particularly poor. Increasing knowledge is the first step in improving clinical practice that is necessary for increasing breastfeeding rates and duration.
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Affiliation(s)
- Mary E O'Connor
- Pediatrics, Community Health Services, Denver Health, and Westside Family Health Center,1100 Federal Boulevard, Denver, CO 80204, USA. Mary.O’
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Wood AM, Jones MD, Wood JH, Pan Z, Parker TA. Neonatal resuscitation skills among pediatricians and family physicians: is residency training preparing for postresidency practice? J Grad Med Educ 2011. [PMID: 23205194 PMCID: PMC3244311 DOI: 10.4300/jgme-d-10-00234.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Pediatricians and family physicians are responsible for providing newborn resuscitation, yet Accreditation Council for Graduate Medical Education requirements for training in this area during residency differ markedly for the two specialties. Our objectives were to determine (1) the extent to which neonatal resuscitation training differs for pediatric and family medicine residents; (2) the extent to which general pediatricians and family physicians engage in newborn resuscitation in their practice; and (3) whether use of resuscitation skills differs between urban/suburban and rural providers. METHODS We surveyed a national cohort of pediatricians and family physicians who obtained board certification between 2001 and 2005. Data were analyzed based on type of physician and setting of current practice. RESULTS Survey response rate was 22% (382 of 1736). Compared with family medicine physicians, pediatricians received more neonatal resuscitation training during residency. Most members of both groups had attended no deliveries in the year prior to the survey (75% [111 of 148] versus 74% [114 of 154]). In their current practice, the groups were equally likely to have provided a newborn bag and mask ventilation, chest compressions, and resuscitation medications. Pediatricians were more likely than family physicians to have attempted to either intubate a newborn (20% [28 of 148] versus 10% [16 of 153]; P = .0495) or insert umbilical catheters (15% [22 of 148] versus 5% [8 of 153]; P = .005). Regardless of specialty, rural physicians were much more likely to report that they attended deliveries (61% [41 of 67] versus 15% [36 of 234]; P < .001). Among rural pediatricians attending deliveries, 44% (7 of 16) reported feeling inadequately prepared for at least one delivery in the past year. CONCLUSIONS Few primary care pediatricians and family physicians provide newborn resuscitation after residency. For those who do attend deliveries, current training 5 provide insufficient preparation. Flexible, individualized residency curricula could target intensive resuscitation training to individuals who plan to practice in rural areas and/or attend deliveries after graduation.
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Campbell DM, Barozzino T, Farrugia M, Sgro M. High-fidelity simulation in neonatal resuscitation. Paediatr Child Health 2011; 14:19-23. [PMID: 19436459 DOI: 10.1093/pch/14.1.19] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2008] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION There are currently few studies describing the use of high-fidelity (hi-fi) simulation in teaching neonatal resuscitation. Traditionally, residents are certified in the neonatal resuscitation program (NRP) after successful completion of a multiple-choice written examination and demonstration of skills during a hands-on 'mega-code'. In the present study, the use of a hi-fi simulation mannequin was compared with a standard plastic mannequin when teaching the megacode portion of the NRP. METHODS In the present pilot study, 15 first-year residents were randomly assigned to demonstrate neonatal resuscitation knowledge, with either the hi-fi mannequin (SimBaby, Laerdal Medical Corporation, USA) or a traditional plastic mannequin (ALS Baby, Laerdal Medical Corporation, USA). A written evaluation was conducted before and after the intervention. Each pair of residents experienced the two scenarios. Video performance was then assessed and compared. RESULTS Residents randomly assigned to the hi-fi mannequin rated the experience higher (31+/-3.3 versus 27+/-3.5; P=0.026), and required less redirection from instructors during the megacode (scenario 1: 4.5+/-1.7 versus 15+/-6.9; P=0.015 and scenario 2: 1.8+/-1.3 versus 9.3+/-2.5; P=0.0009) than those who were randomly assigned to the plastic mannequin. Residents randomly assigned to the hi-fi mannequin did not have improved written scores or improved intubation times. CONCLUSIONS The present pilot study demonstrated that a hi-fi mannequin can be used as part of an educational program, such as the NRP. The use of this technology in neonatal resuscitation training is well-received by learners and may provide a more realistic model for training. Further work is required to clarify its role in task performance and team training.
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Affiliation(s)
- Douglas M Campbell
- Department of Paediatrics, St Michael's Hospital, University of Toronto, Toronto, Ontario
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Gozzo YF, Cummings CL, Chapman RL, Bizzarro MJ, Mercurio MR. Who is performing medical procedures in the neonatal intensive care unit? J Perinatol 2011; 31:206-11. [PMID: 21052046 DOI: 10.1038/jp.2010.121] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Owing to resident work-hour reductions and more permanent personnel in the newborn intensive care unit (NICU), we sought to determine if pediatric housestaff are missing learning opportunities in procedural training due to non-participation. STUDY DESIGN A prospective, observational study was conducted at an academic NICU using self-reported data from neonatal personnel after attempting 188 procedures on 109 neonates, and analyzed using Fisher's exact and χ (2)-tests. RESULT Housestaff first attempted 32% of procedures (P<0.001) and were less likely to make attempts early in the academic year (P<0.001). There was no significant difference in attempts based on urgency of situation (P=0.742). Of procedures performed by non-housestaff personnel, 93% were completed while housestaff were present elsewhere in the unit. CONCLUSION Pediatric housestaff performed the minority of procedures in the NICU, even in non-urgent situations, and were often uninvolved in other procedures, representing missed learning opportunities.
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Affiliation(s)
- Y F Gozzo
- Division of Neonatal and Perinatal Medicine, Yale University School of Medicine, New Haven, CT 06520-8064, USA
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Feldman-Winter L, Barone L, Milcarek B, Hunter K, Meek J, Morton J, Williams T, Naylor A, Lawrence RA. Residency curriculum improves breastfeeding care. Pediatrics 2010; 126:289-97. [PMID: 20603262 DOI: 10.1542/peds.2009-3250] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Multiple studies have revealed inadequacies in breastfeeding education during residency, and results of recent studies have confirmed that attitudes of practicing pediatricians toward breastfeeding are deteriorating. In this we study evaluated whether a residency curriculum improved physician knowledge, practice patterns, and confidence in providing breastfeeding care and whether implementation of this curriculum was associated with increased breastfeeding rates in patients. SUBJECTS AND METHODS A prospective cohort of 417 residents was enrolled in a controlled trial of a novel curriculum developed by the American Academy of Pediatrics in conjunction with experts from the American College of Obstetricians and Gynecologists, American Academy of Family Physicians, and Association of Pediatric Program Directors. Six intervention residency programs implemented the curriculum, whereas 7 control programs did not. Residents completed pretests and posttests before and after implementation. Breastfeeding rates were derived from randomly selected medical charts in hospitals and clinics at which residents trained. RESULTS Trained residents were more likely to show improvements in knowledge (odds ratio [OR]: 2.8 [95% confidence interval (CI): 1.5-5.0]), practice patterns related to breastfeeding (OR: 2.2 [95% CI: 1.3-3.7]), and confidence (OR: 2.4 [95% CI: 1.4-4.1]) than residents at control sites. Infants at the institutions in which the curriculum was implemented were more likely to breastfeed exclusively 6 months after intervention (OR: 4.1 [95% CI: 1.8-9.7]). CONCLUSIONS A targeted breastfeeding curriculum for residents in pediatrics, family medicine, and obstetrics and gynecology improves knowledge, practice patterns, and confidence in breastfeeding management in residents and increases exclusive breastfeeding in their patients. Implementation of this curriculum may similarly benefit other institutions.
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Affiliation(s)
- Lori Feldman-Winter
- Division of Adolescent Medicine, Department of Pediatrics, Cooper University Hospital, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Camden, NJ 08103-1438, USA.
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Wong LFA, Lim KT, Twomey A, Murphy J. A review of neonatal attendances out of hours in a Dublin maternity hospital. Ir J Med Sci 2006; 175:62-5. [PMID: 17312832 DOI: 10.1007/bf03167970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
UNLABELLED BACKGROUND All neonates have free open access to the Baby Clinic at the maternity hospitals in Dublin for assessment of neonatal health issues. Through observation, however there is an increase in number of neonates attending the hospital outside the Baby Clinic hours. AIMS To determine the number of neonates attending the acute neonatal service out of hours and to identify the percentage of neonates treated as true emergency. METHODS Retrospective chart review over a twelve-month period. RESULTS Seven hundred and thirty-two neonates attended the hospital out of hours. The majority were diagnosed with gastrointestinal problems (228/31%), jaundice (101/13.7%), respiratory problems (82/11.1%) and skin disorders (79/10.7%). Only 106 (14.4%) attendances warranted admissions. CONCLUSIONS A large number of neonatal attendances did not require acute assessment out of hours and were managed by reassurance and maternal education. A centralized phone-in-triage system was suggested to relieve the strain on the acute neonatal service.
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Affiliation(s)
- L F A Wong
- Dept of Neonatology, National Maternity Hospital, Dublin.
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Lieberman L, Hilliard RI. How well do paediatric residency programmes prepare residents for clinical practice and their future careers? MEDICAL EDUCATION 2006; 40:539-46. [PMID: 16700769 DOI: 10.1111/j.1365-2929.2006.02479.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
CONTEXT Educators across Canada are presently discussing whether the current 4-year residency programmes adequately prepare paediatricians for their future careers. Studies carried out in the USA have repeatedly shown areas of weakness in residency training, but there are no studies looking at the overall adequacy of training across Canada. OBJECTIVES To assess practising paediatricians' perceptions of the adequacy of their residency training as preparation for clinical practice and to assess practising paediatricians' opinions about the required mandatory length of training. METHODS A questionnaire based on previous studies was sent to 434 paediatricians certified between 1999 and 2003, asking for their opinions of their preparedness for practice in the broad areas of paediatrics and in the professional roles of the doctor-specialist. RESULTS Overall, 239 (55%) paediatricians replied, 96% of whom indicated they were 'adequately' or 'very well' trained. Areas in which opinions on training were positive included emergency medicine, neonatology, endocrinology, haematology/oncology, neurology, infectious diseases and respirology. Areas where preparation was considered to have been less adequate included gynaecology, child psychiatry, behavioural psychology, surgical specialties, orthopaedics and adolescents. With respect to the roles of the doctor-specialist, strengths of training included the areas of medical expert, collaborator, ethics and professionalism, and communicator. Respondents felt they were less adequately prepared for the role of a medical expert dealing with palliative care, for dealing with bereaved parents and as manager of an office practice. Despite these weaknesses, 80% felt that 4 years of training was sufficient. DISCUSSION The results of the study are comparable with those of previous studies carried out in the USA and reinforce the need for regular programme assessment. This study will hopefully lead to the improvement of current paediatric residency programmes and enhanced education and training of future paediatricians. Although overall satisfaction with training was high, paediatric programmes need to make some changes by providing more appropriate training with less tertiary care, hospital-based training and more community and ambulatory-based experiences.
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Affiliation(s)
- Lani Lieberman
- Division of Pediatric Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
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Abstract
Ten percent of all newborns require resuscitation at birth. The Neonatal Resuscitation Program establishes the authoritative technique of newborn resuscitation. Errors continue to occur that are related to the use of unskilled resuscitators; intubation; inadequate suctioning of meconium; and the postresuscitation problems of hypoglycemia, hypocarbia, and hypotension. Specific recommendations are offered to avoid these pitfalls of neonatal resuscitation.
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Affiliation(s)
- Marcus C Hermansen
- Department of Pediatrics, Dartmouth Medical School, One Medical Center Drive, Lebanon, NH 03756-0001, USA.
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Chandran L, Zuniga I, Meloy L, Chen J. Residency Review Committee (RRC) guidelines for pediatric residency training. AMBULATORY PEDIATRICS : THE OFFICIAL JOURNAL OF THE AMBULATORY PEDIATRIC ASSOCIATION 2004; 4:519-20. [PMID: 15548106 DOI: 10.1367/a04-036r.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
The use of hospitalists in the care of newborns appears to be increasing and may be advantageous for several reasons, including decreased cost, decreased length of stay, increased patient survival, increased availability, and greater experience among hospitalists. Research specific to the use of hospitalists in newborn medicine needs to be done to support this hypothesis. Non-clinical activities such as teaching, developing clinical guidelines, and taking an active role in hospital and academic leadership also may improve education and patient care. It is essential that hospitalists who provide care in nurseries work to smooth the transition to a PCP and not act as a barrier. Relatively speaking, the care provided by hospitalists is most often short-term, and the relationship between infants and their parents with the PCP should begin as soon as possible.
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MESH Headings
- Hospitalists
- Hospitals, Community/economics
- Hospitals, Community/organization & administration
- Hospitals, Pediatric/economics
- Hospitals, Pediatric/organization & administration
- Hospitals, University/economics
- Hospitals, University/organization & administration
- Humans
- Infant, Newborn
- Intensive Care Units, Neonatal
- Medically Uninsured
- Physician's Role
- Physicians, Family
- Quality Assurance, Health Care
- United States
- Workforce
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Affiliation(s)
- Douglas W Carlson
- Division of Emergency Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, USA
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