Multi-institutional Development Research Articles

Multi-Institutional Development and Validation of a Radiomic Model to Predict Prostate Cancer Recurrence Following Radical Prostatectomy

The use of multiparametric magnetic resonance imaging (mpMRI)-derived radiomics has the potential to offer noninvasive, imaging-based biomarkers for the identification of subvisual characteristics indicative of a poor oncologic outcome. The present study, therefore, seeks to develop, validate, and assess the performance of an MRI-derived radiomic model for the prediction of prostate cancer (PC) recurrence following radical prostatectomy (RP) with curative intent. mpMRI imaging was obtained from 251 patients who had undergone an RP for the treatment of localized prostate cancer across two institutions and three surgeons. All patients had a minimum of 2 years follow-up via prostate-specific antigen serum testing. Each prostate mpMRI was individually reviewed, and the prostate was delineated as a single slice (ROI) on axial T2 high-resolution image sets. A total of 924 radiomic features were extracted and tested for stability via intraclass correlation coefficient (ICC) following image normalization via histogram matching. Fourteen important and nonredundant features were found to be predictors of PC recurrence at a mean ± SD of 3.2 ± 2.2 years post-RP. Five-fold, ten-run cross-validation of the model containing these fourteen features yielded an area under the curve (AUC) of 0.89 ± 0.04 in the training set (n = 225). In comparison, the University of California San Fransisco Cancer of the Prostate Risk Assessment score (UCSF-CAPRA) and Memorial Sloan Kettering Cancer Center (MSKCC) Pre-Radical prostatectomy nomograms yielded AUC of 0.66 ± 0.05 and 0.67 ± 0.05, respectively (p < 0.01). When the radiomic model was applied to the test set (n = 26), AUC was 0.78; sensitivity, specificity, positive predictive value, and negative predictive value were 60%, 86%, 52%, and 89%, respectively. Accuracy in predicting PC recurrence was 81%.

Multi-institutional Development and External Validation of a Machine Learning Model for the Prediction of Distant Metastasis in Patients Treated by Salvage Radiotherapy for Biochemical Failure After Radical Prostatectomy

BackgroundUp to 40% of patients with prostate cancer may develop biochemical recurrence after surgery, with salvage radiation therapy (SRT) being the only curative option. In 2016, Tendulkar et al. (Contemporary update of a multi-institutional predictive nomogram for salvage radiotherapy after radical prostatectomy. J Clin Oncol 2016;34:3648–54) published a nomogram to predict distant metastasis in a cohort of patients treated with SRT with pre-SRT prostate-specific antigen (PSA) of 0.5 ng/ml after radical prostatectomy. In modern practice, SRT is delivered at lower PSA values. ObjectiveTo train and externally validate a machine learning model to predict the risk of distant metastasis at 5 yr in a contemporary cohort of patients receiving SRT. Design, setting, and participantsWe trained a machine learning model on data from 2418 patients treated with SRT at one institution, with a median PSA value of 0.27 ng/ml. External validation was done in 475 patients treated at two different institutions. Patients with cM1, pN1, or pT4 disease were excluded, as were patients with PSA >2 ng/ml or PSA 0, and patients with radiation dose <60 or ≥80 Gy. Outcome measurements and statistical analysisModel performance was assessed using calibration and time-dependent area under the receiver operating curve (tAUC). Results and limitationsOur model had better calibration and showed improved discrimination (tAUC = 0.72) compared with the Tendulkar model (tAUC = 0.60, p < 0.001). The main limitations of this study are its retrospective design and lack of validation on patients who received hormone therapy. ConclusionsThe updated model can be used to provide more individualized risk assessments to patients treated with SRT at low PSA values, improving decision-making. Patient summaryUp to 40% of patients with prostate cancer may develop biochemical recurrence after surgery, with salvage radiation therapy as the only potentially curative option. We trained and validated a machine learning model using clinical and surgical data to predict a patient’s risk of distant metastasis at 5 yr after treatment. Our model outperformed the reference tool and can improve clinical decision-making by providing more personalized risk assessment.

Multi-institutional Development and Validation of Contouring Guidelines for Para-aortic Elective Nodal Irradiation in Prostate Cancer Based on Patterns of Involvement on Targeted Molecular Imaging Positron Emission Tomography/Computed Tomography

Molecular imaging better identifies anatomic regions of metastatic spread of prostate cancer compared with conventional imaging, resulting in para-aortic (PA) nodal metastases being increasingly identified. Consequently, some radiation oncologists electively treat the PA lymph node region in patients with gross or high risk of PA nodal involvement. The anatomic locations of at-risk PA lymph nodes for prostate cancer are unknown. Our objective was to use molecular imaging to develop guidelines for the optimal delineation of the PA clinical target volume (CTV) in patients with prostate cancer. We conducted a multi-institutional retrospective cohort study of patients with prostate cancer undergoing 18F-fluciclovine or 18F-DCFPyL prostate-specific membrane antigen positron emission tomography (PET)/computed tomography (CT). Images of patients with PET-positive PA nodes were imported into the treatment planning system, avid nodes were contoured, and measurements were taken in relation to anatomic landmarks. A contouring guideline that encompassed the location of ≥95% of PET-positive PA nodes was created using descriptive statistics and then validated in an independent data set. Five hundred fifty-nine patients had molecular PET/CT imaging in the development data set (78% 18F-fluciclovine, 22% prostate-specific membrane antigen). Seventy-six patients (14%) had evidence of PA nodal metastasis. We determined that expanding the CTV to 1.8 cm left of the aorta, 1.4 cm right of the inferior vena cava (IVC), 7 mm posterior to the aorta/IVC or to the vertebral body, and superiorly to the T11/T12 vertebral interface, with the anterior border 4 mm anterior to the aorta/IVC and inferior border at the bifurcation of the aorta/IVC, resulted in coverage of ≥95% of PET-positive PA nodes. When the guideline was used in the independent validation data set (246 patients with molecular PET/CT imaging, of whom 31 had PA nodal metastasis), 97% of nodes were encompassed, thereby validating our guideline. We used molecular PET/CT imaging to determine the anatomic locations of PA metastases to develop contouring guidelines for creating a prostate cancer PA CTV. Although the optimal patient selection and clinical benefits of PA radiation therapy remain uncertain, our results will aid in delineating the optimal target when PA radiation therapy is pursued.

Multi-institutional development and validation of a novel histologic grading system for colonic graft-versus-host disease

AbstractGraft-versus-host disease (GVHD) remains a major complication for patients who have undergone hematopoietic stem cell transplantation. The Lerner system is the most widely used histologic grading score for gastrointestinal GVHD but its clinic utility is debated. The aim of our study was to develop a novel histologic grading system for gastrointestinal GVHD that incorporates independent evaluation of both apoptotic counts and crypt destruction. Colonic biopsies taken to assess for GVHD were retrospectively assessed for: Crypt damage (No crypt dropout or ulceration–0; crypt dropout without ulceration–1; ulceration–2) and crypt apoptotic counts (No apoptosis–0; 1–6 apoptotic bodies per 10 contiguous crypts–1; >6apoptotic bodies per 10 contiguous crypts–2). The two scores were added together to get an overall grade (0–4). Alternative apoptotic cutoff points were examined. An apoptotic cutoff of >9 apoptotic bodies per 10 contiguous crypts marginally improved the area under the curve (AUC), but the AUCs from the resulting novel grade calculations were not significantly different (p = 0.10). Lerner grading was also applied. The study group consisted of an initial analysis cohort (n = 191) and a second validation cohort from a separate institution (n = 97). In the initial analysis cohort, our histologic grading system provided prognostic stratification for GVHD-related death within 6 months (p = 0.0004, AUC = 0.705). The Lerner system performed similarly in terms of providing prognostic stratification for GVHD-related death (p = 0.0001, AUC = 0.707). In the external validation cohort, our histologic grading system was not associated with GVHD-related death (p = 0.14, AUC = 0.621), but the Lerner system was associated with GVHD-related death (p = 0.048, AUC = 0.663). While our grading system may have some advantages compared to the Lerner system, due to lack of reproducibility we do not currently recommend widespread adoption of this system. Nonetheless, we present a standardized tool for assessing both apoptosis and crypt damage. Future studies assessing alternative histologic grading systems with external validation and further examination the lower apoptotic threshold for GVHD diagnosis are warranted.

Impact of a postgraduate year one (PGY-1) otolaryngology bootcamp on procedural skill development

Background: To measure the impact of an intensive eight-week postgraduate year one (PGY-1) otolaryngology bootcamp on the acquisition and retention of otolaryngology residents’ procedural skills compared to the traditional method of skill acquisition through clinical exposure. Methods: Residents at our institution were evaluated on their performance of flexible laryngoscopy, suture ligature, and rigid bronchoscopy setup at three time points: pre-bootcamp, one-week post-bootcamp, and one-year post-bootcamp. Video recordings were scored by two blinded faculty reviewers using a multipoint rating system. A control group of rising postgraduate year two (PGY-2) residents who did not participate in bootcamp were recorded performing these same skills. Scores in the three skills were compared between groups via t-tests. The eight-week bootcamp curriculum for PGY-1s was held at the Montefiore Einstein Center for Innovation in Simulation at Albert Einstein College of Medicine/Montefiore Medical Center. The participants were two classes of PGY-1 residents (n=8) at our institution who participated in a bootcamp at the beginning of residency, and one class of rising PGY-2 residents (n=3) who did not participate in a bootcamp (control group). Results: A comparison of pre-bootcamp scores to one-week post-bootcamp scores showed significant improvement in suture ligature ( P<0.05) and rigid bronchoscopy ( P<0.05), but no difference in flexible laryngoscopy ( P=0.54). Suture ligature ( P=0.09) and rigid bronchoscopy ( P=0.25) skills were not significantly different from one-week post-bootcamp to one-year post-bootcamp; however, a significant skill improvement was observed in flexible laryngoscopy ( P<0.05). By June of PGY1 year, the two bootcamp cohorts were similar to controls in all three skills: flexible laryngoscopy ( P=0.05), rigid bronchoscopy ( P=0.26), and suture ligature ( P=0.10). Conclusions: Participation in PGY-1 bootcamp was associated with improved acquisition and short-term retention of basic procedural skills, suggesting that bootcamps can be an effective arena to teach basic skills in otolaryngology. PGY-1 bootcamp is a promising arena for multi-institutional development.

Impact of a postgraduate year one (PGY-1) otolaryngology bootcamp on procedural skill development.

Background: To measure the impact of an intensive eight-week postgraduate year one (PGY-1) otolaryngology bootcamp on the acquisition and retention of otolaryngology residents' procedural skills compared to the traditional method of skill acquisition through clinical exposure. Methods: Residents at our institution were evaluated on their performance of flexible laryngoscopy, suture ligature, and rigid bronchoscopy setup at three time points: pre-bootcamp, one-week post-bootcamp, and one-year post-bootcamp. Video recordings were scored by two blinded faculty reviewers using a multipoint rating system. A control group of rising postgraduate year two (PGY-2) residents who did not participate in bootcamp were recorded performing these same skills. Scores in the three skills were compared between groups via t-tests. The eight-week bootcamp curriculum for PGY-1s was held at the Montefiore Einstein Center for Innovation in Simulation at Albert Einstein College of Medicine/Montefiore Medical Center. The participants were two classes of PGY-1 residents (n=8) at our institution who participated in a bootcamp at the beginning of residency, and one class of rising PGY-2 residents (n=3) who did not participate in a bootcamp (control group). Results: A comparison of pre-bootcamp scores to one-week post-bootcamp scores showed significant improvement in suture ligature ( P<0.05) and rigid bronchoscopy ( P<0.05), but no difference in flexible laryngoscopy ( P=0.54). Suture ligature ( P=0.09) and rigid bronchoscopy ( P=0.25) skills were not significantly different from one-week post-bootcamp to one-year post-bootcamp; however, a significant skill improvement was observed in flexible laryngoscopy ( P<0.05). By June of PGY1 year, the two bootcamp cohorts were similar to controls in all three skills: flexible laryngoscopy ( P=0.05), rigid bronchoscopy ( P=0.26), and suture ligature ( P=0.10). Conclusions: Participation in PGY-1 bootcamp was associated with improved acquisition and short-term retention of basic procedural skills, suggesting that bootcamps can be an effective arena to teach basic skills in otolaryngology. PGY-1 bootcamp is a promising arena for multi-institutional development.

Multi-institutional development and validation of modified albumin-bilirubin grade for predicting prognosis of hepatocellular carcinoma patients after hepatectomy

Chao LI, Ming-Da WANG, Lei LIANG, Hao XING, Lan-Qing YAO, Zi-Xiang CHEN, Feng SHEN, Dong-Sheng HUANG, Tian YANG*. Ann Hepatobiliary Pancreat Surg 2022;26:S307. https://doi.org/10.14701/ahbps.2022S1.EP-25

Multi-institutional development and validation of a novel calculator for predicting postoperative major morbidity after hepatectomy for hepatocellular carcinoma among patients with HBV infection

Multi-institutional development and validation of a novel calculator for predicting postoperative major morbidity after hepatectomy for hepatocellular carcinoma among patients with HBV infection

Multi-institutional development and external validation of machine learning-based models to predict relapse risk of pancreatic ductal adenocarcinoma after radical resection

BackgroundSurgical resection is the only potentially curative treatment for pancreatic ductal adenocarcinoma (PDAC) and the survival of patients after radical resection is closely related to relapse. We aimed to develop models to predict the risk of relapse using machine learning methods based on multiple clinical parameters.MethodsData were collected and analysed of 262 PDAC patients who underwent radical resection at 3 institutions between 2013 and 2017, with 183 from one institution as a training set, 79 from the other 2 institution as a validation set. We developed and compared several predictive models to predict 1- and 2-year relapse risk using machine learning approaches.ResultsMachine learning techniques were superior to conventional regression-based analyses in predicting risk of relapse of PDAC after radical resection. Among them, the random forest (RF) outperformed other methods in the training set. The highest accuracy and area under the receiver operating characteristic curve (AUROC) for predicting 1-year relapse risk with RF were 78.4% and 0.834, respectively, and for 2-year relapse risk were 95.1% and 0.998. However, the support vector machine (SVM) model showed better performance than the others for predicting 1-year relapse risk in the validation set. And the k neighbor algorithm (KNN) model achieved the highest accuracy and AUROC for predicting 2-year relapse risk.ConclusionsBy machine learning, this study has developed and validated comprehensive models integrating clinicopathological characteristics to predict the relapse risk of PDAC after radical resection which will guide the development of personalized surveillance programs after surgery.

ASO Author Reflections: Multi-institutional Development and External Validation of a Nomogram for Prediction of Extrahepatic Recurrence After Curative-Intent Resection for Hepatocellular Carcinoma.

ASO Author Reflections: Multi-institutional Development and External Validation of a Nomogram for Prediction of Extrahepatic Recurrence After Curative-Intent Resection for Hepatocellular Carcinoma.

Multi-Institutional Development and External Validation of a Nomogram for Prediction of Extrahepatic Recurrence After Curative-Intent Resection for Hepatocellular Carcinoma.

Extrahepatic recurrence of hepatocellular carcinoma (HCC) after surgical resection is associated with unfavorable prognosis. The objectives of the current study were to identify the risk factors and develop a nomogram for the prediction of extrahepatic recurrence after initial curative surgery. A total of 635 patients who underwent curative-intent resection for HCC between 2000 and 2017 were identified from an international multi-institutional database. The clinicopathological characteristics, risk factors, and long-term survival of patients with extrahepatic recurrence were analyzed. A nomogram for the prediction of extrahepatic recurrence was established and validated in 144 patients from an external cohort. Among the 635 patients in the derivative cohort, 283 (44.6%) experienced recurrence. Among patients who recurred, 80 (28.3%) patients had extrahepatic ± intrahepatic recurrence, whereas 203 (71.7%) had intrahepatic recurrence only. Extrahepatic recurrence was associated with more advanced initial tumor characteristics, early recurrence, and worse prognosis versus non-extrahepatic recurrence. A nomogram for the prediction of extrahepatic recurrence was developed using the β-coefficients from the identified risk factors, including neutrophil-to-lymphocyte ratio, multiple lesions, tumor size, and microvascular invasion. The nomogram demonstrated good ability to predict extrahepatic recurrence (c-index: training cohort 0.786; validation cohort: 0.845). The calibration plots demonstrated good agreement between estimated and observed extrahepatic recurrence (p=0.658). An externally validated nomogram was developed with good accuracy to predict extrahepatic recurrencefollowing curative-intent resection of HCC. Thisnomogram may help identify patients at high risk of extrahepatic recurrence and guide surveillance protocols as well as adjuvant treatments.

Multi-institutional development and validation of a nomogram to predict recurrence after curative resection of gastric neuroendocrine/mixed adenoneuroendocrine carcinoma.

To establish a novel nomogram to predict individual 1, 3, and 5 years disease-free survival (DFS) of patients with gastric neuroendocrine carcinoma/mixed adenoneuroendocrine carcinoma [(MA)NEC]. Among patients undergoing radical resection of gastric (MA)NEC, there is still a high tendency for relapse. A retrospective analysis of 777 patients with gastric (MA)NEC at 23 centers in China from 2004 to 2015 was performed. Based on the established nomogram, which included age, ASA, pT, pN and Ki67, the overall patients were divided into low-risk group (LRG) and high-risk group (HRG). The median follow-up time was 40months (1-169months). The C-index, AUC and time-ROC of the nomogram were significantly higher than that of the 8th edition AJCC and ENETS TNM staging systems. The 3-year DFS of patients in HRG generated by the nomogram was significantly lower than that in LRG (all patients: 35% vs 66.9%, p < 0.001), and there were still significant differences in stratified analysis of the TNM staging systems. The local recurrence rate (10.5% vs 2.6%) and distant recurrence rate (45.1% vs 22.6%) in HRG were significantly higher than those in LRG, especially in anastomotic recurrence (6.3% vs 2%), liver recurrence (20.7% vs 13.4%) and peritoneal metastasis (12.7% vs 2.6%). Compared with AJCC and ENETS TNM staging systems, the established novel validated nomogram had a significantly better prediction ability for DFS and recurrence patterns in patients with gastric (MA)NEC. It can also compensate for the shortcomings of existing AJCC and ENETS TNM staging in predicting individual recurrence risk.

A Multimodal Multi-institutional Solution to Remote Medical Student Education for Otolaryngology During COVID-19.

During the coronavirus 2019 pandemic, there has been a surge in production of remote learning materials for continued otolaryngology resident education. Medical students traditionally rely on elective and away subinternship experiences for exposure to the specialty. Delays and cancellation of clinical rotations have forced medical students to pursue opportunities outside of the traditional learning paradigm. In this commentary, we discuss the multi-institutional development of a robust syllabus for medical students using a multimodal collection of resources. Medical students collaborated with faculty and residents from 2 major academic centers to identify essential otolaryngology topics. High-quality, publicly available, and open-access content from multiple sources were incorporated into a curriculum that appeals to a variety of learners. Multimodal remote education strategies can be used as a foundation for further innovation aimed at developing tomorrow's otolaryngologists.

Multi-institutional Development and External Validation of a Nomogram Predicting Recurrence After Curative Liver Resection for Neuroendocrine Liver Metastasis.

To establish and externally validate a novel nomogram to predict recurrence of patients undergoing curative liver resection for neuroendocrine liver metastasis (NELM). A total of 279 patients who underwent curative liver resection for NELM identified from an international multicenter database were utilized to develop a nomogram to predict recurrence; 98 cases from two different institutions were used to externally validate the nomogram. Among 279 patients in the development cohort, median age was 57years, and 50.5% were male. On multivariate analysis, primary tumor location (pancreatic vs nonpancreatic, HR 2.1, p = 0.004), tumor grade (Ref. well, moderate HR 1.9, p = 0.022; poor HR 1.6, p = 0.238), lymph node metastasis (positive vs negative, HR 2.6, p = 0.002), and extent of resection (major vs parenchymal-sparing resection, HR 0.3, p = 0.001) were independently associated with recurrence-free survival. The beta coefficients from the final multivariable model were utilized to develop a nomogram. The nomogram demonstrated good ability to predict risk of recurrence (training cohort, C-index 0.754; validation cohort, C-index 0.748). The calibrated nomogram predicted recurrence-free survival that closely corresponded to actual recurrence. Decision curve analysis demonstrated that the nomogram had a good net benefit for most of the threshold probabilities, especially between 20 and 60%, in both development and validation cohorts. The externally validated novel nomogram predicted 3- and 5-year recurrence-free survival among patients with NELM. Prediction of individual recurrence risk may help guide personalized estimates of prognosis, as well as surveillance protocols and consideration of adjuvant therapies.

Multi-institutional Development and External Validation of a Nomogram to Predict Recurrence After Curative Resection of Pancreatic Neuroendocrine Tumors.

To develop a nomogram estimating the probability of recurrence free at 5 years after resection for localized grade 1 (G1)/ grade 2 (G2) pancreatic neuroendocrine tumors (PanNETs). Among patients undergoing resection of PanNETs, approximately 17% experience recurrence. It is not established which patients are at risk, with no consensus on optimal follow-up. A multi-institutional database of patients with G1/G2 PanNETs treated at 2 institutions was used to develop a nomogram estimating the rate of freedom from recurrence at 5 years after curative resection. A second cohort of patients from 3 additional institutions was used to validate the nomogram. Prognostic factors were assessed by univariate analysis using Cox regression model. The nomogram was internally validated using bootstrap resampling method and on the external cohort. Performance was assessed by concordance index (c-index) and a calibration curve. The nomogram was constructed using a cohort of 632 patients. Overall, 68% of PanNETs were G1, the median follow-up was 51 months, and we observed 74 recurrences. Variables included in the nomogram were the number of positive nodes, tumor diameter, Ki-67, and vascular/perineural invasion. The model bias-corrected c-index from the internal validation was 0.85, which was higher than European Neuroendocrine Tumors Society/ American Joint Committee on Cancer 8th staging scheme (c-index 0.76, P = <0.001). On the external cohort of 328 patients, the nomogram c-index was 0.84 (95% confidence interval 0.79-0.88). Our externally validated nomogram predicts the probability of recurrence-free survival at 5 years after PanNETs curative resection, with improved accuracy over current staging systems. Estimating individual recurrence risk will guide the development of personalized surveillance programs after surgery.

Multi-Institutional Development of a Mastoidectomy Performance Evaluation Instrument

A method for rating surgical performance of a mastoidectomy procedure that is shown to apply universally across teaching institutions has not yet been devised. This work describes the development of a rating instrument created from a multi-institutional consortium. Using a participatory design and a modified Delphi approach, a multi-institutional group of expert otologists constructed a 15-element task-based checklist for evaluating mastoidectomy performance. This instrument was further refined into a 14-element checklist focusing on the concept of safety after using it to rate a large and varied population of performances. Twelve otolaryngological surgical training programs in the United States. A total of 14 surgeons from 12 different institutions took part in the construction of the instrument. By using 14 experts from 12 different institutions and a literature review, individual metrics were identified, rated as to the level of importance and operationally defined to create a rating scale for mastoidectomy performance. Initial use of the rating scale showed modest rater agreement. The operational definitions of individual metrics were modified to emphasize "safe" as opposed to "proper" technique. A second rating instrument was developed based on this feedback. Using a consensus-building approach with multiple rounds of communication between experts is a feasible way to construct a rating instrument for mastoidectomy. Expert opinion alone using a Delphi method provides face and content validity evidence, however, this is not sufficient to develop a universally acceptable rating instrument. A continued process of development and experimentation to demonstrate evidence for reliability and validity making use of a large population of raters and performances is necessary to achieve universal acceptance.

Management of Postoperative Pediatric Patients

OPEN ACCESSOctober 27, 2015Management of Postoperative Pediatric Patients Karen Jerardi, MD, MEd, Katie Meier, MD, Erin Shaughnessy, MD Karen Jerardi, MD, MEd Cincinnati Children's Hospital Medical Center Google Scholar More articles by this author , Katie Meier, MD Cincinnati Children's Hospital Medical Center Google Scholar More articles by this author , Erin Shaughnessy, MD Cincinnati Children's Hospital Medical Center Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.10241 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail Abstract Introduction: According to a 2013 study of career intents, 12% of graduating pediatric residents pursue careers in pediatric hospital medicine, often without additional fellowship training. Increasingly, pediatric hospitalists are asked to help comanage postoperative patients. There is a lack of evidence-based curricula in the management of the postoperative pediatric patient. Recently, the American Academy of Pediatrics Section on Hospital Medicine Surgical Care Subcommittee has identified the need for such curricula as a priority. As a result, the education co-leads for the subcommittee have teamed together with the director of fellowship, resident elective, and advanced practice nurse practitioner education for the Division of Hospital Medicine at Cincinnati Children's to develop this curriculum. Content for this curriculum was chosen based on a needs assessment of recent pediatric residency graduates and practicing pediatric hospitalists, who selected high-yield topics. Methods: The resource was developed by pediatric hospital medicine faculty who focus on the care of the postoperative pediatric patient and includes 11 narrated PowerPoint presentations. Each module contains learning objectives and questions for review. The modules together provide a background of the most common issues that arise in the care of the pediatric postoperative population. The modules can be used as a stand-alone resource or to augment a clinical rotation. Results: The resource has been used for a variety of providers, including pediatric residents, pediatric hospital medicine fellows, faculty, and nurse practitioners. Evaluations from each learner have been collected, and appropriate changes have been made to enhance the curriculum. Outcomes were measured using time spent reviewing the modules, as measured by the learning platform used to store the modules, and self-assessments from the learners. Average time spent accessing the modules was 5.5 hours, with a range of 2-16.5 hours. Learners completed an anonymous evaluation rating the modules and their overall response to the curriculum. Overall, 100% stated that the presentations did “inform your care” of patients, 90% felt the presentations increased their comfort level for caring for surgical patients, and 100% would recommend the curriculum to a colleague. Discussion: There are currently no published curricula addressing topics commonly encountered during the care and co-management of postoperative pediatric patients. This resource was developed by pediatric hospital medicine faculty in response to this vacancy. Educational Objectives At the conclusion of the activity, the participant will: Recognize a typical postoperative course and anticipate complications for pediatric surgical patients.Report increased knowledge and comfort in caring for pediatric surgical patients. ReferencesBaker RC, Klein M, Samaan Z, Lewis K. Effectiveness of an online pediatric primary care curriculum, Acad Pediatr.2010;10(2):131–137. http://dx.doi.org/10.1016/j.acap.2009.12.004Medline, Google ScholarCox ED, Koscik RI, Olson CA, et al. Caring for the underserved: blending service learning and a web-based curriculum, Am J Prev Med.2006;31(4):342–349. http://dx.doi.org/10.1016/j.amepre.2006.06.024Medline, Google ScholarFall LH, Berman NB, Smith S, White CB, Woodhead JC, Olson AL. Multi-institutional development and utilization of a computer-assisted learning program for the pediatric clerkship: the CLIPP project, Acad Med.2005;80(9):847–855. http://dx.doi.org/10.1097/00001888-200509000-00012Medline, Google ScholarFrintner MP, Mulvey HJ, Pletcher BA, Olson LM. Pediatric resident debt and career intentions, Pediatrics.2013;131(2):312–318. http://dx.doi.org/10.1542/peds.2012-0411Medline, Google ScholarRappaport DI, Rosenberg RE, Shaughnessy EE, et al. Pediatric hospitalist comanagement of surgical patients: structural, quality, and financial considerations, J Hosp Med.2014;9(11):737–742. http://dx.doi.org/10.1002/jhm.2266Medline, Google ScholarRauch DA, Percelay JM, Quinonez R, Alverson B, Fisher ES. Pediatric hospital medicine worklife: findings from the American Academy of Pediatrics 2012-13 survey. Presented at: the Annual Meeting of the Society of Hospital Medicine; March 24-27, 2014; Las Vegas, NV.Google ScholarSimon TD, Eilert R, Dickinson LM, Kempe A, Benefield E, Berman D. Pediatric hospitalist comanagement of spinal fusion surgery patients, J Hosp Med.2007;2(1):23–30. http://dx.doi.org/10.1002/jhm.144Medline, Google Scholar Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Postoperative Pediatric Patients Instructor's Guide.docx Venous Thromboembolism.pptx Shunt Malfunction.pptx Posterior Spinal Fusion.pptx Postoperative Anemia.pptx Postoperative Ileus.pptx Postoperative Tachycardia.pptx Postoperative Fever.pptx Syndrome of Inappropriate Anti-Diuretic Hormone Secretion.pptx Postoperative Nutrition.pptx Postoperative Pain.pptx To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationJerardi K, Meier K, Shaughnessy E. Management of Postoperative Pediatric Patients. MedEdPORTAL. 2015;11:10241. https://doi.org/10.15766/mep_2374-8265.10241 Copyright & Permissions© 2015 Jerardi et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsPediatricsSurgical ComanagmentHospital Medicine Disclosures None to report. Funding/Support None to report. tabs.loading

Developing a community of inquiry instrument: Testing a measure of the Community of Inquiry framework using a multi-institutional sample

This article reports on the multi-institutional development and validation of an instrument that attempts to operationalize Garrison, Anderson and Archer's Community of Inquiry (CoI) framework (2000). The results of the study suggest that the instrument is a valid, reliable, and efficient measure of the dimensions of social presence and cognitive presence, thereby providing additional support for the validity of the CoI as a framework for constructing effective online learning environments. While factor analysis supported the idea of teaching presence as a construct, it also suggested that the construct consisted of two factors—one related to course design and organization and the other related to instructor behavior during the course. The article concludes with a discussion of potential implications of further refinement of the CoI measures for researchers, designers, administrators, and instructors.

Multi-institutional Development and Utilization of a Computer-Assisted Learning Program for the Pediatrics Clerkship: The CLIPP Project

Computer-assisted instruction (CAI) holds significant promise for meeting the current challenges of medical education by providing consistent and quality teaching materials regardless of training site. The Computer-assisted Learning in Pediatrics Project (CLIPP) was created over three years (2000-2003) to meet this potential through multi-institutional development of interactive Internet-based patient simulations that comprehensively teach the North American core pediatrics clerkship curriculum. Project development adhered to four objectives: (1) comprehensive coverage of the core curriculum; (2) uniform approach to CAI pedagogy; (3) multi-institutional development by educators; and (4) extensive evaluation by users. Pediatrics clerkship directors from 30 institutions worked in teams to develop a series of 31 patient case simulations. An iterative process of case content and pedagogy development, case authoring, peer review, and pilot-testing ensured that the needs of clerkship directors and medical students were met. Fifty medical schools in the United States and Canada are presently using CLIPP. More than 8,000 students have completed over 98,000 case sessions, with an average of 2,000 case sessions completed per week at this time. Each CLIPP case has been completed by more than 3,000 students. The current cost of CLIPP development is approximately $70 per student user, or $6 per case session. The project's success demonstrates that multi-institutional development and implementation of a peer-reviewed comprehensive CAI learning program by medical educators is feasible and provides a useful model for other organizations to develop similar programs. Although CAI development is both time-consuming and costly, the initial investment decreases significantly with broad use over time.