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Malone S, Bono K, Saito JM, Rangel S, Liu J, Newland JG, McKay V. Evaluating a virtual facilitation workshop with antimicrobial stewardship teams within a cluster randomized stepped-wedge trial. BMC Health Serv Res 2024; 24:1263. [PMID: 39434072 PMCID: PMC11492772 DOI: 10.1186/s12913-024-11714-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 10/07/2024] [Indexed: 10/23/2024] Open
Abstract
BACKGROUND Antimicrobial stewardship programs (ASP) often function naturally as facilitators within clinical hospital settings, by working with individuals and teams to reduce unnecessary antibiotics. Within implementation science, facilitation has been studied and evaluated as an implementation strategy that can accelerate and improve fidelity to implementation efforts. This study describes a novel, virtual facilitation strategy developed and served as an intervention within the optimizing perioperative antibiotics for children trial (OPERATIC trial). This paper: (1) describes ASP team's preferences for and use of a facilitation workshop and (2) describes sustained use of facilitation skills throughout the study period. METHODS Study participants included antimicrobial stewardship team members from the nine children's hospitals that participated in this study and completed facilitation training. All individuals who completed facilitation training were asked to evaluate the training through an online survey. Additionally, site leads were interviewed by the site coordinator every other month and asked about their team's use of facilitation skills throughout the rest of the study period. Survey data were managed and coded in R, and qualitative interview data were analyzed using rapid methodology. RESULTS 30 individuals, including both physicians and pharmacists, completed the evaluation. Individuals largely rated themselves as novice facilitators (53%). Individuals reported satisfaction with virtual facilitation and identified different components of the workshops as valuable. An additional 108 interviews were performed throughout the study period. These interviews found that facilitators reported using all skills throughout the study period and described varied use of skills over time. All nine sites applied facilitation strategies, team building techniques, and communication/conflict skills at some point during the intervention phase. CONCLUSION We describe the use of virtual facilitation as an acceptable and appropriate strategy to enhance facilitation skills for ASP teams working to reduce unnecessary postoperative antibiotics. Participants reported different useful components of facilitation training and described using differing facilitation skills throughout the trial. Overall, the use of facilitation skills continued throughout the duration of the study period. This paper outlines how facilitation training can be conducted virtually in a way that is feasible and acceptable to clinicians. TRIAL REGISTRATION NCT04366440, April 24, 2020.
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Georgeades C, Vacek J, Thurm C, Hall M, Rangel S, Minneci PC, Oldham K, Van Arendonk KJ. Association of Rural Residence With Surgical Outcomes Among Infants at US Children's Hospitals. Hosp Pediatr 2023; 13:733-743. [PMID: 37470121 DOI: 10.1542/hpeds.2023-007227] [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: 07/21/2023]
Abstract
OBJECTIVES Disparities in pediatric health outcomes are widespread. It is unclear whether rurality negatively impacts outcomes of infants with surgical congenital diseases. This study compared outcomes of rural versus urban infants requiring complex surgical care at children's hospitals in the United States. METHODS Rural and urban infants (aged <1 year) receiving surgical care at children's hospitals from 2016 to 2019 for esophageal atresia, gastroschisis, Hirschsprung's disease, anorectal malformation, and congenital diaphragmatic hernia were compared over a 1-year postoperative period using the Pediatric Health Information System. Generalized linear mixed effects models compared outcomes of rural and urban infants. RESULTS Among 5732 infants, 20.2% lived in rural areas. Rural infants were more frequently white, lived farther from the hospital, and lived in areas with lower median household income compared with urban infants (all P < .001). Rural infants with anorectal malformation and gastroschisis had lower adjusted hospital days over 1 year; rural infants with esophageal atresia had higher adjusted odds of 30-day hospital readmission. Adjusted mortality, hospital days, and readmissions were otherwise similar between the 2 groups. Outcomes remained similar when comparing urban infants to rural infant subgroups with the longest hospital travel distance (≥60 miles) and lowest median household income (<$35 000). CONCLUSIONS Despite longer travel distances and lower financial resources, rural infants with congenital anomalies have similar postoperative outcomes to urban infants when treated at children's hospitals. Future work is needed to examine outcomes for infants treated outside children's hospitals and to determine whether efforts are necessary to increase access to children's hospitals.
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Malone S, McKay V, Saito JM, Rangel S, Bono K, Newland J. 553. Designing and evaluating a facilitation workshop for antimicrobial stewardship teams to de-implement inappropriate perioperative antibiotic use in pediatric hospitals. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
In pediatric hospitals, approximately 20% of inappropriate antibiotic use results from unnecessary postoperative antibiotic prophylaxis (POP). Facilitation, an implementation strategy focused on using individuals as change agents, may be an effective strategy. No standard facilitation training has been provided for individuals leading antimicrobial stewardship programs (ASP). We describe the development and evaluation of a virtual facilitation workshop to increase antimicrobial stewards’ ability to reduce POP.
Methods
This work was conducted in the Optimizing Perioperative Antibiotic in Children (OPERATIC) trial, a stepped wedge randomized controlled trial with 9 pediatric hospitals to test strategies with ASPs to reduce POP. After comprehensive literature review, we developed a theoretically supported facilitation training workshop. Four modules were presented weekly that targeted evidence against POP use, data visualization, understanding local context, and enhancing interpersonal skills. After workshop completion, participants completed an electronic survey consisting of 13 Likert questions (scale 1-5; 1=very poor) questions adapted from a published measure for practice facilitation and four open ended questions. Responses were analyzed descriptively.
Results
A total of 10 physicians, 7 pharmacists, and 1 other staff affiliated with ASPs completed the survey for a 75% response rate. Participants rated the overall workshop as a 4.5 on average. Participants stated they were likely to use workshop information in the future. Individuals stated they gained skills regarding communication/conflict style (4.45), implementation science principles (4.3), and data visualization (4.1). Three individuals believed the workshop could be shorter. In free text responses, participants highlighted the usefulness of examples and role play as well as the conceptual shift in viewing the ASP as an active facilitator in the surgical setting.
Conclusion
Virtual facilitation training is feasible and useful for ASP teams. This workshop method could enable skill development within the context of a clinician’s schedule, while still promoting evidence-based strategies for better de-implementation of unnecessary prescribing.
Disclosures
Sara Malone, PhD, LCSW, AHRQ: Grant/Research Support|NIH: Grant/Research Support Jason Newland, MD, AHRQ: Grant/Research Support|Merck: Grant/Research Support|NIH: Grant/Research Support|PEW Charitable Trust: Grant/Research Support|Pfizer: Grant/Research Support.
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Hu A, Chaudhury AS, Fisher T, Garcia E, Berman L, Tsao K, Mackow A, Shew SB, Johnson J, Rangel S, Lally KP, Raval MV. Barriers and facilitators of CT scan reduction in the workup of pediatric appendicitis: A pediatric surgical quality collaborative qualitative study. J Pediatr Surg 2022; 57:582-588. [PMID: 34972565 DOI: 10.1016/j.jpedsurg.2021.11.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/03/2021] [Accepted: 11/30/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Despite ongoing efforts to decrease ionizing radiation exposure from computed tomography (CT) use in pediatric appendicitis, high CT utilization rates are still observed across many hospitals. This study aims to identify factors influencing CT use and facilitators and barriers to quality improvement efforts. METHODS The Pediatric Surgery Quality Collaborative is a voluntary consortium of 42 children's hospitals participating in the National Surgical Quality Improvement Project - Pediatric. Hospitals were compared based on CT utilization from January 1, 2019, to December 31, 2019. Semi-structured interviews were conducted with surgeons, radiologists, emergency medicine physicians, and clinical data abstractors from 7 hospitals with low CT use rates (high performers) and 6 hospitals with high CT use rates (low performers). A mixed deductive and inductive coding approach for analysis of the interview transcripts was used to develop a codebook based on the Theoretical Domains Framework and subsequently identify prominent barriers and facilitators to CT reduction. RESULTS Thematic saturation was achieved after 13 interviews. We identified four factors that distinguish high-performing from low-performing hospitals: (1) consistent availability of resources such as ultrasound technicians, pediatric radiologists, and magnetic resonance imaging (MRI); (2) presence of and adherence to protocols guiding imaging modality decision making and imaging execution; (3) culture of inter-departmental collaboration; and (4) presence of a radiation reduction champion. CONCLUSIONS Significant barriers to reducing the use of CT in pediatric appendicitis exist. Our findings highlight that future quality improvement efforts should target resource availability, protocol adherence, collaborative culture, and radiation reduction champions. LEVELS OF EVIDENCE Level III.
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Berry JG, Rodean J, Leahy I, Rangel S, Johnson C, Crofton C, Staffa SJ, Hall M, Methot C, Desmarais A, Ferrari L. Hospital Volumes of Inpatient Pediatric Surgery in the United States. Anesth Analg 2021; 133:1280-1287. [PMID: 34673726 DOI: 10.1213/ane.0000000000005748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Perioperative outcomes of children depend on the skill and expertise in managing pediatric patients, as well as integration of surgical, anesthesiology, and medical teams. We compared the types of pediatric patients and inpatient surgical procedures performed in low- versus higher-volume hospitals throughout the United States. METHODS Retrospective analysis of 323,258 hospitalizations with an operation for children age 0 to 17 years in 2857 hospitals included in the Agency for Healthcare Research and Quality (AHRQ) Kids' Inpatient Database (KID) 2016. Hospitals were categorized by their volume of annual inpatient surgical procedures. Specific surgeries were distinguished with the AHRQ Clinical Classification System. We assessed complex chronic conditions (CCCs) using Feudtner and Colleagues' system. RESULTS The median annual volume of pediatric inpatient surgeries across US hospitals was 8 (interquartile range [IQR], 3-29). The median volume of inpatient surgeries for children with a CCC was 4 (IQR, 1-13). Low-volume hospitals performed significantly fewer types of surgeries (median 2 vs 131 types of surgeries in hospitals with 1-24 vs ≥2000 volumes). Appendectomy and fixation of bone fracture were among the most common surgeries in low-volume hospitals. As the volume of surgical procedures increased from 1 to 24 to ≥2000, the percentage of older children ages 11 to 17 years decreased (70.9%-32.0% [P < .001]) and the percentage of children with a CCC increased (11.2%-60.0% [P < .001]). CONCLUSIONS Thousands of US hospitals performed inpatient surgeries on few pediatric patients, including those with CCCs who have the highest risk of perioperative morbidity and mortality. Evaluation of perioperative decision making, workflows, and pediatric clinicians in low- and higher-volume hospitals is warranted.
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Masonbrink AR, Harris M, Hall M, Kaiser S, Hogan AH, Parikh K, Clark NA, Rangel S. Safety Events in Children's Hospitals During the COVID-19 Pandemic. Hosp Pediatr 2021; 11:e95-e100. [PMID: 33958441 DOI: 10.1542/hpeds.2020-004937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has impacted hospitals, potentially affecting quality and safety. Our objective was to compare pediatric hospitalization safety events during the pandemic versus previous years. METHODS In this retrospective cohort study of hospitalizations in the Pediatric Health Information System, we compared Pediatric Quality Indicator (PDI) rates from March 15 to May 31, 2017-2019 (pre-COVID-19), with those from March 15 to May 31, 2020 (during COVID-19). Generalized linear mixed-effects models with adjustment for patient characteristics (eg, diagnosis, clinical severity) were used. RESULTS There were 399 113 discharges pre-COVID-19 and 88 140 during COVID-19. Unadjusted PDI rates were higher during versus pre-COVID-19 for overall PDIs (6.39 vs 5.05; P < .001). In adjusted analyses, odds of postoperative sepsis were higher during COVID-19 versus pre-COVID-19 (adjusted odds ratio 1.28 [95% confidence interval 1.04-1.56]). The remainder of the PDIs did not have increased adjusted odds during compared with pre-COVID-19. CONCLUSIONS Postoperative sepsis rates increased among children hospitalized during COVID-19. Efforts are needed to improve safety of postoperative care for hospitalized children.
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Paller A, Tham K, Lefferdink R, Duan K, Lim S, Ibler E, Chima M, Kim H, Wu B, Abu-Zayed H, Rangel S, Guttman-Yassky E, Lee B, Common J. 206 The distinct skin microbiota of congenital ichthyoses. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dellacecca E, Shivde R, Mhlaba J, Cosgrove C, Kundu R, Rangel S, Le Poole I. 231 Bacteroides colonization is associated with reduced depigmentation in vitiligo. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Fell GL, Cho BS, Anez-Bustillos L, Dao DT, Baker MA, Nandivada P, O'Loughlin AA, Hurley AP, Mitchell PD, Rangel S, Gura KM, Puder M. Optimizing Duration of Empiric Management of Suspected Central Line-Associated Bloodstream Infections in Pediatric Patients with Intestinal Failure. J Pediatr 2020; 227:69-76.e3. [PMID: 32687916 DOI: 10.1016/j.jpeds.2020.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/09/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To assess whether a 24-hour length of hospitalization and empiric antibiotic therapy to exclude central line-associated bloodstream infection (CLABSI) in children with intestinal failure is potentially as safe as 48 hours, which is the duration most commonly used but not evidence based. STUDY DESIGN A prospective single-institution observational cohort study was conducted among pediatric patients with intestinal failure from July 1, 2015, through June 30, 2018, to identify episodes of suspected CLABSI. The primary end point was time from blood sampling to positive blood culture. Secondary end points included presenting symptoms, laboratory test results, responses to a parent/legal guardian-completed symptom survey, length of inpatient stay, costs, and charges. RESULTS Seventy-three patients with intestinal failure receiving nutritional support via central venous catheters enrolled; 35 were hospitalized with suspected CLABSI at least once during the study. There were 49 positive blood cultures confirming CLABSI in 128 episodes (38%). The median time from blood sampling to positive culture was 11.1 hours. The probability of a blood culture becoming positive after 24 hours was 2.3%. Elevated C-reactive protein and neutrophil predominance in white blood cell count were associated with positive blood cultures. Estimated cost savings by transitioning from a 48-hour to a 24-hour admission to rule-out CLABSI was $4639 per admission. CONCLUSIONS A 24-hour duration of empiric management to exclude CLABSI may be appropriate for patients with negative blood cultures and no clinically concerning signs. A multi-institutional study would more robustly differentiate patients safe for discharge after 24 hours from those who warrant longer empiric treatment.
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Paller A, Shei J, Rangel S, Ramachandran D, Puar N, Patel V, Jackson K, Silverberg J, Cella D. 509 PIQ-C, a new PROMIS® tool, measures intensity and impact of itch on children with atopic dermatitis. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Diaz A, He H, Pavel A, Lefferdink R, Fang M, Canter T, Rangel S, Krueger J, Paller A, Guttman-Yassky E. 253 RNA-seq profiling of tape strips from infants with atopic dermatitis show profound barrier and immune abnormalities. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kashtan M, Graham D, Anandalwar S, Hills-Dunlap J, Rangel S. Influence of symptom duration and WBC profile on the negative predictive value of a nondiagnostic ultrasound in children with suspected appendicitis. J Pediatr Surg 2020; 55:1032-1036. [PMID: 32171532 DOI: 10.1016/j.jpedsurg.2020.02.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/20/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The aim of this study was to explore the combined negative predictive value (NPV) of symptom duration and WBC profile in children with a nondiagnostic ultrasound (US) for appendicitis. METHODS This was a retrospective analysis of children with suspected appendicitis at a single children's hospital from 1/2010 to 3/2018. NPVs based on WBC profile and symptom duration at presentation were calculated individually and combined for children with a nondiagnostic US. RESULTS 2277 patients were included, of which 1018 (44.7%) had a nondiagnostic US. The NPV of a nondiagnostic US ranged from 83.7% with ≤24 h of symptoms to 94.5% with >72 h of symptoms (p < 0.01). NPV also differed significantly across WBC profiles, ranging from 76.8% when WBC profile was elevated to 97.3% to when WBC profile was normal (p < 0.01). The range of NPVs for a nondiagnostic US was even greater when combining symptom duration and WBC profile, ranging from 73.7% for patients with 24-48 h of symptoms and an elevated WBC profile to 100% for patients with >72 h of symptoms and a normal WBC profile. CONCLUSIONS Incorporation of symptom duration and WBC profile significantly improves the accuracy and clinical utility of the negative predictive value associated with a nondiagnostic ultrasound. LEVEL OF EVIDENCE Study of diagnostic test level II: development of diagnostic criteria in a consecutive series of patients and a universally applied gold standard.
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Kashtan M, Dawson M, Anandalwar S, Hills-Dunlap J, Graham DA, Rangel S. Implementation of a Plan-Do-Study-Act framework to reduce unindicated surgical antimicrobial prophylaxis. J Pediatr Surg 2020; 55:86-89. [PMID: 31679771 DOI: 10.1016/j.jpedsurg.2019.09.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/29/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE The goal of this study was to use a Plan-Do-Study-Act (PDSA) framework to reduce utilization of unindicated surgical antibiotic prophylaxis (SAP) for clean cases without foreign body implantation. METHODS This was a pre-post intervention study conducted at a single children's hospital comparing 6 months of retrospective preintervention data to 10 months of prospectively collected postintervention data. Interventions to reduce unindicated SAP included faculty meetings to review guidelines and establish consensus around inclusion criteria, publicizing guidelines with regular email reminders, and conducting ongoing compliance audits to root cause noncompliance. Early unanticipated noncompliant cases were associated with rotating trainees who prescribed SAP routinely without attending knowledge. A second PDSA cycle then included education-based emails targeting residents with mandatory feedback loop closure. RESULTS Preintervention, 40.4% (107/265) of patients received unindicated SAP. Postintervention, the rate of unindicated SAP decreased to 15.4% (6/39) after the first month and 6.2% (20/323) after 10 months, reflecting an 85% reduction across periods (p < 0.01). There was no difference in the rate of surgical site infections between the pre and postintervention cohorts (0.36% vs. 0.67%, p = 1.00). CONCLUSIONS Unindicated surgical antibiotic prophylaxis was significantly reduced by implementing a Plan-Do-Study-Act intervention targeting both faculty and trainees. LEVEL OF EVIDENCE Prospective comparative treatment study, level II.
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Berman L, Ottosen M, Renaud E, Hsi-Dickie B, Fecteau A, Skarda D, Goldin A, Rangel S, Tsao K. Preventing patient harm via adverse event review: An APSA survey regarding the role of morbidity and mortality (M&M) conference. J Pediatr Surg 2019; 54:1872-1877. [PMID: 30765152 DOI: 10.1016/j.jpedsurg.2018.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 11/01/2018] [Accepted: 12/08/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Peer-review endeavors represent the continual learning environment critical for a culture of patient safety. Morbidity and mortality (M&M) conferences are designed to review adverse events to prevent future similar events. The extent to which pediatric surgeons participate in M&M, and believe M&M improves patient safety, is unknown. METHODS A cross-sectional survey of the American Pediatric Surgical Association membership was conducted to evaluate participation in and perception of M&M conferences. Closed and open-ended questions were provided to gauge participation and perceptions of M&M effectiveness. Standard frequency analyses and tests of associations between M&M program attributes and surgeons' perceptions of effectiveness were performed. RESULTS The response rate was 38% (353/928). Most surgeons (85%) reported that they always participate in M&M, but only 64% believe M&M is effective in changing practice or prevention of future adverse events. Effective M&Ms were more likely to emphasize loop closure, multidisciplinary participation, standardized assessment of events, and connection to quality improvement efforts. CONCLUSIONS Most pediatric surgeons participate in M&M, but many doubt its effectiveness. We identified attributes of M&M conferences that are perceived to be effective. Further investigation is needed to identify how to optimally utilize peer-review programs to prevent adverse events and improve patient safety. LEVEL OF EVIDENCE V.
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Pereira JS, Pereira MF, Rangel S, Caldeira M, Carvalhal G, Santos LM, Cardoso JV, Alves JG. TYPE TESTING OF LiF:Mg,Cu,P (TLD-100H) WHOLE-BODY DOSEMETERS FOR THE ASSESSMENT OF Hp(10) AND Hp(0.07). RADIATION PROTECTION DOSIMETRY 2019; 184:216-223. [PMID: 30496554 DOI: 10.1093/rpd/ncy202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/25/2018] [Accepted: 10/30/2018] [Indexed: 06/09/2023]
Abstract
In this work, the initial results of the type testing of the LiF:Mg,Cu,P (TLD-100H) whole-body personal dosemeters are presented. An assessment of reproducibility, linearity of the response, the residual signal as a function of the dose, energy and angular dependence of the response was performed. In general, the dosemeters show good reproducibility for different dose values and a linear behaviour for a range between 0.1 and 300 mSv. The detection limits obtained are lower than 50 μSv. The system presents a good energy and angular response for different radiation qualities.
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Castañeda-Hidalgo H, Vega-Infante E, González F, Rangel S, Flores F, Peñarrieta-de Cordova I. Validación del instrumento: Competencias del personal de enfermería en Salud Pública, en el contexto mexicano. ENFERMERÍA UNIVERSITARIA 2018. [DOI: 10.22201/eneo.23958421e.2018.4.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introducción: Cuando se utilicen cuestionarios desarrollados en otros países e idiomas en estudios científicos, además de traducirlos, es necesario su adaptación cultural y validación, el objetivo de esta investigación es contar con un instrumento válido y confiable para evaluar las competencias del personal de enfermería en salud pública, para aplicarlo en el contexto mexicano.
Metodología: El estudio fue de tipo descriptivo-transversal, multietápico, la población se integró en 3 grupos para las 3 diferentes etapas, en la primera, por un grupo de 10 expertos en investigación de la Facultad de Enfermería de Tampico, de la Universidad Autónoma de Tamaulipas, México y 17 profesionales que laboran en el primer nivel de atención; en la segunda, 30 profesionales de enfermería y en la tercera 177 profesionales que trabajan en el campo de la salud pública, todos ellos de tres jurisdicciones del Sur de Tamaulipas, México, el muestreo fue por conveniencia.
Resultados: En cuanto a los tres procesos que se realizaron para la validación del instrumento, se mostraron resultados adecuados y satisfactorios para su aplicación, ya que en la prueba de V-Aiken se obtuvo un resultado cercano a 1, en el proceso semántico sólo se realizó modificación a una palabra; a través de la prueba piloto se obtuvo un resultado de 0.97 en el alfa de cronbach.
Conclusiones: El instrumento se considera válido para iniciar con la evaluación de las mencionadas competencias, para contar con un diagnóstico inicial de las áreas de oportunidad para personal de enfermería.
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Vakharia P, Lund E, Rangel S, Temps W, West D, Belknap S. LB953 Spironolactone and psoriasis outcome in young adult women: A report from the RADAR (Research on Adverse Drug events And Reports) project. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tagliafico A, Rangel S, Broadhurst MK. Reproductive aspects of the Atlantic angel shark Squatina dumeril in the southern Caribbean Sea. JOURNAL OF FISH BIOLOGY 2017; 91:1062-1071. [PMID: 28901006 DOI: 10.1111/jfb.13401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/31/2017] [Indexed: 06/07/2023]
Abstract
The maturity and reproduction of the Atlantic angel shark Squatina dumeril were assessed using 77 females (29·2-110·4 cm total length; LT ) and 269 males (58·7-108·2 cm LT ) harvested by artisanal gillnetters off Venezuela. The biased sex ratio implied segregation or sex-specific gear selectivity. Based on the development of the reproductive tract, 50% LT at sexual maturity (LT50 , mean ± s.e.) for females and males were estimated at 86·14 ± 0·64 and 81·55 ± 0·12 cm, respectively. Uterine fecundity ranged between one and six and with a maximum embryo size of 25·7 cm LT . Gravid females were observed from August to December, including those close to parturition and while the gestation period was not confirmed, the size of ovarian follicles among some specimens implied protraction. The low fecundity of the species supports close monitoring of catches.
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Serrano L, Lee D, Ibler E, Rangel S, Nardone B, West D, Gordon K. LB942 Ratio of basal cell carcinoma to squamous cell carcinoma in a large U.S. population of patients with psoriasis. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Orrell K, Nardone B, Serrano L, Lund E, Grushchak S, Rangel S, West D, Laumann A. 158 Psoriasis and sexual dysfunction in young adult males: A cross-sectional study in a large U.S. population. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pereira MF, Pereira J, Rangel S, Saraiva M, Santos LM, Cardoso JV, Alves JG. ENVIRONMENTAL MONITORING WITH PASSIVE DETECTORS AT CTN IN PORTUGAL. RADIATION PROTECTION DOSIMETRY 2016; 170:342-345. [PMID: 26598737 DOI: 10.1093/rpd/ncv479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The aim of this work is to present the methods in use for environmental dose assessment with passive detectors at Campus Tecnológico e Nuclear (CTN) of Instituto Superior Técnico, in Portugal. The methods are based on LiF:Mg,Ti (TLD-100) detectors inserted in Harshaw holders placed at four locations and exchanged on a quarterly basis. An initial group of measurements allowed the estimation of the time interval necessary to attain a stable value, the determination of a fading factor, as well as the calculation method for the assessment of the ambient dose equivalent rate.
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Pereira J, Pereira MF, Rangel S, Saraiva M, Santos LM, Cardoso JV, Alves JG. FADING EFFECT OF LiF:Mg,Ti AND LiF:Mg,Cu,P Ext-Rad AND WHOLE-BODY DETECTORS. RADIATION PROTECTION DOSIMETRY 2016; 170:177-180. [PMID: 26503857 DOI: 10.1093/rpd/ncv445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Thermoluminescence dosemeters are widely used in individual and environmental monitoring. The aim of this work was to compare the thermal stability of dosemeters of the Ext-Rad and whole-body card types with LiF:Mg,Ti and LiF:Mg,Cu,P detectors stored at different temperatures and periods. The dosemeters were stored at 0°C, room temperature and 40°C for periods that lasted 8, 30, 45, 90 and 120 d. In general, TLD-100H detectors present higher TL signal stability than TLD-100 detectors. The intensity of the signal remained constant for both materials for storage periods at 0°C. At RT the same results was observed for TLD-100H. For TLD-100 detectors, a maximum variation of 22 % was registered for the longest period. At 40°C the TL signal decreased with storage time for both detectors. The TL signal of TLD-100H detectors presented maximum variations of 12 % whereas for TLD-100 detectors, larger variations of 25 % were observed.
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Guido N, Cices A, Ibler E, Huynh T, Majewski S, Sable K, Rangel S, Laumann A, West D, Nardone B. LB759 Multiple sclerosis association with psoriasis: A large, single center, cross sectional study. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cices A, Guido N, Majewski S, Ibler E, Huynh T, Rangel S, Laumann A, Martini M, West D, Nardone B. LB763 Risk of melanoma after chronic exposure to aspirin: A large, single center, retrospective study. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Keren R, Shah SS, Srivastava R, Rangel S, Bendel-Stenzel M, Harik N, Hartley J, Lopez M, Seguias L, Tieder J, Bryan M, Gong W, Hall M, Localio R, Luan X, deBerardinis R, Parker A. Comparative effectiveness of intravenous vs oral antibiotics for postdischarge treatment of acute osteomyelitis in children. JAMA Pediatr 2015; 169:120-8. [PMID: 25506733 DOI: 10.1001/jamapediatrics.2014.2822] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Postdischarge treatment of acute osteomyelitis in children requires weeks of antibiotic therapy, which can be administered orally or intravenously via a peripherally inserted central catheter (PICC). The catheters carry a risk for serious complications, but limited evidence exists on the effectiveness of oral therapy. OBJECTIVE To compare the effectiveness and adverse outcomes of postdischarge antibiotic therapy administered via the PICC or the oral route. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective cohort study comparing PICC and oral therapy for the treatment of acute osteomyelitis. Among children hospitalized from January 1, 2009, through December 31, 2012, at 36 participating children's hospitals, we used discharge codes to identify potentially eligible participants. Results of medical record review confirmed eligibility and defined treatment group allocation and study outcomes. We used within- and across-hospital propensity score-based full matching to adjust for confounding by indication. INTERVENTIONS Postdischarge administration of antibiotics via the PICC or the oral route. MAIN OUTCOMES AND MEASURES The primary outcome was treatment failure. Secondary outcomes included adverse drug reaction, PICC line complication, and a composite of all 3 end points. RESULTS Among 2060 children and adolescents (hereinafter referred to as children) with osteomyelitis, 1005 received oral antibiotics at discharge, whereas 1055 received PICC-administered antibiotics. The proportion of children treated via the PICC route varied across hospitals from 0 to 100%. In the across-hospital (risk difference, 0.3% [95% CI, -0.1% to 2.5%]) and within-hospital (risk difference, 0.6% [95% CI, -0.2% to 3.0%]) matched analyses, children treated with antibiotics via the oral route (reference group) did not experience more treatment failures than those treated with antibiotics via the PICC route. Rates of adverse drug reaction were low (<4% in both groups) but slightly greater in the PICC group in across-hospital (risk difference, 1.7% [95% CI, 0.1%-3.3%]) and within-hospital (risk difference, 2.1% [95% CI, 0.3%-3.8%]) matched analyses. Among the children in the PICC group, 158 (15.0%) had a PICC complication that required an emergency department visit (n = 96), a rehospitalization (n = 38), or both (n = 24). As a result, the PICC group had a much higher risk of requiring a return visit to the emergency department or for hospitalization for any adverse outcome in across-hospital (risk difference, 14.6% [95% CI, 11.3%-17.9%]) and within-hospital (risk difference, 14.0% [95% CI, 10.5%-17.6%]) matched analyses. CONCLUSIONS AND RELEVANCE Given the magnitude and seriousness of PICC complications, clinicians should reconsider the practice of treating otherwise healthy children with acute osteomyelitis with prolonged intravenous antibiotics after hospital discharge when an equally effective oral alternative exists.
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