A Survey of Academic Neonatologists on Neonatal Electrical Cardioversion and Defibrillation.

OBJECTIVE: This study aimed to assess neonatologists' experience and comfort with neonatal electrical cardioversion or defibrillation (EC-D). STUDY DESIGN: Electronic surveys were distributed to academic neonatologists affiliated with 12 Midwest academic hospitals. Neonatologists were asked about their residency training; years since completing residency; current certification/competency training in the Basic Life Support (BLS), Pediatric Advanced Life Support (PALS), Advanced Cardiovascular Life Support (ACLS), and Neonatal Resuscitation Program (NRP); experiences with EC-D; availability of a pediatric cardiologist; and their comfort levels with such procedures. Standard statistical tests evaluated comfort with EC-D. RESULTS: Seventy-two out of 180 neonatologists responded to the survey (response rate = 40%). Of them, 98.6% (71), 54.2% (39), and 37.5% (27) maintained current NRP, BLS, and PALS trainings, respectively. Also, 73.6% (n = 53) reported having performed neonatal EC-D. Of those, 50.9% (n = 27) indicated feeling slightly to very uncomfortable performing EC-D. We report a lack of BLS certification being associated with a lack of comfort (odds ratio [OR]: 0.269, 95% confidence interval [CI]: [0.071, 0.936]), and a positive association between a pediatric cardiologist being present and being uncomfortable (OR: 3.722, 95% CI: [1.069, 14.059]). Those reporting greater volume and more recent experience with EC-D report more comfort. CONCLUSION: Of neonatologists who performed EC-D, half of them reported being uncomfortable. BLS certification and experience are positively associated with comfort in performing EC-D. Simulations to increase training in EC-D should be offered regularly to academic neonatologists. KEY POINTS: · Most neonatologists have performed EC-D, but many feel uncomfortable with performing EC-D.. · Many do not maintain current certification in BLS, PALS, or ACLS.. · Simulation training in EC-D will increase comfort with EC-D..

Utilization of an Outpatient Integrated Infusion Suite to Decrease Length of Stay, Increase Revenue, and Improve Patient Experience for Elective Chemotherapy Admissions.

PURPOSE: Reduction of chemotherapy start times (CST) and length of stay (LOS) for elective chemotherapy admissions is a priority. The aim of this project was to improve efficiency of patient care while simultaneously increasing revenue by reducing LOS and transitioning high-cost chemotherapy to the outpatient setting. METHODS: A multidisciplinary quality improvement team proposed building a new outpatient infusion suite in close proximity to the inpatient unit. This suite was then integrated into the flow of elective inpatient chemotherapy admissions and discharges for etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R). Quality measures such as CST, LOS, and revenue were used to evaluate the new infusion suite. RESULTS: In the pilot phase of the study, the average CST improved by approximately 1 hour 45 minutes (P = .0218). The mean LOS was reduced from 4.3 to 4.1 midnights (P = .0214). In terms of hours, LOS was reduced from 105.8 to 95.5 hours (P < .0001). A mean quarterly revenue of $309,410 US dollars was noted during the pilot that had not been previously billed. These improvements were sustained throughout the control phase. CONCLUSION: Delays in CST and prolonged LOS lead to patient dissatisfaction and increased cost to the health care system. Focus groups and patient feedback are important when designing and implementing new workflows. The creation of an outpatient integrated infusion suite allows medical centers to meet patients' expectations of reducing number of visits while also reducing LOS and capturing new revenue. Adherence to scheduling guidelines further reduces the CST for elective chemotherapy administration.

Pediatric Care in the Age of COVID-19.

Two pediatricians share perspectives on patient experience and delivery, future health care encounters, and social implications during the coronavirus 2019 pandemic. Collateral effects may comprise the most significant impacts on children, from limitations on hospital visitors, to closures of child-friendly hospital playrooms during this pandemic, to an alarming decrease in vaccination rates. Educational disparities will also likely widen, especially among those with limited access to technology at home. [Pediatr Ann. 2020;49(9):e403-e404.].

The Persistent Effects of Youth Savings Reminders: Experimental Evidence from Text-Message Campaigns in Colombia.

We report on a nationwide field experiment with a commercial bank in Colombia in which low-income youth (12 years old on average) who open new accounts are randomly assigned immediately after opening the account to control or to receive one of three twelve-month text-messaging campaigns: i) monthly savings reminders, ii) semimonthly reminders, iii) monthly action-oriented financial education messages. Relative to control, monthly and semimonthly reminders groups increase account balances during the campaign as a result of reduced withdrawals, potentially through savings shifts from home to bank accounts. After the campaign youth in both reminders groups continue to use the accounts but do not deplete balances. The financial education campaign had a smaller, not statistically significant, effect on account balances, but some short-term effect on reducing withdrawals, possibly through shifts from home savings.

Birth defects surveillance: experiences in Argentina and Colombia.

Birth defects (BDs) are structural or functional anomalies, sporadic or hereditary, of prenatal origin. Public health surveillance is defined as the ongoing systematic collection, analysis, and interpretation of outcome-specific data for use in the planning, implementation, and evaluation of public health practice. BD surveillance systems may have different characteristics according to design, coverage, type of surveillance, case ascertainment, case definition, BD description, maximum age of diagnosis, pregnancy outcomes, coding systems, and the location of the coding process (central or local). The aim of this article is to describe and compare methodology, applications, and results of birth defect surveillance systems in two South-American countries: Colombia and Argentina. In both countries, the surveillance systems developed activities in relation to the Zika virus emergency. For most BDs, a statistically significant higher prevalence is observed in Argentina-RENAC than in Colombian registries. This may be due to methodological reasons or real differences in prevalence. The strengths, weaknesses, and the future perspectives of the Argentine and Colombian systems are presented. When developing a surveillance system, the objectives, the available resources, and previous experiences in similar contexts must be taken into account. In that sense, the experience of Argentina and Colombia can be useful for others when developing a birth defect surveillance system.

Etiología y fisiopatología del Hallux Valgus / Etiology and phisiology of Hallux Valgus

El hallux valgus es uno de los motivos de consulta más frecuentes dentro de las patologías que afectan el pie, el 90% de los pacientes son mujeres. Se caracteriza por deformidad en varo de primer metatarsiano y valgo del primer dedo, dolor en la prominencia ósea medial y debajo de cabeza de los metatarsianos. Además, se puede acompañar de artejos menores en garra y metatarsalgia. El uso de calzado inadecuado, ya sea en punta y con tacón alto, así como el antecedente genético, se han descrito como las principales causas de esta patología. El tratamiento depende exclusivamente de la sintomatología y está encaminado inicialmente al uso de calzado amplio y cómodo, plantillas cuando hay metatarsalgia asociada. El tratamiento ortopédico puede mejorar el dolor más no la deformidad. Si este manejo no da resultado, se recurre al tratamiento quirúrgico. La cirugía tiene como objetivo realinear las estructuras óseas para corregir la deformidad mediante osteotomías y liberación de tejidos blandos, lo cual mejora el dolor y facilita el uso de calzado. Existen múltiples técnicas quirúrgicas descritas, que se escogen dependiendo de la severidad del hallux y de la experiencia del cirujano. Los resultados del tratamiento quirúrgico son exitosos aproximadamente en el 85% de los casos. Como en todas las patologías hay riesgo complicaciones post operatorias y estas pueden ocurrir en el 15% de los pacientes; las más frecuentes son la recidiva de la deformidad e infecciones superficiales. El riesgo de recidiva aumenta en deformidades severas, pacientes con pie plano o inestabilidad de articulación cuneo metatarsiana.

The hallux valgus is one of the most frequent reasons for consultation within the pathologies that affect the foot, 90% of patients are women. It is characterized by varus deformity of the first metatarsal and valgus of the first toe, pain in the medial bony prominence and below the head of the metatarsals, in addition minor claw and metatarsalgia can be accompanied. The use of inappropriate shoes, narrow and high-heeled, as well as the genetic background have been described as the main causes of this pathology. The treatment depends exclusively on the symptomatology and is initially aimed at the use of wide and comfortable shoes, insoles when there is associated metatarsalgia. Orthopedic treatment can improve pain, not deformity. Surgical treatment is reserved for those patients who, despite performing adequate orthopedic treatment, do not improve. The aim of the surgical treatment is to realign the bony structures to correct the deformity by means of osteotomies and soft tissues release, this improves the pain and facilitates the use of footwear. There are multiple surgical techniques described, which are chosen depending on the severity of the hallux and the experience of the surgeon. The results of surgical treatment are successful in approximately 85% of cases. As in all pathologies there is a risk of post-operative complications, which may occur in 15% of patients; the most frequent are the recurrence of deformity and superficial infections.

Percepción y experiencias frente a la hiperplasia epitelial focal en una comunidad indígena huitoto/ticuna del amazonas colombiano / Knowledge, attitude, and practices about focal epithelial hyperplasia in the Huitoto/Ticuna native community of Colombian Amazon

Antecedentes. La hiperplasia epitelial focal, es una enfermedad frecuente en ciertas comunidades indígenas, es producida por un tipo de virus, en la que además parecen participar algunos otros factores socio-demográficos en su desarrollo y presentación. Objetivo. Explorar los conocimientos, actitudes y prácticas de una comunidad indígena Huitoto Ticuna del Amazonas sobre la hiperplasia epitelial focal. Material y métodos. De acuerdo a la presentación de los casos por familia, se diseñó una guía de entrevista considerando: percepción del problema, experiencias previas, impacto y manejo de las lesiones. Se escogieron 10 viviendas con casos positivos realizando entrevistas semiestruc¬turadas y un análisis por subtópicos y por dominios, se aplicó metodología cualitativa para la obtención de la información, dentro de un estudio descriptivo. Resultados. Participaron tres hombres y nueve mujeres; 11 pertenecían a la etnia Ticuna y una a la etnia Yagua. Los entrevistados se encontraron entre 17 y 46 años. Sólo dos casos se reportaron en niñas, el resto fueron reportados en niños, cuyas edades oscilaban entre los dos y ocho años. La lesión es conocida por la comunidad, pero para ellos no constituye un problema importante, ya que aparte de la implicación estética, no ocasiona sintomatología que interfiera de forma importante con su vida cotidiana. Consideran que la enfermedad se produce por contacto con elementos contaminados, niegan la posibilidad de contagio persona a persona. Para el tratamiento utilizan sustancias, como sal y ceniza, raspan las lesiones considerando que al salir la sangre, sale la enfermedad y además aplican tópicamente sustancias referidas por ellos como resinas vegetales. Conclusiones. Como mecanismo etiológico principal refieren el contagio por medio de vectores, buscan eliminar la enfermedad por el aspecto estético; conocen métodos naturales para el tratamiento de estas lesiones, estos se caracterizan por utilizar los elementos de plantas y animales. Teniendo en cuenta la etiología viral, las campañas psicoeducativas deberán dirigirse a controlar factores de riesgo en el contagio no sólo por control de vectores, sino también persona a persona.