Evaluating curricular modules in the care of children with medical complexity: A mixed-methods randomized controlled trial

ConclusionA standardized complex care curriculum delivered in a classroom setting did not lead to improved performance in an OSCE station despite increased resident-reported self-efficacy in approaching care for CMC. These findings highlight the need for multidimensional educational interventions and assessments in complex care.
Source: Academic Pediatrics - Category: Pediatrics Source Type: research

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Authors: Wannberg M, Miao X, Li N, Wikman A, Wahlgren CM Abstract Introduction Platelets are critical for hemostasis, and a low platelet count predicts mortality in trauma. The role of platelet dysfunction in severe traumatic hemorrhage and coagulopathy needs to be further defined. The aim of this study was to evaluate the platelet function in a new model of experimental traumatic hemorrhage. Material and methods New Zealand white rabbits (n = 10) were subjected to tracheostomy and trauma laparotomy, and then bilateral femur fractures with 40% hemorrhage of their estimated blood volume. Arterial blood gases, standa...
Source: Platelets - Category: Hematology Tags: Platelets Source Type: research
Tracheal cuff hyperinflation can have serious complications resulting from decreased tracheal mucosal blood flow and range in severity from tracheal ulceration and necrosis, formation of tracheoesophageal or tracheoinnominate fistulae, recurrent laryngeal nerve injury, to fatal tracheal rupture (1).
Source: The Journal of Emergency Medicine - Category: Emergency Medicine Authors: Tags: Visual Diagnosis in Emergency Medicine Source Type: research
Tracheo-innominate fistula(TIF) is a life-threatening condition in patients with an existing tracheostomy and carries a high mortality rate. Mild bleeding from the tracheostomy site arises more often from mucosal trauma, but a ‘herald’ bleed from a TIF may be easily missed and so is the window to intervene in a controlled situation. In the setting of a major bleed from an old tracheostomy site, a majority of our readers may believe the standard of care for these patients is an emergent trip to the operating room and a STAT page to the on call cardiac surgeon.
Source: Seminars in Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: ADULT – Editorial Commentary Source Type: research
Objectives: Tracheostomy utilization has dramatically increased recently. Large gaps exist between expected and actual outcomes resulting in significant decisional conflict and regret. We determined 1-year patient outcomes and healthcare utilization following tracheostomy to aid in decision-making and resource allocation. Design: Retrospective cohort study. Setting: All California hospital discharges from 2012 to 2013 with follow-up through 2014. Patients: Nonsurgical patients who received a tracheostomy for acute respiratory failure. Interventions: None. Measurements and Main Results: Our primary outcome ...
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Clinical Investigations Source Type: research
Conclusions: ICU-based end-of-life care resources do not appear to change mortality but are associated with increased hospice utilization. Given that this finding was not confirmed by the instrumental variable analysis, future studies should attempt to verify this finding, and identify specific resources or processes of care that impact the care of ICU patients at the end of life.
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Clinical Investigations Source Type: research
Carter Roberts’ motorized wheelchair didn’t arrive until the day he died. It had been a long time coming and his parents had fought hard to get it. The chair cost more than $32,000 and the insurance companies wouldn’t cover it, so the family went to court. One insurer eventually agreed to pay for some components of the chair but not the whole thing. And then none of it mattered anyway. On Sept. 22, 2018, the Roberts’ doorbell rang and the chair was delivered. Also on Sept. 22, 2018, Carter died, just three months shy of his sixth birthday. He had been largely paralyzed for the final two years of his...
Source: TIME: Health - Category: Consumer Health News Authors: Tags: Uncategorized Infectious Disease viruses Source Type: news
ConclusionsThe presence of frailty among patients receiving mechanical ventilation is associated with increased odds of hospital mortality, discharge to long-term care, extubation failure, and need for tracheostomy.
Source: Intensive Care Medicine - Category: Intensive Care Source Type: research
High-flow oxygen therapy via nasal cannula (HFOTNASAL) increases airway pressure, ameliorates oxygenation and reduces work of breathing. High-flow oxygen can be delivered through tracheostomy (HFOTTRACHEAL), but ...
Source: Annals of Intensive Care - Category: Intensive Care Authors: Tags: Research Source Type: research
AbstractTracheostomy a lifesaving procedure done more frequently for critically ill patients for mechanical ventilation, bronchopulmonary toileting, reduce pulmonary effort has variable complications to itself. The common being secondary infection with bacteria and fungi, which in turn lead to granulation formation in stoma and on peristomal region. This prospective study was done with an aim to study, correlate and compare the microbial organisms grown in culture from tracheostomy tubes and peristomal granulation in ventilated and non-ventilated patient. We studied 210 patients out of them 100 patients satisfied the inclu...
Source: Indian Journal of Otolaryngology and Head and Neck Surgery - Category: ENT & OMF Source Type: research
Conclusion: This study suggests that females with AST present with a greater number of pre-existing co-morbidities, a higher frequency of thoraco-lumbar trauma, less severe neurological impairment and a greater proportion of MVA-related injuries. However, females and males have a similar length of stay in the acute spine center, and comparable in-hospital survival, need for mechanical ventilation, and tracheostomy after AST. PMID: 31573442 [PubMed - in process]
Source: Journal of Spinal Cord Medicine - Category: Orthopaedics Tags: J Spinal Cord Med Source Type: research
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