2019 Graduate Medical Education Research Day Compendium

Anyone engaged in research knows that the process can be daunting. Add the rigors of training in a graduate medical education program to this, and it might seem all but impossible to accomplish anything meaningful. However, the individuals highlighted in our 2019 Graduate Medical Education Research Day Compendium were able to overcome those odds. Their abstracts are showcased here and their efforts to advance the collective knowledge in their respective fields are commendable. We thank these Resident and Fellow Physicians and all who have supported them in their endeavors to reach this point with their research. Most of all, we encourage their great work to continue in the spirit of intellectual curiosity that will lead everyone into a better tomorrow

Outcomes following admission to paediatric intensive care: A systematic review

Introduction Paediatric Intensive Care has developed rapidly in recent years with a dramatic increase in survival rates. However, there are increasing concerns regarding the impact that admission to a Paediatric Intensive Care Unit (PICU) has on both the child and their family. Following discharge from PICU, children may be living with complex medical problems as well as dealing with the psychosocial impact that their illness has had on them and their family. Objectives To describe the long-term health outcomes of children admitted to a paediatric intensive care unit (PICU). Methods A full literature search was conducted including the databases; MEDLINE via PubMed, Cochrane Central Register of Controlled Trials, (CENTRAL), Scopus, Web of Science, CINAHL, ERIC, Health Source Nursing/Academic, APA PsycInfo. All studies including children under 18 admitted to a PICU were included. Primary outcome was short- and longerterm mortality. Secondary outcomes were neurodevelopment/cognition/school performance; physical function, psychological function/behaviour impact, quality of life outcomes and social/family implications. Studies focused on Neonatal Intensive Care Admission and articles with no English translation were excluded. Results One hundred and five articles were included in the analysis. Mortality in PICU ranged from 1.3% to 50%. Mortality in high income countries reduced over time but the data did not show the same trend for low- and middle-income countries. Higher income countries were found to have lower Standardised Mortality Rates (SMRs) than low- and middle-income countries. Children had an ongoing risk of death for up to 10 years following PICU admission. Children admitted to PICU also have more ongoing morbidity than their healthy counterparts with more cognitive/developmental problems, more functional health issues, poorer quality of life as well as increased psychological problems. Their parents also have an increased risk of Post Traumatic Stress Disorder (PTSD). Discussion Most of the studies identified are from high income countries and only include short-term follow up. More data is needed from low- and middle-income countries and over longer terms. The studies were markedly heterogenous and were all observational. Agreement is needed regarding which outcomes are most important to measure as well as standardised methods of assessing them. Further research is needed to identify the risk factors which cause children to have poorer outcomes as well as to identify predictive and modifiable factors which could be targeted in practice improvement initiatives

Mild postoperative acute kidney injury and outcomes after surgery for congenital heart disease

ObjectiveThe effect of mild acute kidney injury (AKI) on outcomes after heart surgery in children is unclear. We sought to characterize the epidemiology of mild AKI associated with surgery for congenital heart disease (CHS-AKI) in children.MethodsWe conducted a single-center, retrospective cohort study of 693 patients (aged 6 days-18 years) who underwent heart surgery in 2009. The prevalence of AKI within 72 hours of surgery was determined using the 3-stage Acute Kidney Injury Network criteria. Factors associated with both hospital length of stay and AKI were used in a proportional hazards model to test the association of stage 1 AKI with hospital length of stay.ResultsThe median age of the patients was 11.5 months (interquartile range, 3-54 months). Eighteen percent of the cohort had single ventricle heart disease and 54% underwent RACHS-1 category 3 or higher surgery. The prevalence of stages 1, 2, and 3 AKI in this cohort was 11% (n = 77), 3% (n = 19), and 1% (n = 8), respectively. Factors independently associated with AKI were prematurity, single ventricle physiology, peak postoperative lactic acid concentration, cardiopulmonary bypass time, and a history of heart surgery. Stage 2 or greater CHS-AKI was associated with hospital length of stay (adjusted hazard ratio [AHR], 0.53; 95% confidence interval [CI], 0.33-0.87; P = .01), but stage 1 was not (AHR, 0.85; 95% CI, 0.66-1.10; P = .22).ConclusionsAKI occurs after surgery for congenital heart disease but may be less common than previously reported. Although moderate to severe CHS-AKI is independently associated with prolonged recovery after heart surgery, mild disease does not appear to be

Pediatric Infectious Disease in Resource-Limited Settings: Describing Post-Discharge Mortality in Uganda

Background and Objectives Pediatric post-discharge mortality in low-resources settings is a topic only starting to be understood. However, it has been largely demonstrated that children are dying after hospitalization, and in rates yet to be fully realized. Using Critical Social Theory as a framework, objectives included: to determine the current evidence addressing pediatric post-discharge mortality in resource-poor settings; determine potential predictor variables for infant post-discharge mortality at the time of initial hospital admission; and to establish the state of knowledge of social justice in global health within the nursing profession and provide clarity and understanding to the concept. Methods A manuscript-style approach was used, wherein each manuscript addresses an individual objective. This is achieved using a systematic literature review, modified two-stage Delphi process, and concept analysis. Results Rates of post-discharge mortality continue to be comparable to or exceed in-hospital mortality, with most post-discharge deaths occurring at home. Risk factors consistently highly associated with post-discharge mortality underlay the vulnerability associated with factors regardless of underlying infectious etiology. Predictor variables for post-discharge mortality among infants brought objectivity and insight to aspects of predictive value, reliability, availability, and applicability in low-resource settings. The identified variables are a valuable starting point for the construction of a predictive model to identify at-risk infants. A greater understanding of social justice, in particular within a global health context for the nursing profession, is developed for nursing to move to a more global practice as agents of social change. Significance Children continue to die unnecessarily and in staggering, under-recognized numbers, particularly in countries where strained and resource-limited health systems attempt to assist millions of socioeconomically disadvantaged children. Addressing these issues, identifying the most vulnerable children, and developing effective interventions is essential for achieving the Sustainable Development Goals outlined by the United Nations. Every day nurses as key members of health care teams around the world play a critical role in the health and wellbeing of patients, families, communities, and nations. Nursing has a vital role to play in not only addressing childhood post-discharge mortality, but in global health in its entirety. It must be a concerted effort on all parts, from health care teams to policy makers, community leaders, researchers, and funders

Fusion, 2021

https://hsrc.himmelfarb.gwu.edu/smhs_fusion/1013/thumbnail.jp

2016 Touro College & University System Faculty Publications

This is the 2016 edition of the Faculty Publications Book of the Touro College & University System. It includes all eligible 2016 publication citations of faculty within the Touro College & University System, including New York Medical College (NYMC). It was produced as a joint effort of the Touro College Libraries and the Health Sciences Library at NYMC.https://touroscholar.touro.edu/facpubs/1000/thumbnail.jp