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Epigastric Pain and Pleural Effusion in a 12-Year-Old

Beverstock, Andrew; Griesman, Dana; Coren, Charles; Leavens-Maurer, Jill; Noyola, Estela
PMID: 36475387
ISSN: 1938-2707
CID: 5383052

Utilization of Family as Faculty: A Patient Directed Simulation Education to Improve Patient and Family Communication during Patient-Family Centered Rounds (PFCR)

Asuncion, Arsenia M; Quintos-Alagheband, Maria Lyn; Leavens-Maurer, Jill; Akerman, Meredith; Janicke, Patricia; Cavanaugh, Sean
Introduction/UNASSIGNED:Patient-family-centered care (PFCC) is based on the understanding that the family is the child's source of strength and support. Effective communication between families and providers is an essential component of PFCC. Our interprofessional team designed an initiative to improve medical providers' communication in partnership with the Patient and Family Advisory Council (PFAC). Strategies included the creation of a competency rubric and simulation curriculum using the family as faculty. The SMART aim was to improve the percentage of respondents who answered "Always" to doctor communication domains from 72% to 75.6% in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) by December 2020. Methods/UNASSIGNED:Pediatric residents, medical students, faculty, nurses, and PFAC members formed a Quality Improvement (QI) team to address PFCR competency. The team created a PFCC checklist to address competency. PFAC volunteers served as standardized parents in an in situ simulation of PFCR scenarios involving interprofessional in-patient teams. Evaluators observed rounds for the pre and postintervention assessment using the checklist. The outcome measure was the percentage of respondents who answered "Always" in the HCAPHS domain for physician communication. The process measure was the PFCR pre and postintervention, using Fisher's exact test for analysis. Results/UNASSIGNED:Using a statistical process chart (SPC), HCAHPS data from 2018 to 2020 showed that we exceeded our aim of >5% increase in the physician communication performance. Pre-post intervention data showed improvement in PFCR competency. Conclusion/UNASSIGNED:Family as faculty simulation led to improved physician communication, translating to improved performance in the HCAHPS score and PFCR competency communication domains.
PMID: 35720860
ISSN: 2472-0054
CID: 5281782


Picache, D; Kogan, D; Noor, A; Leavens-Maurer, J; Krilov, L; Fiorito, T; Senken, B; Akerman, M
Purpose of Study We studied the risk of apnea in otherwise healthy infants < 6 mo based on severity of illness at presentation. We also compared clinical courses between mild and severe disease groups. Methods Used This is a retrospective chart review of infants evaluated in the emergency department (ED) over 3 consecutive RSV seasons: 2017-2018, 2018-2019, and 2019-2020. We included infants < 6 mo with RSV diagnosed using multiplex PCR assay. Infants with history of prematurity ( 37 weeks), past apnea, chronic lung disease, heart disease, airway anomalies, neuromuscular diseases, and genetic disorders were excluded. Clinical data were reviewed to separate patients into mild or severe cases. Infants with respiratory rate (RR) >= 60, retractions, oxygen saturation < 90%, poor oral intake, or dehydration were classified as severe. Summary of Results A total of 161 infants met study criteria: 52 mild and 109 severe. There was no risk of apnea in mild cases and low risk in severe cases. Significant differences included length of stay (LOS), oxygen requirement, ICU admission, and hospital readmission (table 1). About 59% of severe cases required oxygen support, the majority of which received high flow nasal cannula, while 29% of mild cases required support and most were placed on regular nasal cannula (table 2). Twenty-seven severe cases required ICU and LOS was 1 day longer than mild. Forty-two severe cases were readmitted after initial discharge compared to 2 mild cases. Conclusions There was a low incidence of apnea in full term infants < 6 mo with RSV regardless of severity of disease, suggesting that risk of apnea is not a reliable factor when considering hospital admission. Conversely, high RR, retractions, hypoxia on presentation, poor PO intake, and dehydration were specific to severe RSV disease. The differences in oxygen support, ICU admission, and readmission emphasize the importance of identifying mild versus severe RSV to anticipate clinical courses. Further studies are needed to standardize and validate characteristics of RSV that require hospitalization. (Table Presented)
ISSN: 1708-8267
CID: 5251492

Impact of Maternal SARS-CoV-2 Detection on Breastfeeding Due to Infant Separation at Birth

Popofsky, Stephanie; Noor, Asif; Leavens-Maurer, Jill; Quintos-Alagheband, Maria Lyn; Mock, Ann; Vinci, Alexandra; Magri, Eileen; Akerman, Meredith; Noyola, Estela; Rigaud, Mona; Pak, Billy; Lighter, Jennifer; Ratner, Adam J; Hanna, Nazeeh; Krilov, Leonard
OBJECTIVE:To assess the impact of separation of SARS-CoV-2 PCR-positive mother-newborn dyads on breastfeeding outcomes. STUDY DESIGN/METHODS:This is an observational longitudinal cohort study of SARS-CoV-2 PCR-positive mothers and their infants at three NYU Langone Health hospitals from March 25, 2020 through May 30, 2020. Mothers were surveyed by telephone regarding pre-delivery feeding plans, in-hospital feeding, and home feeding of their neonates. Any change prompted an additional question to determine whether this change was due to COVID-19. RESULTS:Of the 160 mother-newborn dyads, 103 mothers were reached by telephone, and 85 consented to participate. No significant difference was observed in pre-delivery feeding plan between the separated and unseparated dyads (P = .268). Higher rates of breastfeeding were observed in the unseparated dyads compared with the separated dyads in the hospital (p<0.001), and at home (p=0.012). Only two mothers in each group reported expressed breast milk as the hospital feeding source (5.6% of unseparated vs 4.1% of separated). COVID-19 was more commonly cited as the reason for change among the separated compared with the unseparated group (49.0% vs 16.7%, p<0.001). When dyads were further stratified by symptom status into four groups (asymptomatic separated, asymptomatic unseparated, symptomatic separated, and symptomatic unseparated), results remained unchanged. CONCLUSION/CONCLUSIONS:In the setting of COVID-19, separation of mother-newborn dyads impacts breastfeeding outcomes, with lower rates of breastfeeding both during hospitalization and at home following discharge compared with unseparated mothers and infants. No evidence of vertical transmission was observed; one case of postnatal transmission occurred from an unmasked symptomatic mother who held her infant at birth.
PMID: 32791077
ISSN: 1097-6833
CID: 4556622