Husseingillespie4034

To determine the timeframe in which coronary artery aneurysms (CAAs) caused by Kawasaki disease reach their maximum diameter, the timeframe in which they regress to normal size, and the cutoff point of the diameter for CAA regression.

We reviewed 195 CAAs of the right coronary artery, left anterior descending artery, and left coronary artery measured by 2-dimensional echocardiography ≥5 times for 1year after Kawasaki disease in 84 patients using medical records from 1995. The maximum diameters of CAAs were investigated retrospectively. The time to CAA regression using both absolute diameter and Z score were investigated. The cutoff points of the diameter of CAA regression in the 2 classifications were identified using receiver operator characteristic curve analysis. One year after Kawasaki disease, a CAA of <3.0mm in absolute diameter and a Z score of <2.5 were defined as CAA regression.

The time when CAAs reached their maximum diameter ranged from 11days to 87days, with a median of 35days (n=195). The time to CAA regression ranged from 41 to 386days, with a median of 136days in the absolute diameter classification (n=92); 78% of CAA regression regressed by 200days. The cutoff point for CAA regression at one year was 5.7mm for the absolute diameter (area under the curve, 0.887; P<.0001; n=190) and 9.5 for the Z score (area under the curve, 0.815; P<.0001; n=195).

CAAs with a smaller diameter regressed earlier, and most CAAs of <6mm regressed by 6months after Kawasaki disease.

CAAs with a smaller diameter regressed earlier, and most CAAs of less then 6 mm regressed by 6 months after Kawasaki disease.This study followed 173 newborn infants in the PREmedication Trial for Tracheal Intubation of the NEOnate multicenter, double-blind, randomized controlled trial of atropine-propofol vs atropine-atracurium-sufentanil for premedication before nonemergency intubation. At 2 years of corrected age, there was no significant difference between the groups in death or risk of neurodevelopmental delay assessed with the Ages and Stages Questionnaire. Trial registration Clinicaltrials.gov NCT01490580.

To develop a diagnostic error index (DEI) aimed at providing a practical method to identify and measure serious diagnostic errors.

A quality improvement (QI) study at a quaternary pediatric medical center. Five well-defined domains identified cases of potential diagnostic errors. Identified cases underwent an adjudication process by a multidisciplinary QI team to determine if a diagnostic error occurred. Confirmed diagnostic errors were then aggregated on the DEI. The primary outcome measure was the number of monthly diagnostic errors.

From January 2017 through June 2019, 105 cases of diagnostic error were identified. Morbidity and mortality conferences, institutional root cause analyses, and an abdominal pain trigger tool were the most frequent domainsfor detecting diagnostic errors. Appendicitis, fractures, and nonaccidental trauma were the 3 most common diagnoses that were missed or had delayed identification.

A QI initiative successfully created a pragmatic approach to identify and measure diagnostic errorsby utilizing a DEI. The DEI established a framework to help guide future initiatives to reduce diagnostic errors.

A QI initiative successfully created a pragmatic approach to identify and measure diagnostic errors by utilizing a DEI. Guggulsterone E&Z mw The DEI established a framework to help guide future initiatives to reduce diagnostic errors.

Evidence-based economic decision making is key in health care. Presently, however, studies reporting financial outcomes of ventilator-associated pneumonia (VAP) care bundles have not been systematically evaluated.

This scoping review investigated the characteristics and findings of studies of the economic impact of VAP bundle implementation. A systematic search of electronic databases (MEDLINE, CINAHL) for relevant English language studies was undertaken (January 2000-February 2020). Methodological quality was evaluated using a Joanna Briggs Institute quality appraisal checklist. Article screening and quality appraisals were performed by 2 reviewers. Reference lists of included studies were hand-searched for additional articles. Reporting followed PRISMA Extension for Scoping Reviews (PRISMA-ScR) standards.

From 181 citations, 10 articles met inclusion criteria. Eight studies evaluated cost impacts on acute care and there were 2 cost-modeling studies. Results consistently indicated that effective VAP bundle implementation decreased healthcare costs. However, studies were heterogeneous with respect to research methods and objectives and were judged to have a moderate-to-high risk of bias.

Effective implementation of VAP care bundles was associated with superior clinical and economic outcomes. However, despite finding a moderate volume of research, study heterogeneity inhibited strong conclusions being drawn regarding the degree of associated cost savings.

Additional research involving multisite/multijurisdiction studies using experimental designs are needed to progress the field and overcome gaps in the existing literature.

Additional research involving multisite/multijurisdiction studies using experimental designs are needed to progress the field and overcome gaps in the existing literature.Stress encompasses profound psychological and physiological changes that are observable on all levels, from cellular mechanisms, humoral changes, and brain activation to subjective experience and behavior. While the impact of stress on health has already been studied for decades, a more recent field of research has revealed effects of stress on human social cognition and behavior. Initial studies have attempted to elucidate the underlying biological mechanisms of these stress-induced effects by measuring physiological responses or by using pharmacological approaches. We provide an overview of the current state of research on the effects of acute stress induction or pharmacological manipulations of stress-related neuro circuitry on social cognition and behavior. Additionally, we discuss the methodological challenges that need to be addressed in order to gain further insight into this important research topic and facilitate replicability of results. Future directions may help to disentangle the complex interplay of psychological and biological stress variables and their effects on social cognition and behavior on health and in disorders with social deficits.