Mercy Hospital Research Articles

A Feasibility Study of a Music Enrichment Program on Relative Reinforcing Value of Food and Home Environmental Enrichment among Families of Low Socioeconomic Status.

Emerging evidence suggests that low socioeconomic status (SES) home environments may play a role by promoting excess energy intake through a lack of access to non-food reinforcers. Because of the deleterious effects of SES-related disparities on child health and development, feasible and culturally acceptable interventions are urgently needed. Community-based music enrichment programs may be an ideal intervention strategy. In collaboration with a local non-profit organization and music studio, we conducted a pilot randomized controlled trial to assess the effects of a music enrichment program versus a play date control in a group of 9-24-month-old healthy infants (N = 16). The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Children's Mercy Hospital Kansas City. This study is registered with clinicaltrials.gov (NCT05868811). Overall, we found some intervention effects on the relative reinforcing value of food (RRVfood) and the home environmental enrichment measures (i.e., increased music use at home and the home language environment). Our intervention demonstrated large effects on the increased use of music at home. We did not find significant group differences in the RRVfood and home language environment, but some of the effect sizes were medium-to-large. Results also suggest that our intervention is feasible and acceptable. Parent feedback indicated that the intervention was well-liked and that the steps we took to help reduce barriers worked. Music enrichment programs may be a high-impact, low-cost strategy to address socioeconomic disparities.

Pain experience with outpatient hysteroscopy: A prospective cohort study

BackgroundAbnormal uterine bleeding (AUB) affects women of all ages and is one of the most common reasons for referral to a gynaecological clinic. Operative hysteroscopic procedures allow for a see-and-treat approach to AUB, and these techniques have been shown to be feasible and acceptable in the outpatient setting. ObjectiveTo assess if there is an increase in pain scores for women who are undergoing an operative hysteroscopic procedure with Myosure LITE® (Hologic; mechanical hysteroscopic tissue removal system) compared to outpatient diagnostic hysteroscopy alone. Study designA prospective cohort study was performed. All participants attending the outpatient hysteroscopy clinic at Mercy Hospital for Women completed a pre-and post-procedure questionnaire. This included a visual analogue scale (VAS) for any pre-existing pain, anticipated pain, and actual pain experienced during procedure. Factors influencing overall satisfaction and willingness to attend again were also assessed. Data was entered into RedCap® for analysis. A difference in VAS of 10 mm or more was considered clinically significant. An alpha of p < 0.05 was assigned for statistical significance. ResultsBetween February 2020 and November 2022, 208 women underwent outpatient diagnostic hysteroscopy followed by an operative hysteroscopy with MyoSure®. To allow for standardisation of analgesia, only participants who had a cervical block before their Myosure® procedure were included for analysis (n = 111). There was statistical evidence (t(111) = 2.36, p = 0.02) of a lower mean VAS pain score for operative Myosure (36.5 mm, 95 % CI: 31.1–41.8 mm) compared to outpatient diagnostic hysteroscopy (44.1 mm, 95 % CI: 39.0–49.2 mm). The mean difference in VAS pain score was estimated as 7.7 mm (95 % CI: 1.2–14.1 mm) lower for Myosure compared to hysteroscopy. Given the threshold for clinical significance was considered as 10 mm difference in VAS, the variance in pain scores is under the likely clinically significant range. There was no significant difference in pain scores for diagnostic hysteroscopy with or without paracervical block (mean difference = 1.42; 95 % CI: −6.35 to 9.20). There was no association between pre-existing pain, and actual pain for hysteroscopy, or Myosure (p = 0.997 and p = 0.065 respectively). The anticipated pain score was weakly associated with actual pain during the operative Myosure procedure (p = 0.02), and with outpatient diagnostic hysteroscopy (p = 0.019). ConclusionOutpatient hysteroscopy procedures are generally well tolerated. The pain experience with operative Myosure was less than that reported during the diagnostic hysteroscopy by the same patient although this is unlikely of clinical significance. Importantly, Myosure was not more painful than the initial diagnostic procedure, and most patients were satisfied with the outcome and would choose to have the procedure again in an outpatient setting. This is in keeping with other studies which have shown a high degree of patient tolerance and satisfaction with this approach.

Implementing a Halo Gravity Traction Program: A Multidisciplinary Endeavor.

Halo gravity traction (HGT) is a preoperative modality for children with severe spinal deformity used to optimize spine flexibility and balance while decreasing the likelihood of neurologic injury. HGT is a dependable solution for these challenging spinal deformities. Aligning treatment guidelines and providing resources, education, and training for staff are key components for a successful HGT program. The HGT program at Children's Mercy Hospital was then developed with a systems approach with the holistic goal of multidisciplinary collaboration with physical/occupational therapy, hospital medicine, pulmonology, psychology, nutrition, child life, and complex care management. Education, research, and national collaboration to standardize this therapy should improve patient safety and support quality improvement.

A Review of an Interfacility Transport Program Pediatric Stroke Clinical Practice Guideline.

Pediatric acute ischemic stroke is a rare diagnosis that requires timely recognition and definitive management to prevent morbidity and mortality. Children often present to primary care offices, urgent care clinics, and adult emergency departments for evaluation of symptoms that may be signs and symptoms of stroke. Currently, there are no published prehospital or transport protocols specific to pediatric acute ischemic stroke. The Children's Mercy Hospital Critical Care Transport Team (CMCCT) created a pediatric-specific clinical practice guideline (CPG) for suspected acute ischemic stroke. This retrospective, descriptive study reports pediatric patients aged younger than 18 years who met criteria for the pediatric stroke CPG and required interfacility transport by CMCCT over a 4- year period. Large vessel occlusion (LVO) scores used in adults were calculated retrospectively. Seventeen patients met inclusion criteria. Four (24%) of 17 had radiographic evidence of acute thrombus, 3 of whom received alteplase and/or endovascular clot retrieval. Median age of confirmed stroke was 83 months (interquartile range, 65-148) compared with 177 months for nonstroke (interquartile range, 169-191), P = 0.126. The most common presenting symptom was hemiplegia in the confirmed stroke group. The confirmed stroke group scored significantly lower on the Glasgow Coma Scale (median of 8 vs 15, P = 0.014), significantly higher on the Los Angeles Motor Scale LVO score (median 4 vs 0, P = 0.021), and significantly higher on the Rapid Arterial Occlusion Evaluation LVO (median 4 vs 0, P = 0.036). To our knowledge, the CMCCT CPG is the first pediatric transport protocol aimed at recognition and management of pediatric stroke described in the literature. Retrospective calculation of LVO scores show that they may be helpful in application to pediatric patients.

Treatment or correction? Insane priests in the first half of the 19th century. Brothers of Mercy Hospital in Prague

Treatment or correction? Insane priests in the first half of the 19th century. Brothers of Mercy Hospital in Prague

Small for gestational age at preterm birth identifies adverse neonatal outcomes more reliably than antenatal suspicion of fetal growth restriction

Background Fetal growth restriction (FGR) is an important reason for premature delivery and a leading cause of perinatal morbidity and mortality. We aimed to evaluate whether classification as small for gestational age (SGA; <10th centile) at birth or antenatal suspicion of FGR was more strongly associated with neonatal morbidity and mortality in preterm infants. Methods A retrospective audit of infants born between 24 + 0 and 32 + 6 weeks of gestation from 2012–2019 and admitted to the Neonatal Unit at Mercy Hospital for Women (MHW). Infants were categorized according to whether FGR was listed as an antenatal complication in the medical records and whether they were SGA (<10th centile on Fenton chart) or appropriate for gestational age (AGA) at birth, and comparisons for neonatal outcomes were made. Results 371/2126 preterm infants (17.5%) had antenatal suspicion of FGR, and 166 (7.8%) were SGA at birth. No differences in any neonatal outcomes were found between infants with or without suspected FGR, except decreased intraventricular hemorrhage (IVH) in the FGR group. SGA classification was associated with increased rates of all morbidities other than IVH, including bronchopulmonary dysplasia, retinopathy of prematurity, and necrotizing enterocolitis, compared with the AGA group. Death was significantly higher in the SGA group (7.2%) compared with the AGA group (3.5%). Conclusion SGA by Fenton chart more reliably identified neonates at risk of adverse neonatal outcomes than antenatal suspicion of FGR, suggesting it is a reasonable clinical proxy. This most likely reflects the much lower tenth centile weight cutoffs on the Fenton charts compared to in-utero charts used antenatally to diagnose FGR based on ultrasound estimated fetal weight. SGA classification by Fenton approximately equates to <3rd centile on in-utero charts at our institution, therefore identifying the most severe FGR cases.

Improving Women's Health.

This invited Team Profile was created by the McClements and the Wen groups, Institute for Biomedical Materials and Devices, Faculty of Science, University of Technology Sydney (Australia); and the Kaitu'u-Lino/Hannan groups, Mercy Hospital for Women, the University of Melbourne (Australia). They recently published an article on the development and validation of the first-in-class point-of-care assay for preeclampsia diagnosis. This assay can detect and quantify the concentration of FKBPL and CD44 proteins in human plasma in 15 minutes with high sensitivity and specificity enabling timely diagnosis of early-onset preeclampsia. "Quantitative Point of Care Tests for Timely Diagnosis of Early-Onset Preeclampsia with High Sensitivity and Specificity", S. M. Ghorbanpour, S. Wen, T.'u. J. Kaitu'u-Lino, N. J. Hannan, D. Jin, L. McClements, Angew. Chem. Int. Ed. 2023, 62, e202301193.

Improving Women's Healt

AbstractThis invited Team Profile was created by the McClements and the Wen groups, Institute for Biomedical Materials and Devices, Faculty of Science, University of Technology Sydney (Australia); and the Kaitu'u‐Lino/Hannan groups, Mercy Hospital for Women, the University of Melbourne (Australia). They recently published an article on the development and validation of the first‐in‐class point‐of‐care assay for preeclampsia diagnosis. This assay can detect and quantify the concentration of FKBPL and CD44 proteins in human plasma in 15 minutes with high sensitivity and specificity enabling timely diagnosis of early‐onset preeclampsia. “Quantitative Point of Care Tests for Timely Diagnosis of Early‐Onset Preeclampsia with High Sensitivity and Specificity”, S. M. Ghorbanpour, S. Wen, T.'u. J. Kaitu'u‐Lino, N. J. Hannan, D. Jin, L. McClements,, Angew. Chem. Int. Ed. Engl. 2023, 62, e202301193.

Definition and Clinical Evaluation for Trimethoprim-Sulfamethoxazole Severe Acute Respiratory Failure.

Trimethoprim-sulfamethoxazole (TMP-SMX)-associated severe acute respiratory distress syndrome (ARDS) has gone underrecognized. We propose the first disease definition and clinical evaluation for a novel adverse drug reaction (ADR) based on a series of recently identified rare cases of life-threatening ADRs. A retrospective study was conducted. All medical records were evaluated. Available pathology samples were sent to Massachusetts General for clinical consultation. Blood samples from surviving patients were obtained and human leukocyte antigen (HLA) analysis was performed by the Children's Mercy Hospital Genomic Center and Vanderbilt University Medical Center. U.S. ICUs, 1996-2021. Nineteen young patients (10-37) were identified. Patients were previously healthy, with no preexisting pulmonary disease, no other cause for respiratory failure, and no chronic history of smoking/vaping. None. Through our retrospective analysis, we analyzed clinical characteristics associated with TMP-SMX. Pathology samples were reviewed, and HLA analysis was performed on available samples by the study team or as standard of care at treatment hospitals in some cases. In 19 critically ill patients, we identified a pattern of severe respiratory failure requiring ICU admission, mechanical ventilation, and frequent extracorporeal membrane oxygenation use. We describe the first three-part clinical diagnosis and evaluation strategy: 1) Clinical definition: Unexplained severe respiratory failure in a patient receiving greater than or equal to 6 days of TMP-SMX at treatment dose (not prophylaxis). TMP-SMX ARDS is a diagnosis of exclusion. 2) Genetic association: One hundred percent of currently available TMP-SMX respiratory failure patient genomic data, ( n = 11) have been carriers of both HLA-B*07:02 and HLA-C*07:02 alleles. HLA allele evaluation could be considered in patients with suspected TMP-SMX respiratory failure. 3) Lung pathology: A unique pulmonary pathologic pattern of lung injury termed diffuse alveolar injury with delayed epithelialization has been observed in these cases. In suspected cases, surgical lung biopsy early in the clinical course could be considered. TMP-SMX is a commonly prescribed antibiotic. However, we find it imperative to share this relatively rare but life-threatening condition with clinicians as the mortality rate approaches 40%.

1816-PUB: Training and Support for Hospital Staff in the Use of Continuous Glucose Monitoring as Standard of Care in a Real-World Hospital Setting

Use of continuous glucose monitoring (CGM) in the hospital is limited and staff familiarity with CGM technology is low. During the COVID-19 pandemic and following the non-objection of the FDA to use of CGM in the hospital, the CGM as “standard of care” (CGM as SOC) program was implemented at Scripps Mercy Hospital in San Diego, CA using the Dexcom G6 CGM system. The implementation process of CGM as SOC included generating daily eligible patient lists, deploying specialized teams for CGM placement and connecting to nursing station iPads and centralized monitoring dashboards, and training of hospital nursing staff for CGM readings. A remote Advanced Practice Nurse (APN) served as an on-site trainer and expert consultant for troubleshooting. A Learning Management System (LMS) module was created for staff training and surveys assessed the training process. From May 2020-December 2022, CGM devices were placed on over 1200 adult hospitalized patients with diabetes requiring insulin. The APN conducted 30 live trainings for all units and shifts over 6 months. N=838 RNs completed the LMS module and met the required post-test passing rate of ≥ 80%. A total of N=38 self-report surveys were completed by nursing staff. Survey responses confirmed that most RNs felt confident in using the CGM nursing guide (97%) and had access to experts for troubleshooting (89%). Most common questions were related to technology troubleshooting (71%) compared to clinical issues (29%). Daily bedtime validation was transitioned from the APN to the bedside nursing staff using a validation calculator within EPIC. Despite limited baseline knowledge of CGM by hospital staff, deployment of specialized teams, APN on-site training and delivery of LMS modules supported the rapid implementation of CGM as SOC in a large community-based hospital. Standard training tools and processes can allow replication in health systems for use as part of the current provisional FDA allowance. Disclosure S.Lohnes: Consultant; Dexcom, Inc. R.Acuna: None. S.M.Saenz: None. T.Juarez: None. A.Philis-tsimikas: Advisory Panel; Dexcom, Inc., Novo Nordisk A/S, Sanofi, Other Relationship; Medtronic, Research Support; Novo Nordisk A/S, Lilly, Viking Therapeutics, NIH - National Institutes of Health. A.Bastian: None. A.L.Fortmann: Employee; Dexcom, Inc. L.Talavera: None. R.Belasco: None. H.Sandoval: None. M.Chichmarenko: None. S.R.Spierling bagsic: None. E.Soriano: None.

940-P: Real-World Concordance between Point-of-Care and Continuous Glucose Monitoring among Hospitalized Patients with Diabetes

Concordance between continuous glucose monitoring (CGM) and point-of-care testing (POCT) in research studies has been promising; however, the accuracy of using CGM for glucose management in real-world settings requires evaluation. Amid the COVID-19 pandemic, the CGM as “standard of care” (CGM as SOC) program was implemented at Scripps Mercy Hospital in San Diego, CA. In this real-world setting, concordance between the Dexcom G6 CGM system and POCT was evaluated among hospitalized adult patients with diabetes requiring insulin from May 2020-July 2022. For N=880 admissions, CGM readings over the first 24 hours of wear were analyzed relative to POCT conducted within 5 minutes. Patients had a median of 3 CGM-POCT data pairs, and the first CGM-POCT pair occurred a median of 2.75 hours after CGM device placement. Mean absolute relative difference (MARD) decreased over the first 24 hours of wear (B= -0.09%, p=0.0005; Figure 1A). Following the %20/20 rule, 62% of CGM readings were concordant upon the first measured POCT; 15.8% did not meet criteria at all during the first 24-hours. Using the Clarke Error Grid to describe concordance between CGM-POCT pairs (n=3015), only 0.7% (n=22) of CGM readings would have led to incorrect treatment decisions indicated by zones D/E (Figure 1B). These findings provide support for the accuracy of CGM for glucose management in the hospital. Disclosure S.R.Spierling bagsic: None. L.Talavera: None. A.Philis-tsimikas: Advisory Panel; Dexcom, Inc., Novo Nordisk A/S, Sanofi, Other Relationship; Medtronic, Research Support; Novo Nordisk A/S, Lilly, Viking Therapeutics, NIH - National Institutes of Health. A.L.Fortmann: Employee; Dexcom, Inc. R.Belasco: None. A.Ritko: None. S.Lohnes: Consultant; Dexcom, Inc. H.Sandoval: None. M.Chichmarenko: None. E.Soriano: None. A.Bastian: None.

949-P: Hypoglycemia Detection during Real-Time Continuous Glucose Monitoring in a Real-World Hospital Setting

Continuous glucose monitoring (CGM) in the hospital can detect hypoglycemia that may go unnoticed by point-of-care testing (POCT). Following the non-objection of the FDA to the use of CGM in the hospital, using the Dexcom G6 CGM system, the “CGM as Standard of Care” (CGM as SOC) program was implemented at Scripps Mercy Hospital San Diego with a 24/7 remote-monitoring team (RMT) using a Digital Dashboard (DD). The DD alerts for glucose ≤80mg/dL and prioritizes patients by clinical risk. Using these alerts, the RMT notifies on-site bedside nurses (RN). Hypoglycemic events, defined as &amp;gt;15 minutes of consecutive glucose readings &amp;lt;70mg/dL, identified in retrospective evaluation of CGM data were analyzed to 1) evaluate appropriateness of response to events and 2) assess the accuracy of the events. 86/745 (12%) unique admissions enrolled in the CGM as SOC program between January 2021-June 2022 experienced a hypoglycemic event during the RMT period. These patients averaged 60.2 years of age, 62% male, 48% Hispanic and 87% with a type 2 diabetes diagnosis. Median number of events per admission = 1.90, for a total of 163 events. All alerts were acknowledged by the RMT, documentation that bedside RN was alerted was found on 134/163 (82%) events. It is possible that the RMT neglected to document RN outreach in the remaining 29 (18%). 90/163 events (55%) were treated as appropriate clinically, with insulin dosing changes as needed. In the remaining 69/163 (42%) events, patients were determined to not be (or no longer be) in an actionable hypoglycemia range that warranted treatment when evaluated by the RN. A small portion (10/69, 14%) were caused by documented compression on device resulting in artificially low CGM values. There were 4 (3%) events with insufficient documentation. These findings provide preliminary support of the value of an RMT in hypoglycemia surveillance in a real-world hospital setting. Additional data and recommendations for process refinements will be presented. Disclosure R.Belasco: None. L.Talavera: None. A.Philis-tsimikas: Advisory Panel; Dexcom, Inc., Novo Nordisk A/S, Sanofi, Other Relationship; Medtronic, Research Support; Novo Nordisk A/S, Lilly, Viking Therapeutics, NIH - National Institutes of Health. A.L.Fortmann: Employee; Dexcom, Inc. S.R.Spierling bagsic: None. A.Bastian: None. S.Lohnes: Consultant; Dexcom, Inc. A.Ritko: None. H.Sandoval: None. M.Chichmarenko: None. E.C.Soriano: None.

Editorial introductions.

Editorial introductions.

Analysis of High Flow Nasal Cannula Utilization During Pediatric Critical Care Transport

ObjectiveThere are limited studies on the safety and efficacy of high flow nasal cannula (HFNC) use in pediatrics during interfacility critical care transport. This 15-month retrospective study aims to describe our transport team's utilization of HFNC within the pediatric population and evaluates the need for patient escalation in respiratory support within 24 hours of hospital admission including increased liter flow, transition to noninvasive ventilation, or intubation. MethodsRetrospective charts were reviewed by study members from January 1, 2019, through March 31, 2020. Study dates were specifically chosen to reflect when HFNC was implemented in the transport department and before the beginning of the severe acute respiratory syndrome coronavirus disease 2019 (SARS-COVID-19) pandemic because of variability in respiratory support recommendations at the beginning of the pandemic. Patients were screened for inclusion criteria and were included if they were >30 days and <18 years of age, required HFNC at ≥4 L/min during transport, and were admitted to Children's Mercy Hospital. ResultsDuring the study period, we completed 6,279 pediatric transports, of which 382 had documented HFNC use and 358 met the inclusion criteria. Our HFNC patients had a median age of 0.7 years with an interquartile range (IQR) of 0.3 to 1 year, a median weight of 8.4 kg with an IQR of 6.2 to 11 kg, a median liter flow of 10 L/min and 1.2 L/kg/min, and required a median transport time of 80 minutes with an IQR of 69 to 115 min. Patients were tracked for 24 hours post-admission for any escalations in care; 33% required an escalation, 76% of those had an increase in flow, 24% required noninvasive ventilation, and 0% required intubation. ConclusionOur study suggests HFNC is a safe and effective means for providing respiratory support to the pediatric population during interfacility critical care transport. Our data support utilization of 1 to 2 L/kg/min in the smaller pediatric population (<10 kg) during transport. There was minimal risk of escalation to noninvasive ventilation, and no patients required intubation within 24 hours post drop-off, likely because of the appropriate utilization of HFNC during transport. Additional studies, especially multicenter pediatric studies, are needed to analyze HFNC utilization with non-restricting circuits and vibrating mesh nebulizers.

Incidental Finding of an Inverted Appendix.

Children’s Mercy Hospital and Clinics, 2401 Gillham Road, Kansas City, MO, USA, 64108 Emails: First Author: [email protected] Consent: The parents of the patient signed informed patient consent for publication of the patient’s clinical information and imaging of his procedure. Corresponding author: [email protected]

Negotiating Shanghai Mercy Hospital: Philanthropy, Business and Control of Madness in Republican China.

This study examines the initiation and administration of Mercy Hospital in Republican Shanghai. It explains the protracted negotiations that underpinned the collaboration between the Chinese founder Lu Bohong, the Shanghai Municipal Council (SMC) of the International Settlement and the Municipal Administration (FMA) of the French Concession. Despite mutual needs for a psychiatric hospital, the collaboration was undermined by disputes over funding shares and administrative direction. While Lu expected a symbolic modern philanthropy, the SMC and FMA saw it as an economic tool to relieve the responsibility of regulating refugees and the increasing mental patients. They repeatedly forced Lu to make concessions with financial instruments, but ended up non-cooperation, leading the patrons to compromise to keep their problem solver. However, after Lu's murder and the subsequent dysfunction of the Chinese municipal government, the SMC and FMA could not help but take on this task to protect their settlements from the threat.

Use of a Lean Six Sigma approach to investigate excessive quality control (QC) material use and resulting costs

PurposeThe Eastern Health Clinical Biochemistry Laboratories cater to the province of Newfoundland and Labrador. Over the last ten years, a significant increase in annual expenses on quality control material and calibrator purchases was observed. Two major Clinical Chemistry Laboratories at the Health Sciences Centre (HSC) and St. Clare’s Mercy Hospital (STC), St. John’s, work as referral centers for the province. The study’s design was based on the Six Sigma DMAIC (Define, Measure, Analyze, Improve, and Control) process and involved tests performed on ten automated Abbott Clinical Chemistry (CC) and Immunoassay (IA) analyzers. The cost of purchasing the QC material from Bio-Rad and Randox had increased due to defective QC and analyzer test assignment process design. The processes were modified. An Individualized Quality Control Plan (IQCP) was developed. ResultsModification in quality control processes helped in bringing down the cost and usage of both QC and calibrators. The cost and usage of individual control material were reduced by 25 to 52% depending on the type of quality control. Total annual expenditure on the purchase of different QC materials before modification was estimated as CAD 346,395(2019) which was reduced to CAD 255,267 with annual savings of 91,128 CAD (26%) after modification (2020). The average usage reduction for various calibrators was 40% with the highest reduction in the use of urine calibrators. The annual cost of calibrators was reduced from CAD 30,568.42 (2019-20) to CAD 17,517 (2020-21) with the saving of approximately 13,051 Canadian dollars (43 %) for the laboratory. ConclusionsThere is a constant compulsion in every industry to manage costs. Implementation of Lean and Six Sigma methodology in removing Muda of high costs in a Clinical Chemistry Laboratory is the most warranted strategy in developing a cost-effective laboratory framework.

Increasing Incentive Spirometry Use in Patients with Sickle Cell Disease Admitted to Children's Mercy Hospital

Introduction: Acute chest syndrome is one of the leading causes of morbidity and mortality in patients with sickle cell disease. The National Heart, Lung, and Blood Institute (NHLBI) recommends providing ten breaths of incentive spirometry (IS) every two hours while awake for patients with sickle cell disease admitted to the hospital to help prevent development of acute chest syndrome. Methods: We reviewed provision of IS at Children's Mercy Hospital (CMH) in Kansas City, Missouri between 08/01/2021 and 11/01/2021. Data were collected and the target population was identified via a report generated from the electronic medical records of those patients admitted with sickle cell disease and vaso-occlusive pain requiring continuous opioid infusion. We reviewed the frequency with which IS was offered each hospital day and found that during that 3-month time period, no patients were offered IS at the frequency recommended by the NHLBI. Meetings with stakeholders identified that IS orders were inconsistent between electronic medical record order sets and were not based on current NHLBI recommendations. To address this potential root cause, order sets were updated to match NHLBI recommendations. We then reviewed provision of IS following implementation of standardized IS orders between 12/21/2021 and 3/14/2022. Our primary aim with our initial plan-do-study-act (PDSA) cycle was to increase the frequency IS was being offered to patients to meet NHLBI guidelines. Results: Between 08/01/2021 and 11/01/2021, there were 285 hospital days with patients admitted to CMH with a sickle cell vaso-occlusive pain. We excluded days of admission and discharge (94 days). Of 191 full hospital days, only 53% (101/191) had IS documented at all. When IS was documented, 0% of patients were offered the recommended frequency of IS and the median time between IS offerings was 6.3 hours. Following implementation of updated orders on 12/21/2021 IS was offered to patients at the recommended frequency 1% of the time, and the median hours between when IS was offered decreased to 5.9 hours. Conclusion: The initial goal of this project was to increase the daily occurrences of IS offered to sickle cell patients admitted to the hospital with vaso-occlusive pain to meet the NHLBI recommended frequency from 0% to 10% over a 3-month period following the implementation of updated IS orders within Cerner powerplans. Further PDSA cycles will continue to refine our approach to increasing frequency IS is offered to the patient and documented in the medical record. Subsequent PDSA cycles will also focus on increasing patient use of IS as well as analyzing supplemental oxygen use before and after each intervention as a patient outcome measure.

Assisted reproductive… training.

Emergency Medicine AustralasiaEarly View Trainee Focus Assisted reproductive… training Natasha Thomson MBBS (Hons), BBiomedSci, GradDipEd (Sec), GradDipClinEd, Corresponding Author Natasha Thomson MBBS (Hons), BBiomedSci, GradDipEd (Sec), GradDipClinEd RACP Advanced Training Registrar, Paediatric Emergency Medicine/General Paediatrics drtashthomson@gmail.com Paediatric Intensive Care Unit, Monash Medical Centre, Melbourne, Victoria, Australia Correspondence: Dr Natasha Thomson, Paediatric Intensive Care Unit, Monash Medical Centre, 246 Clayton Road, Melbourne, VIC 3168, Australia. Email: drtashthomson@gmail.comSearch for more papers by this authorKate McIlwaine MBBS (Hons), FRANZCOG, Kate McIlwaine MBBS (Hons), FRANZCOG MRMed Consultant, Gynaecologist, Fertility Specialist Genea Fertility and Mercy Hospital for Women, Melbourne, Victoria, AustraliaSearch for more papers by this author Natasha Thomson MBBS (Hons), BBiomedSci, GradDipEd (Sec), GradDipClinEd, Corresponding Author Natasha Thomson MBBS (Hons), BBiomedSci, GradDipEd (Sec), GradDipClinEd RACP Advanced Training Registrar, Paediatric Emergency Medicine/General Paediatrics drtashthomson@gmail.com Paediatric Intensive Care Unit, Monash Medical Centre, Melbourne, Victoria, Australia Correspondence: Dr Natasha Thomson, Paediatric Intensive Care Unit, Monash Medical Centre, 246 Clayton Road, Melbourne, VIC 3168, Australia. Email: drtashthomson@gmail.comSearch for more papers by this authorKate McIlwaine MBBS (Hons), FRANZCOG, Kate McIlwaine MBBS (Hons), FRANZCOG MRMed Consultant, Gynaecologist, Fertility Specialist Genea Fertility and Mercy Hospital for Women, Melbourne, Victoria, AustraliaSearch for more papers by this author First published: 25 October 2022 https://doi.org/10.1111/1742-6723.14118Read 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 Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Idiopathic intracranial hypertension: 33 observations during 5 years in the neurology department of the Mercy Hospital Metz- France and analysis of the literature

Idiopathic intracranial hypertension: 33 observations during 5 years in the neurology department of the Mercy Hospital Metz- France and analysis of the literature