Human-centered design approach to building a transition readiness mHealth intervention for early adolescents.

OBJECTIVE: Mobile health (mHealth) interventions may be an efficacious strategy for promoting health behaviors among pediatric populations, but their success at the implementation stage has proven challenging. The purpose of this article is to provide a blueprint for using human-centered design (HCD) methods to maximize the potential for implementation, by sharing the example of a youth-, family-, and clinician-engaged process of creating an mHealth intervention aimed at promoting healthcare transition readiness. METHOD: Following HCD methods in partnership with three advisory councils, we conducted semistructured interviews with 13- to 15-year-old patients and their caregivers in two phases. In Phase 1, participants described challenges during the transition journey, and generated ideas regarding the format, content, and other qualities of the mHealth tool. For Phase 2, early adolescents and caregivers provided iterative feedback on two sequential intervention prototypes. Data were analyzed using thematic analysis in Phase 1 and the rapid assessment process for Phase 2. RESULTS: We interviewed 11 youth and 8 caregivers. The sample included adolescents with a range of chronic health conditions. In Phase 1, participants supported the idea of developing an autonomy-building tool, delivering transition readiness education via social media style videos. In Phase 2, participants responded positively to the successive prototypes and provided suggestions to make information accessible, relatable, and engaging. CONCLUSIONS: The procedures shared in this article could inform other researchers' plans to apply HCD in collaboration with implementation partners to develop mHealth interventions. Our future directions include iteratively developing more videos to promote transition readiness and implementing the intervention in clinical care.

Barriers and enablers influencing female athlete return-to-sport postpartum: a scoping review.

OBJECTIVE: Motherhood within sport has become more common with many female athletes seeking to return-to-sport (RTS) postpartum; yet few sport organisations possess policies that support female athletes to RTS postpartum. Our aim was to synthesise existing literature to identify the barriers and enablers that influence female athlete RTS postpartum to help guide the development of evidence-based policies to support postpartum athlete RTS. DESIGN: Scoping review. DATA SOURCES: Ovid-Medline, Embase, SportDiscus and Scopus were systematically searched. Reference lists of eligible studies were also searched to identify additional studies of relevance. ELIGIBILITY CRITERIA: Original, empirical, peer-reviewed, English-language studies reporting on female athletes and their RTS postpartum. Reviews, book chapters and grey literature were excluded. RESULTS: Twenty-two studies were included in this review. Identified barriers and enablers reflected 11 categories which occurred within and/or across three domains of the socioecological model. Five key factors were found to significantly influence female athlete RTS postpartum including (1) postpartum recovery time; (2) time to manage motherhood and sport demands; (3) sport organisation policies; (4) stereotypes; and (5) social support. CONCLUSION: Various barriers and enablers exist that influence successful RTS postpartum. These factors present opportunities for clinicians and sport organisations to improve their support of postpartum athletes. Paid maternity leave, offering job security, travel support for carer and child and affordable and accessible childcare are critical policy inclusions to appropriately support female athletes in their RTS postpartum.

The Measurement of Pediatric Inpatient Nursing Using the Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO©) Tool.

PURPOSE: Physiologic measurement of patient acuity has been used to predict patient outcomes, length of stay, and resource utilization. To date, these tools are not sufficiently comprehensive to inform nurse staffing assignments and have limited practical application. The Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO©) acuity tool was initially developed and validated to quantify patient acuity in terms of complexity of nursing cognitive workload in pediatric intensive care units (ICU). This article describes development and implementation of the Inpatient CAMEO© in the pediatric inpatient setting. DESIGN AND METHODS: Utilizing a modified Delphi technique, an expert panel convened to scale and implement the Inpatient CAMEO© in the pediatric inpatient units through four Delphi rounds. RESULTS: The expert panel identified care items unique to the pediatric inpatient setting and assigned a cognitive workload scale of 1-5. To consolidate the tool, the panel identified items to be classified as "Standard of Care" and developed a new baseline score for the Inpatient CAMEO©. Expert panel members served as unit-based ambassadors to foster the expansion and implementation of the new Inpatient CAMEO©. CONCLUSIONS: The Inpatient CAMEO© describes and quantifies acuity beyond the intensive care setting. The implementation and use of the Inpatient CAMEO© was accomplished through unit-based ambassadors and the support of leadership. PRACTICE IMPLICATIONS: Quantifying nursing cognitive workload in both direct and indirect care is important to determining nursing assignments and comprehensive staffing models in the pediatric inpatient setting.

Nursing science fellowship at Boston Children's Hospital.

INTRODUCTION: Clinical inquiry is vital to safeguard nursing practice and ensure optimal outcomes for our patients and families. The innovative Nursing Science Fellowship (NSF) was developed to provide structured mentorship for pediatric nurses by nurse scientists to design and conduct clinical inquiry generated from their practice. METHODS: Each fellow is paired with a nurse scientist mentor to receive support for timely project completion. Dedicated mentors guide the immersion of fellows in nursing science by providing them with didactic content detailing the process of clinical inquiry and bi-monthly one-on-one mentorship sessions. Throughout their journey, fellows learn the appropriate method by which to address their clinical inquiry question and complete a scholarly project that contributes to the science of nursing. On a quarterly basis, fellows share their progress and achievements with peers, mentors, and senior leadership. RESULTS: Since 2011, 84 fellows have enrolled in this two-year program. Sixty-two nurses have graduated from the NSF and 22 fellows are currently active. Collectively, the fellows have received 46 grants to support their projects. Twenty-one fellows have received promotions and 22 fellows have furthered their education in a masters, clinical or research doctorate program. There have been 78 external disseminations highlighting their clinical inquiry work, including poster and podium presentations and peer-reviewed published manuscripts. Lastly, there have been 26 new or updated clinical practices implemented across the enterprise as a result of completed projects. CONCLUSIONS: Combined these efforts have ensured a sustained commitment to advancing the science and practice of pediatric nursing.

Feasibility and Safety of the Preemie Orthotic Device to Manage Deformational Plagiocephaly in Extremely Low Birth Weight Infants.

BACKGROUND: Premature infants are predisposed to developing deformational plagiocephaly. Deformational plagiocephaly may affect the infant's social well-being and neurobehavioral development. PURPOSE: This pilot study investigated the feasibility and safety of the preemie orthotic device (POD); a noncommercial, supportive orthotic device to manage deformational plagiocephaly. METHODS: The setting for this prospective, descriptive, phase 1 clinical trial was 2 urban and 1 suburban neonatal intensive care units that provided care for critically ill premature and term infants. Participants included a convenience sample of 10 premature extremely low-birth-weight infants weighing less than 1 kg. All participants received the experimental treatment with the POD. Time spent on the device with and without the supportive foam insert, provider perception, adverse events, and head shape measurements were collected to assess feasibility and safety of the device. RESULTS: Participants had a median gestational age of 25.4 weeks and median birth weight of 0.673 kg. The POD was used a median of 21.2 hours per day and the foam insert was used a median of 11.1 hours per day. At enrollment, 1 participant had a normal cranial index compared with 5 participants at study completion. All participants had normal cranial symmetry at study enrollment and completion. No device-related adverse events were reported. IMPLICATION FOR PRACTICE: The POD was found to be feasible and safe. Staff had favorable responses to the device. Recommendations by nursing staff included enlarging the device to extend its use. IMPLICATION FOR RESEARCH: Further studies are warranted to assess the POD's effectiveness.

The current practice and care of paediatric patients post cardiac catheterisation.

BACKGROUND: Literature is lacking to guide standardised care and assessment practices for paediatric patients post cardiac catheterisation. In response to this gap, we sought to describe the current state of practice in cardiology programmes performing paediatric cardiac catheterisations procedures in the United States of America.Materials and methodsA web-based survey was distributed to the Congenital Cardiovascular Interventional Study Consortium Listserv, with representation from 113 identified institutions. A 36-question survey, including fixed-choice and open-ended questions, was developed and piloted for reliability and validity before distribution. Data were summarised descriptively with count and frequency or median and range. RESULTS: Of the 113 identified institutions, 52% (n=59) responded to the survey. Manual pressure is used to achieve haemostasis by 94.9% of the respondents. Pressure dressings are used by a majority of the facilities and the length of time for bed rest is variable, with the majority using 6 hours for arterial access and 4 hours for venous access. Predominantly, respondents use the time of haemostasis as the start time of bed rest while a third of respondents reported using the time the sheath was removed. CONCLUSION: In this study, variation in a number of post catheterisation care and assessment practices for paediatric patients was noted across cardiology programmes. Information from this assessment identifies key opportunities to collaborate in developing standardised practices for the care and assessment of the paediatric patients post catheterisation.

The Impact of Critical Care Nursing Certification on Pediatric Patient Outcomes.

OBJECTIVES: To examine the relationship of nursing and unit characteristics including Critical Care Registered Nurse certification on patient complications for children undergoing congenital heart surgery in free-standing children's hospitals in the United States. DESIGN: A cross-sectional descriptive survey of nursing and organizational characteristics was sent electronically. SETTING: Free-standing children's hospitals in the United States. PATIENTS: Children undergoing congenital heart surgery (congenital cardiac cases). INTERVENTION: Nursing and unit characteristics from children's hospitals were obtained via electronic survey during years 2010 and 2014. Survey data from 2014 were linked with patient-level data age less than 18 years old using the Pediatric Health Information System for years 2013-2014. The Complication Screening Method of Congenital Heart Surgery was used to adjust for baseline patient differences. MEASUREMENTS AND MAIN RESULTS: Among 23 of 43 free-standing children's hospitals (53%) in 2014, the median proportion of nurses with Bachelor of Science in Nursing preparation or higher at each site was 77% and with Critical Care Registered Nurse certification was 24%. Among 12,324 eligible congenital cardiac cases, the rate of complication was 34.4%. The odds of complications significantly decreased as the institutional percentage of nurses with a Bachelor of Science in Nursing increased (odds ratio, 0.83; p = 0.04). The odds of complications also significantly decreased as the institutional percentage of nurses with Critical Care Registered Nurse certification increased (odds ratio, 0.86; p = 0.02). CONCLUSIONS: Bachelor of Science in Nursing education and Critical Care Registered Nurse certification significantly impact pediatric patient outcomes. Recognition of nursing and organizational characteristics that are associated with improved pediatric patient outcomes is important to patients, their families, and society. Clinical leaders must commit to facilitating pathways for hiring candidates with Bachelor of Science in Nursing as a minimum to practice in PICUs and supporting a culture of professional certification.

Measuring Care Coordination in the Pediatric Cardiology Ambulatory Setting.

The role of ambulatory nursing is diverse, and the impact on patient outcomes is difficult to measure. The concept of care coordination is an important focus for the ambulatory nurse. We describe the efforts to implement the Cardiac Care Coordination Measurement Tool to document and quantify care coordination activities in a pediatric cardiac ambulatory setting.

The Evolution of a Pediatric Ventricular Assist Device Program: The Boston Children's Hospital Experience.

Mechanical circulatory support in the form of ventricular assist devices (VADs) in children has undergone rapid growth in the last decade. With expansion of device options available for larger children and adolescents, the field of outpatient VAD support has flourished, with many programs unprepared for the clinical, programmatic, and administrative responsibilities. From preimplantation VAD evaluation and patient education to postimplant VAD management, the VAD program, staffed with an interdisciplinary team, is essential to providing safe, effective, and sustainable care for a new technology in an exceedingly complex patient population. Herein, this paper describes the Boston Children's Hospital VAD experience over a decade and important lessons learned from developing a pediatric program focusing on a high-risk but low-volume population. We highlight the paramount role of the VAD coordinator, clinical infrastructure requirements, as well as innovation in care spanning inpatient and outpatient VAD supports at Boston Children's Hospital.

Predictors of Persistent Infant Car Seat Challenge Failure.

BACKGROUND: Premature and other at-risk infants can experience cardiorespiratory problems when positioned in their car seats. The American Academy of Pediatrics recommends that all premature and at-risk infants undergo a period of observation in their car seat to monitor for apnea, bradycardia, and oxygen desaturation before hospital discharge. This Infant Car Seat Challenge (ICSC) is used to determine readiness for infant travel in a car seat. Infants failing the ICSC are discharged home in car beds and referred for a follow-up screen in the outpatient clinic. PURPOSE: The purpose of this study was to identify predictors for infants failing the follow-up ICSC after hospital discharge. METHODS/SEARCH STRATEGY: A retrospective, cross-sectional study design was used to examine charts of 436 infants referred from across New England, to Boston Children's Hospital's, Center for Healthy Infant Lung Development clinic between August 2008 and May 2015 for a follow-up ICSC. FINDINGS/RESULTS: Infants who failed the follow-up ICSC had statistically significant lower weights (0.27 ± 0.14 kg, difference ± standard error, P = .03) and younger postmenstrual ages (0.9 ± 0.4 weeks, P = .03). History of a cardiac condition (odds ratio, 3.6; 95% confidence interval, 1.5-8.5; P = .005) and respiratory illness (odds ratio, 2.1; confidence interval, 1.1 to 4.2; P = .03) were significant predictors of ICSC failure. IMPLICATIONS FOR PRACTICE: A follow-up ICSC is recommended for the safe transition of infants from a car bed to a car seat. IMPLICATIONS FOR RESEARCH: Further research is needed to investigate the causes of ICSC failure among high-risk infant populations.

The Healthy Community Neighborhood Initiative: Rationale and Design.

OBJECTIVE: To describe the design and rationale of the Healthy Community Neighborhood Initiative (HCNI), a multi-component study to understand and document health risk and resources in a low-income and minority community. DESIGN: A community-partnered participatory research project. SETTING: A low-income, biethnic African American and Latino neighborhood in South Los Angeles. PARTICIPANTS: Adult community residents aged >18 years. MAIN OUTCOME MEASURES: Household survey and clinical data collection; neighborhood characteristics; neighborhood observations; and community resources asset mapping. RESULTS: We enrolled 206 participants (90% of those eligible), of whom 205 completed the household interview and examination, and 199 provided laboratory samples. Among enrollees, 82 (40%) were aged >50 years and participated in functional status measurement. We completed neighborhood observations on 93 street segments; an average of 2.2 (SD=1.6) study participants resided on each street segment observed. The community asset map identified 290 resources summarized in a Community Resource Guide given to all participants. CONCLUSIONS: The HCNI community-academic partnership has built a framework to assess and document the individual, social, and community factors that may influence clinical and social outcomes in a community at high-risk for preventable chronic disease. Our project suggests that a community collaborative can use culturally and scientifically sound strategies to identify community-centered health and social needs. Additional work is needed to understand strategies for developing and implementing interventions to mitigate these disparities.

Monitoring the health of the work environment with a daily assessment tool: the REAL - Relative Environment Assessment Lens - indicator.

BACKGROUND: Evidence shows that the health of the work environment impacts staff satisfaction, interdisciplinary communication, and patient outcomes. Utilising the American Association of Critical-Care Nurses' Healthy Work Environment standards, we developed a daily assessment tool. METHODS: The Relative Environment Assessment Lens (REAL) Indicator was developed using a consensus-based method to evaluate the health of the work environment and to identify opportunities for improvement from the front-line staff. A visual scale using images that resemble emoticons was linked with a written description of feelings about their work environment that day, with the highest number corresponding to the most positive experience. Face validity was established by seeking staff feedback and goals were set. RESULTS: Over 10 months, results from the REAL Indicator in the cardiac catheterisation laboratory indicated an overall good work environment. The goal of 80% of the respondents reporting their work environment to be "Great", "Good", or "Satisfactory" was met each month. During the same time frame, this goal was met four times in the cardiovascular operating room. On average, 72.7% of cardiovascular operating room respondents reported their work environment to be "Satisfactory" or better. CONCLUSION: The REAL Indicator has become a valuable tool in assessing the specific issues of the clinical area and identifying opportunities for improvement. Given the feasibility of and positive response to this tool in the cardiac catheterisation laboratory, it has been adopted in other patient-care areas where staff and leaders believe that they need to understand the health of the environment in a more specific and frequent time frame.

Factors Associated with Human Papillomavirus Vaccine Acceptance Among Haitian and African-American parents of Adolescent Sons.

ACKNOWLEDGEMENTS: The authors would like to thank Cecilia Marquez, Justine Lavoye, Elaine Shu and Hailey Tipton for their efforts with participant recruitment and data collection. OBJECTIVE: To assess knowledge, attitudes, beliefs and practices related to HPV vaccination among African-Americans and Haitian immigrant parents, and to compare vaccination rates of their sons. STUDY DESIGN: We performed semi-structured interviews with parents of boys aged 11-17 who had not yet received the HPV vaccine. We used validated surveys of HPV knowledge, trust in physicians, and intention to vaccinate. We probed participants' thought processes about HPV vaccination, and examined parental attitudes, beliefs, and practices toward HPV vaccination using open-ended questions. We then reviewed medical records to determine whether sons were subsequently vaccinated. RESULTS: 25 African-American and 30 Haitian immigrant parents and legal guardians participated in the study. Haitian immigrants were more likely to be married and to practice a religion than African-Americans. Both groups had limited knowledge of HPV (32% of questions were answered correctly by Haitian immigrants vs. 31% by African-Americans). Sixty-four percent of African-Americans and 79% of Haitians intended to vaccinate their sons, however only 24% of African-American and 20% of Haitian sons received vaccination within 12 months of the interview. Open-ended questions revealed that most African-Americans felt that vaccination fell within the parental role, while some Haitian immigrants felt uncomfortable vaccinating against sexually transmitted infections because they felt children should not be having sex. Both groups wanted more information about HPV vaccines. CONCLUSIONS: Improving HPV vaccine rates in Haitian and African-American boys may require culturally competent approaches that address ethnic-specific barriers among their parents.

nab-Paclitaxel Plus Gemcitabine Regimen for Pancreatic Cancer.

The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic therapy, and the agents, both commercially available and investigational, used to treat malignant diseases. Questions or suggestions for topics should be addressed to Dominic A. Solimando, Jr, President, Oncology Pharmacy Services, Inc, 4201 Wilson Blvd #110-545, Arlington, VA 22203, e-mail: OncRxSvc@comcast.net; or J. Aubrey Waddell, Professor, University of Tennessee College of Pharmacy; Oncology Pharmacist, Pharmacy Department, Blount Memorial Hospital, 907 E. Lamar Alexander Parkway, Maryville, TN 37804, e-mail: waddfour@charter.net.

Skill acquisition interventions for the learning of sports-related skills: A scoping review of randomised controlled trials.

BACKGROUND: Skill acquisition science is the study of how motor skills are acquired, developed and/or learned. There is substantive evidence for general motor skill acquisition in controlled laboratory settings yet the literature on the learning of sports-related skills is typically less conclusive. OBJECTIVES: This scoping review aimed to summarise the current literature on skill acquisition intervention studies examining the learning of sports-related skills as part of a randomised controlled trial, by synthesizing and extracting the most relevant features. METHODS: Four electronic databases (PsychINFO, PubMed, SPORTDiscus and Web of Science) were searched for relevant studies. The sample characteristics of these studies were extracted, and summarised. Two systematic searches of the literature were conducted. In the first search, eighty-six studies were retained. A second search was conducted in July 2022 to include new studies and specifically focused on the inclusion of within-subject design studies, resulting in the inclusion of 35 additional studies. A third search was conducted in May 2023 to include new studies resulting in the inclusion of 10 additional studies. RESULTS: One hundred and thirty studies across 29 sports were included in the review. The vast majority of the studies in this scoping review (n = 104) examined the learning of a sport-related skill in participants with no experience. Twenty-eight percent of all retained studies (n = 35) considered only the learning of a golf skill, and all studies were practiced in a laboratory environment, examining closed motor skills (n = 130). The most common intervention categories reported were attention (n = 22), instruction and demonstration (n = 20), practice design (n = 20), and perceptual training (n = 19). Nearly half of all studies used an immediate retention test within 48 h of the cessation of practice (n = 63), and just over one quarter of studies (n = 34) reported incorporating some form of transfer test. Eighty-six percent (n = 112) reported positive findings. CONCLUSIONS: The skewed focus on golf skills across a small number of skill acquisition interventions, the inconsistent use and reporting of performance measures, practice durations and measures of learning alongside the relatively small sample sizes consisting mostly of inexperienced learners and the skewed publication of positive findings should warrant caution. More empirical studies across a broader range of sports and with more consistent methodologies are needed to develop a robust pool of literature that can support academics and practitioners interested in which skill acquisition interventions could be used to influence the learning of sports-related skills.

Measuring the Interprofessional Health of the Pediatric Cardiovascular Operating Room Work Environment.

Introduction: Pediatric cardiac surgery is complex and has significant risk, requiring interprofessional teamwork for optimal outcomes. Unhealthy work environments have been linked to poor patient outcomes, staff dissatisfaction, and intention to leave. We describe the interprofessional health of pediatric cardiovascular operating room (CVOR) work environments in the United States and the establishment of a healthy work environment (HWE) benchmark score. Methods: Utilizing the American Association of Critical Care Nurses Healthy Work Environments Assessment Tool (HWEAT), interprofessional staff from 11 pediatric CVORs were surveyed. Responses were aggregated, summarized, and stratified by role to examine differences. The following phase used an e-Delphi approach to obtain expert consensus on a benchmark target. Results: Across 11 centers, 179 (60%) completed surveys were reviewed. The interprofessional mean HWEAT score was 3.55 (2.65-4.34). Mean scores for each standard were within the "good" range. Participants reported the highest scores for effective decision-making, with a mean of 3.69 (3.00-4.20). Meaningful recognition scored lowest, mean 3.26 (2.33-4.07). When stratified, surgeons reported higher overall HWE scores (M = 3.79, SD = 0.13) than nurses (M = 3.41, SD = 0.19; P = 0.02, two-tailed). The proposed benchmark was 3.50. Conclusions: This is the first time the American Association of Critical Care Nurses HWEAT has been used to describe the interprofessional health of work environments in pediatric CVORs in the United States. The targeted benchmark can support pediatric CVOR improvement strategies. Creating and sustaining an HWE is an interprofessional opportunity to support high-quality patient outcomes and clinical excellence.

A community-partnered approach for diversity in COVID-19 vaccine clinical trials.

Introduction: Communities of color have faced disproportionate morbidity and mortality from COVID-19, coupled with historical underrepresentation in US clinical trials, creating challenges for equitable participation in developing and testing a safe and effective COVID-19 vaccine. Methods: To increase diversity, including racial and ethnic representation, in local Los Angeles County NIH-sponsored Phase 3 SARS-CoV-2 vaccine clinical trials, we used deliberative community engagement approaches to form a Community Consultant Panel (CCP) that partnered with trial research teams. Thirteen members were recruited, including expertise from essential workers, community-based and faith-based organizations, or leaders from racial and ethnic minority communities. Results: Working closely with local investigators for the vaccine studies, the CCP provided critical insight on best practices for community trust building, clinical trial participation, and reliable information dissemination regarding COVID-19 vaccines. Modifying recruitment, outreach, and trial protocols led to majority-minority participants (55%-78%) in each of the three vaccine clinical trials. CCP's input led to cultural tailoring of recruitment materials, changes in recruitment messaging, and supportive services to improve trial accessibility and acceptability (transportation, protocols for cultural competency, and support linkages to care in case of an adverse event). Barriers to clinical trial participation unable to be resolved included childcare, requests for after-hours appointment availability, and mobile locations for trial visits. Conclusion: Using deliberative community engagement can provide critical and timely insight into the community-centered barriers to COVID-19 vaccine trial participation, including addressing social determinants of health, trust, clinical trial literacy, structural barriers, and identifying trusted messenger and reliable sources of information.

Measuring Acuity and Pediatric Critical Care Nursing Workload by Using ICU CAMEO III.

BACKGROUND: The Intensive Care Unit Complexity Assessment and Monitoring to Ensure Optimal Outcomes (ICU CAMEO III) acuity tool measures patient acuity in terms of the complexity of nursing cognitive workload. OBJECTIVE: To validate the ICU CAMEO III acuity tool in US children's hospitals. METHODS: Using a convenience sample, 9 sites enrolled children admitted to pediatric intensive care units (ICUs). Descriptive statistics were used to summarize patient, nursing, and unit characteristics. Concurrent validity was evaluated by correlating the ICU CAMEO III with the Therapeutic Intervention Scoring System-Children (TISS-C) and the Pediatric Risk of Mortality III (PRISM III). RESULTS: Patients (N = 840) were enrolled from 15 units (7 cardiac and 8 mixed pediatric ICUs). The mean number of ICU beds was 23 (range, 12-34). Among the patients, 512 (61%) were diagnosed with cardiac and 328 (39%) with noncardiac conditions; 463 patients (55.1%) were admitted for medical reasons, and 377 patients (44.9%) were surgical. The ICU CAMEO III median score was 99 (range, 59-163). The ICU CAMEO complexity classification was determined for all 840 patients: 60 (7.1%) with level I complexity; 183 (21.8%) with level II; 201 (23.9%), level III; 267 (31.8%), level IV; and 129 (15.4%), level V. Strong correlation was found between ICU CAMEO III and both TISS-C (ρ = .822, P < .001) and PRISM III (ρ = .607, P < .001) scores, and between the CAMEO complexity classifications and the PRISM III categories (ρ = .575, P = .001). CONCLUSION: The ICU CAMEO III acuity tool and CAMEO complexity classifications are valid measures of patient acuity and nursing cognitive workload compared with PRISM III and TISS-C in academic children's hospitals.

Mechanisms for Community Health Worker Action on Patient-, Institutional-, and Community-Level Barriers to Primary Care in a Safety-Net Setting.

Medically and socially complex patients disproportionately face barriers to primary care, contributing to health inequities and higher health care costs. This study elicited perspectives on how community health workers (CHWs) act upon barriers to primary care in 5 patient (n = 25) and 3 CHW focus groups (n = 17). Participants described how CHWs acted on patient-level barriers through social support, empowerment, and linkages, and system-level barriers by enhancing care team awareness of patient circumstances, optimizing communication, and advocating for equitable treatment. Limitations existed for influencing entrenched community-level barriers. CHWs, focusing on patient preferences, motivators, and circumstances, intervened on multilevel barriers to primary care, including advocacy for equitable treatment. These mechanisms have implications for existing CHW conceptual models.

Breast imaging training and attitudes: update survey of senior radiology residents.

OBJECTIVE: The purpose of this study was to investigate the training and attitudes of senior residents regarding breast imaging. MATERIALS AND METHODS: In 2008 a follow-up survey was completed by a chief or senior resident at 201 radiology training programs in North America. Questions included organization of breast imaging rotation, resident responsibilities, clinical practice protocols at the institution, resident impressions regarding breast imaging, and resident interest in performing breast imaging after residency. Results were compared with those of a survey completed in 2000. RESULTS: Of 201 training programs, 200 (99.5%) had dedicated breast imaging rotations; 190 (95%), 12 weeks or longer; and 39 (19%), 16 weeks or longer. Residents regularly performed real-time ultrasound imaging in 138 programs (69%), needle localization in 159 (79%), ultrasound-guided biopsy in 154 (77%), and stereotactically guided biopsy in 145 programs (72%). One hundred sixty-two residents (81%) reported that interpreting mammograms was more stressful than interpretation of other imaging studies; 143 (71%) believed that only breast imaging subspecialists should interpret mammograms; and 104 (52%) would not consider pursuing a breast imaging fellowship. As in 2000, the most common reasons cited for not considering a fellowship were lack of interest in the field, fear of lawsuits, and the stressful nature of the job. CONCLUSION: Residency programs have devoted more time to breast imaging and made improvements in their curricula, but current residents report decreased opportunities to perform some studies and procedures. Although most residents would not consider a fellowship and did not want to interpret mammograms in future practice, the percentage of residents who would not consider breast imaging as a subspecialty has decreased since 2000. An accurate picture of current breast imaging curricula and variations among residency programs is necessary to identify and correct systemic problems and to improve the training of future breast imagers.