54 research outputs found

    Efficacy and Safety of Pediatric Critical Care Physician Telemedicine Involvement in Rapid Response Team and Code Response in a Satellite Facility

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    OBJECTIVES: Satellite inpatient facilities of larger children's hospitals often do not have on-site intensivist support. In-house rapid response teams and code teams may be difficult to operationalize in such facilities. We developed a system using telemedicine to provide pediatric intensivist involvement in rapid response team and code teams at the satellite facility of our children's hospital. Herein, we compare this model with our in-person model at our main campus. DESIGN: Cross-sectional. SETTING: A tertiary pediatric center and its satellite facility. PATIENTS: Patients admitted to the satellite facility. INTERVENTIONS: Implementation of a rapid response team and code team model at a satellite facility using telemedicine to provide intensivist support. MEASUREMENTS AND MAIN RESULTS: We evaluated the success of the telemedicine model through three a priori outcomes: 1) reliability: involvement of intensivist on telemedicine rapid response teams and codes, 2) efficiency: time from rapid response team and code call until intensivist response, and 3) outcomes: disposition of telemedicine rapid response team or code calls. We compared each metric from our telemedicine model with our established main campus model. MAIN RESULTS: Critical care was involved in satellite campus rapid response team activations reliably (94.6% of the time). The process was efficient (median response time 7 min; mean 8.44 min) and effective (54.5 % patients transferred to PICU, similar to the 45-55% monthly rate at main campus). For code activations, the critical care telemedicine response rate was 100% (6/6), with a fast response time (median 1.5 min). We found no additional risk to patients, with no patients transferred from the satellite campus requiring a rapid escalation of care defined as initiation of vasoactive support, greater than 60 mL/kg in fluid resuscitation, or endotracheal intubation. CONCLUSIONS: Telemedicine can provide reliable, timely, and effective critical care involvement in rapid response team and Code Teams at satellite facilities

    Developing a framework for arts in health programs targeting individuals with chronic pain: a mixed-methods study of practitioners

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    Objectives: Chronic pain is a leading cause of morbidity and disability across the world. Cultural engagement may be a valuable tool in addressing the social disconnection that often accompanies chronic pain. This study sought to develop a framework for arts in health programs targeting individuals with chronic pain. / Study design: Sequential explanatory mixed-methods study. / Methods: Web-based, cross-sectional survey sent to arts and cultural professionals to assess their experience with arts in health programming. Semi-structured interviews conducted with a sample of survey respondents to explore their perspectives on targeted arts in health programming for individuals with chronic pain. / Results: Between October 2019 and January 2020, 208 surveys were completed by arts and cultural professionals. One hundred and twenty (58%) of the respondents indicated that they currently run an arts in health or museums in health program. Among these 120 respondents, 52 (43%) targeted older adults, 50 (42%) targeted individuals with mental health concerns, and 18 (15%) targeted individuals living with pain. Improving well-being (101 [84%]) and reducing social isolation (90 [75%]) were the most common intended program outcomes, while improving pain was the least common outcome (26 [22%]). Fifteen survey respondents were interviewed. Interviewees identified four interdependent themes regarding best practices for arts in health programs pertaining to (1) program content and structure, (2) program facilitation, (3) partnerships, and (4) programs for individuals with chronic pain. / Conclusions: The cultural sector can support chronic pain prevention and treatment efforts through the development of specialized programs. This study provides a framework for developing arts in health programs that support individuals living with chronic pain

    Fusion evaporation-residue cross sections for Si28+40Ca at E(28Si)=309, 397, and 452 MeV

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    Velocity distributions of mass-identified evaporation residues produced in the Si28+40Ca reaction have been measured at bombarding energies of 309, 397, and 452 MeV using time-of-flight techniques. These distributions were used to identify evaporation residues and to separate the complete-fusion and incomplete-fusion components. Angular distributions and upper limits for the total evaporation-residue and complete-fusion evaporation-residue cross sections were extracted at all three bombarding energies. The complete-fusion evaporation-residue cross sections and the deduced critical angular momenta are compared with earlier measurements and the predictions of existing models. The ratios of the complete-fusion evaporation-residue cross section to the total evaporation-residue cross section, along with those measured for the Si28+12C and Si28+28Si systems at the same energies, support the entrance-channel mass-asymmetry dependence of the incomplete-fusion evaporation-residue process reported earlier

    Comparison of venous and pooled capillary hemoglobin levels for the detection of anemia among adolescent girls

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    IntroductionBlood source is a known preanalytical factor affecting hemoglobin (Hb) concentrations, and there is evidence that capillary and venous blood may yield disparate Hb levels and anemia prevalence. However, data from adolescents are scarce.ObjectiveTo compare Hb and anemia prevalence measured by venous and individual pooled capillary blood among a sample of girls aged 10–19 years from 232 schools in four regions of Ghana in 2022.MethodsAmong girls who had venous blood draws, a random subsample was selected for capillary blood. Hb was measured using HemoCue® Hb-301. We used Lin’s concordance correlation coefficient (CCC) to quantify the strength of the bivariate relationship between venous and capillary Hb and a paired t-test for difference in means. We used McNemar’s test for discordance in anemia cases by blood source and weighted Kappa to quantify agreement by anemia severity. A multivariate generalized estimating equation was used to quantify adjusted population anemia prevalence and assess the association between blood source and predicted anemia risk.ResultsWe found strong concordance between Hb measures (CCC = 0.86). The difference between mean venous Hb (12.8 g/dL, ± 1.1) and capillary Hb (12.9 g/dL, ± 1.2) was not significant (p = 0.26). Crude anemia prevalence by venous and capillary blood was 20.6% and 19.5%, respectively. Adjusted population anemia prevalence was 23.5% for venous blood and 22.5% for capillary (p = 0.45). Blood source was not associated with predicted anemia risk (risk ratio: 0.99, 95% CI: 0.96, 1.02). Discordance in anemia cases by blood source was not significant (McNemar p = 0.46). Weighted Kappa demonstrated moderate agreement by severity (ĸ = 0.67). Among those with anemia by either blood source (n = 111), 59% were identified by both sources.ConclusionIn Ghanaian adolescent girls, there was no difference in mean Hb, anemia prevalence, or predicted anemia risk by blood source. However, only 59% of girls with anemia by either blood source were identified as having anemia by both sources. These findings suggest that pooled capillary blood may be useful for estimating Hb and anemia at the population level, but that caution is needed when interpreting individual-level data

    Energy dependence of fusion evaporation-residue cross sections in the Si28+28Si reaction

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    Velocity distributions of mass-identified evaporation residues produced in the t28/rSi+28Si reaction have been measured at bombarding energies of 174, 215, 240, 309, 397, and 452 MeV using time-of-flight techniques. These distributions were used to identify evaporation residues and to separate the complete-fusion and incomplete-fusion components. Angular distributions and total cross sections were extracted at all six bombarding energies. The complete-fusion evaporation-residue cross sections and the deduced critical angular momenta are compared with lower energy data and the predictions of existing models

    Correspondence from J. Gosdin

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    Correspondence from J. Gosdin regarding absent soldiers from Waldo Count
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