A Team-Based Approach for Children With Congenital Cardiac Disease Undergoing Antireflux Procedure With Gastrostomy

INTRODUCTION

Laparoscopic Nissen fundoplication with gastrostomy tube (LPNF-GT) placement is often indicated in children with congenital cardiac diseases (CCDs) for nutritional optimization. This study aims to evaluate institutional outcomes of LPNF-GT, with a team-based approach in operative management.

METHODS

Five years of an institutional database at a tertiary care children's hospital was queried for LPNF-GT in children with CCDs. Descriptive analyses were performed. A national comparison was performed utilizing the 2012-2013 Pediatrics NSQIP database, using propensity score matching. Outcome measures of interest were operative-time, unplanned readmission, and 30-day mortality.

RESULTS

A team-based approach was utilized in 51 cases. Median operative time was 68.5 (IQR: 48-89) minutes. All patients tolerated tube feeds postoperatively. All patients survived 30 days post surgery. When compared to 136 similarly matched children nationally, the risk-adjusted operative time with a team-based approach was 47.38 (12.43-82.33) minutes shorter (P < .05). There were no statistically significant differences in the likelihood of being in the hospital past 30 days, unplanned readmissions, and mortality (P > .05).

CONCLUSION

LPNF-GT can be safely performed in children with CCDs. A team-based approach demonstrates improved operative time and achieved similar outcomes when compared nationally.

The translational sciences clinic: From bench to bedside

The mission of the National Center for Advancing Translational Science (NCATS) is to speed the development of drugs from discovery to approval to dissemination and implementation. The Medical University of South Carolina and the South Carolina Clinical and Translational Research Institute host a NCATS funded predoctoral T32 training grant (TL1) with a focus on translational research. Doctoral (PhD) trainees working at the bench usually have limited opportunity for clinical interactions to gain a clinical perspective on the diseases that are the focus of their dissertation research. To provide TL1 trainees with an opportunity to see how their research could be translated into improved patient care, we developed a mentored clinical exposure experience named the Translational Sciences Clinic. Trainees spend one-half day a week in a clinic related to their basic science research for one semester interacting with patients and clinical mentors and discuss the most recent literature related to the patient's clinical problem with their clinical mentor. Trainees deemed the rotation to be one of the most rewarding experiences that they had as a part of their predoctoral training. Participating clinical mentors were also very enthusiastic and agreed that they would be willing to mentor similar trainees again.

[The Ideal Role of Pharmacists: A Nurse's Perspective]

Drug-related work is one of the most difficult tasks for nurses. This may stem from the lack of knowledge of pharmacology as the minimum duration of the pharmacology course in basic nursing education is only 30 h (2 units). According to the Project to Collect Medical Near-miss/Adverse Event Information 2018 Annual Report of the Japan Council for Quality Health Care, 9.2% of incidents were related to medication and the majority involved nurses. Several medication management tasks in hospitals are currently managed by nurses, while at the same time many nurses have high expectations of pharmacists as experts in pharmacology. Nurses recognize that pharmacists working in hospital wards have great responsibilities. Furthermore, in hospitals that promote advanced treatments, the expertise of pharmacists is demonstrated in the fields of chemotherapy and palliative care in cancer treatment, infection control, and nutrition support team (NST). In many hospitals, however, nurses are responsible for several medication management tasks. Therefore, nurses believe that it would be beneficial for pharmacists to participate more in medical management tasks.

Team-based parent training by child specialists helps maltreated children

BACKGROUND

This study assessed the effects of the parent training (PT) technique, in which child specialists (CS) such as preschool and school teachers promote secure attachment in children with aberrant social behavior following maltreatment, using a team approach.

METHODS

Child specialists confirmed the presence of child abuse, according to Japanese Ministry of Health, Labour and Welfare criteria. CS such as homeroom, special education-related, student guidance-related, nursing teachers and co-workers received a PT course conducted by the authors. A homeroom teacher provided classroom management to model good examples of social life for the target child. A nursing teacher and assistant offered individualized instruction to foster the formation of secure attachments by the target child.

RESULT

Behavioral abnormalities in both school and home resolved in seven out of 12 cases. These subjects received the intervention for 2-4 years. In the other cases, behavioral abnormalities disappeared or decreased at school, but continued at home. Almost all children met the alternative criteria of attachment disorder proposed by Boris and Zeanah. One child met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for reactive attachment disorder. This intervention is significantly more effective for children who have yet to begin elementary school than those in elementary school.

CONCLUSIONS

The PT technique as applied by CS using a team approach may be a useful intervention for fostering secure attachment in children with maltreatment who exhibit behavioral abnormalities. Early detection and intervention are necessary to successfully address the behavioral abnormalities of children with maltreatment.

Emergency ultrasound fellowship training: a novel team-based approach

OBJECTIVES

To describe our experience with implementation of a novel team-based emergency ultrasound (EUS) fellowship training program.

METHODS

We conducted a retrospective review at an academic medical center. All emergency department (ED) faculty and residents were divided into 3 teams, and a fellow was assigned to each team. Each fellow was responsible for ultrasound (US) education of their team members and faculty credentialing. Additionally, each fellow was assigned to one of these specific responsibilities every month: (1) education, (2) quality assurance/billing, and (3) equipment. The fellows also received a checklist at the beginning of the fellowship training, which outlined research, reading, teaching, and scanning requirements.

RESULTS

With a team-based approach, all US examinations were reviewed for quality control within 1 week after the scans were performed. The number of US examinations billed by faculty increased by 180%. The US billing revenue increased by 60% during the study period. Fifteen additional faculty members were credentialed to use US in the ED. Compliance with bedside documentation of US findings increased from 30% to 90%. There was increased resident engagement, and the number of scans performed by residents increased by 130%. There was also a substantial decrease in the funds required to replace damaged transducers.

CONCLUSIONS

A team-based EUS fellowship training program had a substantial impact on US use in the ED, quality control review, faculty credentialing, US billing revenue, compliance with documentation, and resident US education.