Division Of Care Research Articles

The Future of Vascular Access in Children.

* Abbreviations: CVAD — : central venous access device MAGIC — : Michigan Appropriateness Guide for Intravenous Catheters miniMAGIC — : Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics PICC — : peripherally inserted central catheter At the interface of clinical practice and medical science, evidence emerges. In domains of clinical practice that lack adequate evidence, clinical decisions are guided by a combination of clinical experience, clinician intuition, and resource availability (material and personnel). Consequently, where evidence gaps exist, clinical care can feel autonomous and innovative but is often inconsistent and may generate adverse outcomes for patients who are underappreciated. For children with serious illness, clinical decisions regarding achieving and sustaining venous access predominantly occur without much evidence, resulting in more variability than predictability in selecting central venous access devices (CVADs). In this supplement, an international group of pediatric experts propose a way forward using the Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics (miniMAGIC) evidence framework,1 which used the RAND Corporation–University of California, Los Angeles Appropriateness Method. miniMAGIC … Address correspondence to Matthew M. Davis, MD, MAPP, Division of Academic General Pediatrics and Primary Care, Ann & Robert H. Lurie Children’s Hospital, 225 E Chicago Ave, Box 162, Chicago, IL 60611. E-mail: mmdavis{at}luriechildrens.org

Ten minutes with Hassan Khouli, chair of Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic

![Graphic][1] ### Biography Dr Hassan Khouli, MD, is the chair of the Department of Critical Care Medicine in the Respiratory Institute at the Cleveland Clinic. He has over 20 years...

SUN-343 Prevalence and Incidence of Hypomagnesemia and Hypermagnesemia in Medical Settings

Electrolytes disturbances are commonly observed in clinical practice. However, magnesium (Mg) disorders are often poorly considered. Our primary aim was to update the prevalence and the incidence of hypomagnesemia and hypermagnesemia in a real-life scenario. The secondary aim was to investigate the association of Mg disturbances with age and gender. Data from patients whose Mg serum levels were measured between January 2015 and December 2017 at our University Hospital were recorded. Hypomagnesemia was defined by Mg levels <1.5 mg/dL and hypermagnesemia by levels> 3.8 mg/dL. Hypo and hypermagnesemia cases were considered according to age, gender, year of observation and setting of subjects including outpatients and inpatients. In particular, inpatients were recruited from a total of 25 Hospital Divisions (i.e. Cardiology, Endocrinology, Geriatrics, Hematology, Intensive Care, Internal Medicine, Infectious Disease, Nephrology, Neonatal Intensive Care, Neurology, Neuropsychiatry, Neuroradiology, Oncology, Pulmonology, Pediatrics, Psychiatry, Rheumatology and Surgical Area that included 8 Units). Over the observation period, we recognized 12,696 patients whose Mg levels were checked. Prevalences of hypomagnesemia and hypermagnesemia were 8.43% (n=1071) and 1.78% (n=226) respectively. Hypomagnesemia was encountered more frequently in female [53.3% (n=560)] rather than in male patients [47.7 % (n=511)] (χ2= 4.03, p<0.045) and was significantly influenced by age: the higher prevalence of hypomagnesemia was found in patients over 65 yr. [59.01% (n=632)], whereas a lower prevalence was detected in the other age groups, specifically in 9.52 % (n=102) of patients aged 0-18 yr. and in 31.46 % (n=337) of patients between 19 and 65 yr. (χ2= 592.64; p<0.0001). Incidence of hypomagnesemia decreased over time with a borderline significance only in subjects over 65 yr. (r=-0.99; p=0.07). Geriatrics, Oncology and Intensive Care Division showed the highest incidences of hypomagnesemia. The hypermagnesemia prevalence was observed higher in outpatients in comparison with inpatients from any other Hospital Division and the hypermagnesemia incidence did not significantly change over time (r=0.96; p=0.16). Mg disorders, mainly hypomagnesemia, are quite common in clinical practice particularly in older hospitalized patients. Among the other electrolytes’ disturbances, Mg disorders, because of life-threatening significances, may be checked and corrected.

Correction to: SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes.

The affiliation of the second author (Kenneth S. Knox) should have been Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA instead of Department of Medicine, University of Arizona-Phoenix, Phoenix, AZ 85004, USA.

Endovascular Therapy for Patients With Acute Ischemic Stroke During the COVID-19 Pandemic: A Proposed Algorithm.

Endovascular Therapy for Patients With Acute Ischemic Stroke During the COVID-19 Pandemic: A Proposed Algorithm.

Maternity Leave: Not Just a Challenge for Trainees.

To the Editor: We applaud Dr. Stack and colleagues’ recent Research Report illustrating the variability and limitations of maternity leave during residency.1 We echo the authors’ sentiments regarding how we might better support maternity leave for our trainees. However, we are also concerned about challenges for faculty. Although faculty family leave policies exist at many institutions, both policies and salary coverage vary widely.2 Despite women comprising an increasing proportion of the physician work force, little has been done to address concerns regarding maternity leave policies, fertility management, child care, and breastfeeding at work.3 One particular challenge is ambiguous policy wording which may inadvertently disadvantage women by restricting leave to the primary caregiver or may imply that benefits are granted at the discretion of departmental leadership. Perceived lack of support for taking leave may be why the average length of maternity leave for women physicians is less than the recommended minimum leave duration of 12 weeks.4 Finally, many workplaces do not clarify whether clinical effort will be prorated for maternity leave time or missed call will need to be paid back. This uncertainty, piled atop the challenges of navigating new motherhood and breastfeeding at work, is unnecessary and harmful. Absent of any national mandates surrounding family leave policy, there are several things institutions can do to better support women who are simultaneously trying to grow their careers and families. First, parental leave policies should be normalized, flexible, and transparent, maximizing the amount of time that both parents can spend with their newborns. Departments should not “penalize” employees for taking leave by requiring payback of call or heavier clinical loads over shorter time periods. Departmental policies for coverage should exist so women do not need to negotiate for coverage of clinical responsibilities while on leave. Every effort should be made at the institutional level to offer paid leave time, as this is paramount to recruitment and retention of faculty. Finally, breastfeeding upon return to work should be fully supported with adequate space, time, and flexibility provided for milk expression for a minimum of 12 months, as recommended by the American Academy of Pediatrics.5 Only by acknowledging that women faculty face similar challenges as trainees regarding parental leave can we hope to make progress toward truly inclusive workplaces. Kathryn M. Pendleton, MDAssistant professor, Department of Internal Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; [email protected]; Twitter: @Pendlkm; ORCID: https://orcid.org/0000-0003-3248-5738.Arghavan Salles, MD, PhDScholar in residence, Stanford University School of Medicine, Palo Alto, California; Twitter: @arghavan_salles.

We Still Round the Next Day.

The ICU team gathers for their morning rounds. One of their patients died the day before. The team members look at the room where the patient had been; perhaps it is empty, or perhaps it has already been filled with another patient and family. The day the patient died may have been filled with escalating therapies and vigorous resuscitation attempts that failed to save her, or perhaps the staff had been gently supporting a child and family through the night as technology was removed and comfort assured. For some on the team (maybe a student or resident) this could be the first patient they have cared for who died.1 For others (fellow, attending, ICU nurses), this may have become a more-common experience. Multiple team members may still be thinking about the events of the day before, remembering the patient or wondering about the outcome and why certain decisions were made. Our ICU teams have developed a practice of debriefing a patient death at the beginning of patient-care rounds the following day. In effect, we “round” on the patient for one final day after the death. The patient’s primary resident or nurse practitioner begins with a 1- to 2-sentence description of the patient and events of the previous day, and then the attending facilitates a group discussion. We typically spend <10 minutes in the discussion, before moving on to current patients and daily work of … Address correspondence to Wynne Morrison, MD, MBE, FCCM, Division of Critical Care, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, 6 Wood, Philadelphia, PA 19104. E-mail: morrisonw{at}email.chop.edu

Comparison of Phenytoin, Valproate and Levetiracetam in Pediatric Convulsive Status Epilepticus: A Randomized Double-blind Controlled Clinical Trial

To compare the efficacy of phenytoin, valproate, and levetiracetam in the management of pediatric convulsive status epilepticus. Randomized double-blind controlled clinical trial. Pediatric critical care division in a tertiary care institute from June, 2016 to December, 2018. 110 children aged three month to 12 year with convulsive status epilepticus. Patients not responding to 0.1 mg/kg intravenous lorazepam were randomly assigned (1:1:1) to receive 20 mg/kg of phenytoin (n=35) or valproate (n=35) or levetiracetam (n=32) over 20 minutes. Patients with nonconvulsive status epilepticus, recent hemorrhage, platelet count less than 50,000 or International normalized ratio (INR) more than 2, head injury or neurosurgery in the past one-month, liver or kidney disease, suspected or known neurometabolic or mitochondrial disorders or structural malformations, and allergy to study drugs; and those who were already on any one of the study drugs for more than one month or had received one of the study drugs for current episode, were excluded. The primary outcome was the proportion of patients that achieved control of convulsive status epilepticus at the end of 15 minutes after completion of the study drug infusion. Secondary outcomes were time to control of seizure, rate of adverse events, and the requirement of additional drugs to control seizure, length of ventilation, hospital stay, and functional status after three months (Glasgow Outcome Scale). The study was stopped after the planned mid-interim analysis for futility. Intention to treat analysis was done. There was no difference in primary outcome in phenytoin (31/35, 89%), valproate (29/35, 83%), and levetiracetam (30/32, 94%) (P=0.38) groups. There were no differences between the groups for secondary outcomes. One patient in the phenytoin group had a fluid-responsive shock, and one patient in the valproate group died due to encephalopathy and refractory shock. Phenytoin, valproate, and levetiracetam were equally effective in controlling pediatric convulsive status epilepticus.

The Haiti Humanitarian Response Course: A Novel Approach to Local Responder Training in International Humanitarian Response.

Countries most affected by disasters are often those with limited local capacity to respond. When local capacity is overwhelmed, international humanitarian response often provides needs-based emergency response. Despite global progress in education and the development of international humanitarian response standards, access to training and integration of local actors in response mechanisms remains limited. In May 2017, the Haiti Humanitarian Response Course (HHRC) was implemented in Mirebalais, Haiti to increase local capacity and allow for effective future engagement with international humanitarian actors in a country prone to disasters. In collaboration with the Hôpital Universitaire de Mirebalais' (HUM; Mirebalais, Haiti) Department of Medical Education and Emergency Medicine (EM) residency program, four physicians from the Division of Global Emergency Care and Humanitarian Studies at Brigham and Women's Hospital (Boston, Massachusetts USA) facilitated the course, which included 53 local physicians and staff. Following 15 hours of online pre-course preparation, through didactics and practical small-group exercises, the course focused on key components of international humanitarian response, minimum standards for effective response, and the roles of key response players. The course was free to participants and taught in English and French. The HHRC reduced the barriers often faced by local actors who seek training in international humanitarian response by offering free training in their own community. It presents a novel approach to narrow critical gaps in training local populations in international humanitarian response, especially in environments prone to crises and disasters. This approach can help local responders better access international humanitarian response mechanisms when the local response capacity is exhausted or overwhelmed. The HHRC demonstrates a potential new model for humanitarian and disaster training and offers a model for similar programs in other disaster-prone countries. Ultimately, local capacity building could lead to more efficient resource utilization, improved knowledge sharing, and better disaster response.

When equal partners become unequal parents: couple relationships and intensive parenting culture

Based on longitudinal research with (heterosexual) couples in the UK, this article tracks their experiences of becoming parents for the first time. The suggestion is that new parents are caught in an uncomfortable confluence between competing discourses around ideal relationships and those around ideal parenting. On the one hand, they must be committed to egalitarian ideals about the division of care. On the other, they must be parenting ‘intensively’, in ways which are markedly more demanding for mothers, and which makes paternal involvement more complicated. Drawing on accounts of relationship difficulties, elicited over a five-year period, the article demonstrates the incommensurability of these ideals at physiological, material and ideological levels. As a contribution to the body of work known as parenting culture studies, this article brings, for the first time, an empirical focus to the question of how an ‘intensive’ parenting culture affects couples, rather than just mothers or fathers.

Does flexible work ‘work’ in Australia? A survey of employed mothers’ and fathers’ work, family and health

ABSTRACT Workplace flexibility is perceived to benefit parents yet evidence of the effectiveness of formal work arrangements in promoting parents’ health is mixed, and few have evaluated informal flexibility. This study investigates Australian mothers’ and fathers’ use of formal (employer-provided) and informal (self-directed) work arrangements and associations with work-family conflict and health outcomes (psychological distress, occupational fatigue, burnout). Online survey data from a national cross-sectional sample of 4268 employed parents (one or more children ≤18 years) were collected in 2016. Standardised measures of health outcomes were reported. Analyses were stratified by gender given the gendered division of work and care in Australia. Multivariate linear regression analyses showed greater use of flexible work arrangements (e.g. flexitime, flexiplace) was associated with lower fatigue and less burnout for fathers and mothers. Conversely, higher use of flexible leave arrangements (e.g. purchased leave) and informal arrangements (e.g. performing family-related tasks at work) were each associated with poorer health outcomes. Findings contribute novel evidence on the status of workplace flexibility for Australian fathers and mothers. Flexible work arrangements may have some health benefits, yet the widespread use of informal arrangements suggests flexible workplace provisions alone are not meeting parents’ needs for family-related support.

Gender in Families: A Comparison of the Gendered Division of Child Care in Rural and Urban China

Understanding the regional differences in child care is critical as the gendered division of child care in the family remains unequal between husbands and wives in China. The study aims to assess how child care time is divided differently between husband and wife within the families in urban and rural sectors, and how these divisions are associated with factors such as one’s own or spouse’s employment status, educational achievement, and earnings. We analyzed data from the China Health and Nutrition Survey (2004, 2006, 2009, and 2011), using the relative resources theory, “doing gender” perceptive, as well as the gender attitudes model to explain gender differentials in child care among urban and rural families. The gender difference in child care continues to persist but with a variation between urban and rural sectors. In addition to the wife’s own employment status, the husband’s employment status as well as income has played important roles in influencing the child care division inside the household. The relative resources theory explains the pattern of the gendered division of child care in rural sectors but cannot account for the patterns in urban sectors. Instead, patterns in urban women’s child care time were more consistent with a “doing gender” perspective and urban men’s child care time were consistent with an egalitarian gender attitudes model.

Quantifying Clinical Pharmacist Activities in a Tertiary Care Hospital Using Key Performance Indicators.

Background: Key performance indicators (KPIs) are a set of measures used to help an organization in assessing and achieving goals critical to success. The aim of this study was to quantify the clinical pharmacists' contribution to patient care in a tertiary care hospital using predefined clinical pharmacy KPIs. Method: This study was a prospective, observational study conducted by the Pharmaceutical Care Division of a tertiary care hospital. Clinical pharmacy KPIs were submitted by each clinical pharmacist on a monthly basis for 12 months during 2017. All clinical pharmacists up to the managerial level were included in the study. Data were analyzed, stratified, and correlated using Microsoft Excel, JMP statistical software, and Spearman correlation. The study was approved by the hospital's Office of Research Affairs, RAC number 2171-080. Results: A total of 42 clinical pharmacists reviewed 104 728 patient encounters. They performed an adjusted average of 1221 interventions with an acceptance rate of 91.5%, 273 medication reconciliations, 325 discharge consultations, 332 pharmacokinetic consultations, 700 total parenteral nutrition consultations and follow-ups, and 12 688 electronic order verifications per clinical pharmacist per year. These interventions collectively resulted in a cost saving of $316 087.65 per clinical pharmacist per year. Statistical significance with positive correlation was noted for a number of precepted residents/students and clinical pharmacists' experience (R = 0.382, P = .013) and board certification (R = 0.428, P = .0047). Conclusion: Clinical pharmacy KPIs were able to quantify the clinical pharmacists' contributions to patient care and cost savings, which may lead to improve, standardize, and benchmark clinical pharmacy activities in the region.

Continuing Care for Older Adults Through and Beyond a Pandemic.

COVID-19 will remain a threat to millions of older adults for the foreseeable future, challenging healthcare providers to find successful ways to address this population's special needs. Thanks to well-defined core values and an experienced and innovative team of colleagues, Trinity Health's Continuing Care division has been able to adroitly support thousands of older adults throughout the COVID-19 pandemic. Our response has also included working to maintain the safety and well-being of thousands of staff who serve in this space every day. The pandemic is less than a year old, yet we have learned lessons that an organization typically takes many years to learn, and we are pleased to share them here. One of the greatest lessons is that, to best respond to a pandemic, everyone in an organization should have a clear understanding of purpose and strategy. In other words, know why you exist and what you need to do to weather the unknown until a vaccine or cure is available for all.

Patient Safety Culture Change over Time-Health Care Staffs’ Perceptions

Rationale and Aim: Patient safety is of great interest in health care organisations, worldwide. In Sweden, a national patient safety initiative was launched in 2011. The aim of this study was to examine and compare patient safety culture change over time from health care staffs’ perspective. A further aim was to examine factors that have had an effect on patient safety culture. Methods: Patient safety culture was assessed in 2009, 2011 and 2013 using the Swedish version of the Hospital Survey of Patient Safety Culture. Respondents in this study were registered nurses (n = 2149), enrolled nurses (n = 959), physicians (n = 355) and managers (n = 159) working in three health care divisions in a Swedish county council. Results: Patient safety culture decreased significantly over time for all but two dimensions. The dimension “Information to Patients/Relatives” was the only dimension to increase significantly over time. Health care staffs’ profession and health care division belonging had significant main effects on 14 and 8 dimensions, respectively. Managers and enrolled nurses scored patient safety culture significantly higher than registered nurses and physicians. Health care staff working in a mixed medical-surgical health care division scored significantly higher than those working in medical or surgical divisions did. Conclusions: Despite efforts for patient safety work in the county council, health care staffs’ perceptions of patient safety culture decreased over time. To improve hospital patient safety culture, managers and staff groups must meet and communicate with each other in order to create a common view of patient safety.

Division of Parent Care Among Adult Children.

Many older adults rely on their children's support to sustain community residence. Although filial norms encourage adult children to help their parents, not every child provides parent care in times of need. The majority of prior studies have adopted an individualistic perspective to examine factors associated with individual children's caregiving behavior. This study complements previous work by using the family systems perspective to understand how caregiving responsibilities are allocated among children in the family and how the pattern of care division evolves over time. Data came from seven rounds of the National Health and Aging Trends Study (2011-2017), in which community-dwelling respondents were asked about all of their children and which children provided them with care. Multilevel models were estimated to examine how caregiving responsibilities were distributed among children and how the children's caregiving efforts responded to changes in their parents' frailty. About three quarters of older adults reported receiving help from only one child, and the average of monthly care hours was about 50 at baseline. As parents' frailty increased, the proportion of children providing parents rose and the allocation of parent-care hours became more equal. This study underscores the importance of using the family systems perspective to better understand adult children's caregiving behavior. Although just one adult child providing care is the most common caregiving arrangement initially, adult children tend to work with their siblings to support parents' aging in place as parents' need for care increases.

Primary vs delayed primary closure in patients undergoing lower limb amputation following trauma: A randomised control study

Lower limb crush injury is a major source of mortality and morbidity in trauma patients. Complications, especially surgical site infections (SSIs) are a major source of financial burden to the institute and to the patient as it delays rehabilitation. As such, every possible attempt should be made to reduce any complications. We, thus, aimed to compare the outcomes in early vs delayed closure of lower extremity stumps in cases of lower limb crush injury requiring amputation, so as to achieve best possible outcome. A randomised controlled study was conducted in the Division of Trauma Surgery & Critical Care at Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi from 1 September 2018 to 30 June 2019 and included patients undergoing lower limb amputation below hip joint. Patients were randomised in two groups, in one group amputation stump was closed primarily, while in the second group delayed primary closure of stump was performed. We compared rate of SSI, length of hospital stay, and number of surgeries in both the groups. Fifty-six patients with 63 amputation stumps were recruited in the study. Mean age of patients in the study was 34 years, of which about 95% patients were males. The most common mechanism of injury was road traffic injury in 66% of patients. Mean injury severity score was 12.28 and four patients had diabetes preoperatively. Total 63 extremities were randomised with 30 cases in group I and 33 cases in group II as per computer-generated random number. Above knee amputations was commonest (57.14%) followed by below knee amputations (33.3%). Two patients died in the current study. In group I, In-hospital infection was detected in 7 cases (23.3%) and in group II 9 cases (27.3%) had SSI during hospital admission (P > .05). Mean hospital stay in group I was 10.32 ± 7.68 days and in group II was 11 ± 8.17 days (P > .05). Road traffic injuries and train-associated injuries are a major cause of lower limb crush injuries, leading to limb loss. Delayed primary closure of such wounds requires extra number of surgical interventions than primary closure. There is no difference in extra number of surgical interventions required in both the groups. Thus, primary closure can be safely performed in patients undergoing lower limb amputations following trauma, provided that a good lavage and wound debridement is performed.

Semiquantititative lung ultrasound scores are accurate and useful in critical care, irrespective of patients’ ages: The power of data over opinions

Journal of Ultrasound in MedicineVolume 39, Issue 6 p. 1235-1239 Commentary Semiquantititative lung ultrasound scores are accurate and useful in critical care, irrespective of patients’ ages: The power of data over opinions Daniele De Luca MD, PhD, Corresponding Author Daniele De Luca MD, PhD [email protected] orcid.org/0000-0002-3846-4834 Division of Pediatrics and Neonatal Critical Care, Antoine Béclère Medical Center, Paris-Saclay University Hospitals, Assistance Publique–Hôpitaux de Paris, Clamart, France Paris-Saclay University, Physiopathology and Therapeutic Innovation Unit 999, Paris, France Address correspondence to Daniele De Luca, MD, PhD, Service de Pédiatrie et Réanimation Néonatale, Groupe Hospitalier Universitaire Paris Sud, Hôpital Antoine Béclère, 157 Rue de la Porte de Trivaux, 92140 Clamart, France. E-mail: [email protected]Search for more papers by this author Daniele De Luca MD, PhD, Corresponding Author Daniele De Luca MD, PhD [email protected] orcid.org/0000-0002-3846-4834 Division of Pediatrics and Neonatal Critical Care, Antoine Béclère Medical Center, Paris-Saclay University Hospitals, Assistance Publique–Hôpitaux de Paris, Clamart, France Paris-Saclay University, Physiopathology and Therapeutic Innovation Unit 999, Paris, France Address correspondence to Daniele De Luca, MD, PhD, Service de Pédiatrie et Réanimation Néonatale, Groupe Hospitalier Universitaire Paris Sud, Hôpital Antoine Béclère, 157 Rue de la Porte de Trivaux, 92140 Clamart, France. E-mail: [email protected]Search for more papers by this author First published: 16 December 2019 https://doi.org/10.1002/jum.15195Citations: 12 The author of this article has reported no disclosures. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume39, Issue6June 2020Pages 1235-1239 RelatedInformation

Lessons From My Father

Spring 2005 was the first major period of uncertainty in my life. I was in my final semester of high school and experiencing a growing apprehension about leaving my family to attend college on the other side of the country. That April, our family accompanied my father, Dr Michael Wayne Shannon, on a business trip to India. Soon after returning, I developed progressively worsening myalgias, neck stiffness, and fevers. My parents brought me to Boston Children’s Hospital, where my father was the Chief of Emergency Medicine. In the corner of the emergency bay stood my father, his measured demeanor belying his concern. He and his colleagues agreed that I would need a lumbar puncture. He calmly explained what the procedure entailed. One of his emergency pediatric fellows would perform the procedure, but he would be by my side for its entirety. The fellow made several unsuccessful attempts before passing the spinal needle to my father’s senior colleague. He was also unable to extract fluid. Finally, my father decided he would make a final attempt. He removed his impeccably tied bowtie, rolled up his sleeves, prepared for the procedure, and with one attempt achieved a champagne tap. My father died suddenly on March 10, 2009, at the age of 55. He succumbed to a massive pulmonary embolism after returning home from a tango festival with my mother, his favorite dance partner and the love of his life. At … Address correspondence to Evan Michael Shannon, MD, MPH, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, 1620 Tremont St, Boston, MA 02120. E-mail: eshannon2{at}bwh.harvard.edu

Editorial Comment.

No AccessJournal of UrologyAdult Urology1 Nov 2019Editorial CommentThis article comments on the following:Toileting Behaviors and Bladder Symptoms in Women Who Limit Restroom Use at Work: A Cross-Sectional Study Alayne D. Markland Alayne D. MarklandAlayne D. Markland Geriatric Research Education and Clinical Center, Birmingham Veterans Affairs Medical Center Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000579624.34013.a9AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 202(5), p. 1014 Reference 1. : Infrequent voiders syndrome (nurses bladder). Prevalence among nurses and assistant nurses in a surgical ward. Scand J Urol Nephrol 1991; 25: 201. Google Scholar © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of UrologyOct 9, 2019, 5:43:23 AMToileting Behaviors and Bladder Symptoms in Women Who Limit Restroom Use at Work: A Cross-Sectional Study Volume 202Issue 5November 2019Page: 1014-1014 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alayne D. Markland Geriatric Research Education and Clinical Center, Birmingham Veterans Affairs Medical Center Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama More articles by this author Expand All Advertisement Loading ...