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Article ; Online: A Modified Delphi Study for Curricular Content of Simulation-Based Medical Education for Pediatric Residency Programs.

Huber, Lorel / Good, Ryan / Bone, Meredith F / Flood, Shannon M / Fredericks, Ryan / Overly, Frank / Tofil, Nancy M / Wing, Robyn / Walsh, Kathryn

Academic pediatrics

2024

Abstract: Objective: We sought to establish core knowledge topics and skills that are important to teach pediatric residents using simulation-based medical education (SBME).: Methods: We conducted a modified Delphi process with experts in pediatric SBME. ... ...

Abstract	Objective: We sought to establish core knowledge topics and skills that are important to teach pediatric residents using simulation-based medical education (SBME). Methods: We conducted a modified Delphi process with experts in pediatric SBME. Content items were adapted from the American Board of Pediatrics certifying exam content and curricular components from pediatric entrustable professional activities (EPAs). In round 1, participants rated 158 items using a four-point Likert scale of importance to teach through simulation in pediatric residency. A priori, we defined consensus for item inclusion as ≥ 70% rated the item as extremely important and exclusion as ≥ 70% rated the item not important. Criteria for stopping the process included reaching consensus to include and/or exclude all items, with a maximum of 3 rounds. Results: A total of 59 participants, representing 46 programs and 25 states participated in the study. Response rates for the three rounds were 92%, 86% and 90%, respectively. The final list includes 112 curricular content items deemed by our experts as important to teach through simulation in pediatric residency. Seventeen procedures were included. Nine of the seventeen EPAs had at least 1 content item that experts considered important to teach through simulation as compared to other modalities. Conclusions: Using consensus methodology, we identified the curricular items important to teach pediatric residents using SBME. Next steps are to design a simulation curriculum to encompass this content. What's new: It is unknown what content pediatric residents should learn through SBME. Consensus on which core material is important to teach through SBME to supplement existing curricula will allow residency training programs to utilize simulation most effectively.
Language	English
Publishing date	2024-04-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2483385-X
ISSN	1876-2867 ; 1876-2859
ISSN (online)	1876-2867
ISSN	1876-2859
DOI	10.1016/j.acap.2024.04.008
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Article ; Online: Emergency Department Prescribing Patterns for Pharyngitis in Children.

Flood, Shannon M / Desai, Neil M / Leonard, Jan E / Mistry, Rakesh D

Clinical pediatrics

2020 Volume 59, Issue 11, Page(s) 995–1003

Abstract: Pharyngitis is commonly diagnosed in the emergency department (ED) and accounts for substantial antibiotic burden in pediatrics. This study describes ED patterns of group A streptococcal (GAS) pharyngitis diagnosis and antibiotic prescribing patterns. ... ...

Abstract	Pharyngitis is commonly diagnosed in the emergency department (ED) and accounts for substantial antibiotic burden in pediatrics. This study describes ED patterns of group A streptococcal (GAS) pharyngitis diagnosis and antibiotic prescribing patterns. This was a secondary data analysis of the National Hospital Ambulatory Medical Care Survey. Diagnosis and antibiotic treatment for GAS and non-GAS (viral) pharyngitis were reported in all ages and specifically examined in children <3 years of age from 2010 to 2015. GAS pharyngitis was diagnosed in 29% of visits for children with pharyngitis; however, 60% of patients with any pharyngitis received antibiotics. Twenty percent of children <3 years were diagnosed with GAS pharyngitis, yet over half were given antibiotics. Broad-spectrum antibiotics were commonly prescribed. Antibiotic treatment of pharyngitis, including broad-spectrum antibiotics, remains high when compared with the known prevalence of GAS pharyngitis. Diagnosis and treatment of GAS pharyngitis in patients <3 years persists despite recommendations against testing.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Antimicrobial Stewardship/organization & administration ; Child ; Child, Preschool ; Emergency Service, Hospital ; Female ; Humans ; Male ; Pharyngitis/diagnosis ; Pharyngitis/diet therapy ; Practice Patterns, Physicians'/statistics & numerical data ; Streptococcal Infections/diagnosis ; Streptococcal Infections/drug therapy
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2020-06-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	207678-0
ISSN	1938-2707 ; 0009-9228
ISSN (online)	1938-2707
ISSN	0009-9228
DOI	10.1177/0009922820927042
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Article: Severe SARS-CoV-2 Infection in a Pediatric Patient Requiring Extracorporeal Membrane Oxygenation.

Flood, Shannon M / Osborne, Christina M / Martin, Blake / Derderian, S Christopher / Stenson, Erin / Grubenhoff, Joseph A

Case reports in pediatrics

2020 Volume 2020, Page(s) 8885022

Abstract: The overwhelming majority of pediatric cases of SARS-CoV-2 infection are mild or asymptomatic with only a handful of pediatric deaths reported. We present a case of severe COVID-19 infection in a pediatric patient with signs of hyperinflammation and ... ...

Abstract	The overwhelming majority of pediatric cases of SARS-CoV-2 infection are mild or asymptomatic with only a handful of pediatric deaths reported. We present a case of severe COVID-19 infection in a pediatric patient with signs of hyperinflammation and consumptive coagulopathy requiring intubation and extracorporeal membrane oxygenation (ECMO) and eventual death due to ECMO complications.
Keywords	covid19
Language	English
Publishing date	2020-10-09
Publishing country	United States
Document type	Case Reports
ZDB-ID	2659094-3
ISSN	2090-6811 ; 2090-6803
ISSN (online)	2090-6811
ISSN	2090-6803
DOI	10.1155/2020/8885022
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Article ; Online: Severe SARS-CoV-2 Infection in a Pediatric Patient Requiring Extracorporeal Membrane Oxygenation

Shannon M. Flood / Christina M. Osborne / Blake Martin / S. Christopher Derderian / Erin Stenson / Joseph A. Grubenhoff

Case Reports in Pediatrics, Vol

2020 Volume 2020

Abstract	The overwhelming majority of pediatric cases of SARS-CoV-2 infection are mild or asymptomatic with only a handful of pediatric deaths reported. We present a case of severe COVID-19 infection in a pediatric patient with signs of hyperinflammation and consumptive coagulopathy requiring intubation and extracorporeal membrane oxygenation (ECMO) and eventual death due to ECMO complications.
Keywords	Pediatrics ; RJ1-570 ; covid19
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Hindawi Limited
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Disparities in Telemedicine Access: A Cross-Sectional Study of a Newly Established Infrastructure during the COVID-19 Pandemic.

Hsiao, Vivian / Chandereng, Thevaa / Lankton, Robin L / Huebner, Jeffrey A / Baltus, Jeffrey J / Flood, Grace E / Dean, Shannon M / Tevaarwerk, Amye J / Schneider, David F

Applied clinical informatics

2021 Volume 12, Issue 3, Page(s) 445–458

Abstract: Background: The COVID-19 pandemic led to dramatic increases in telemedicine use to provide outpatient care without in-person contact risks. Telemedicine increases options for health care access, but a "digital divide" of disparate access may prevent ... ...

Abstract	Background: The COVID-19 pandemic led to dramatic increases in telemedicine use to provide outpatient care without in-person contact risks. Telemedicine increases options for health care access, but a "digital divide" of disparate access may prevent certain populations from realizing the benefits of telemedicine. Objectives: The study aimed to understand telemedicine utilization patterns after a widespread deployment to identify potential disparities exacerbated by expanded telemedicine usage. Methods: We performed a cross-sectional retrospective analysis of adults who scheduled outpatient visits between June 1, 2020 and August 31, 2020 at a single-integrated academic health system encompassing a broad range of subspecialties and a large geographic region in the Upper Midwest, during a period of time after the initial surge of COVID-19 when most standard clinical services had resumed. At the beginning of this study period, approximately 72% of provider visits were telemedicine visits. The primary study outcome was whether a patient had one or more video-based visits, compared with audio-only (telephone) visits or in-person visits only. The secondary outcome was whether a patient had any telemedicine visits (video-based or audio-only), compared with in-person visits only. Results: A total of 197,076 individuals were eligible (average age = 46 years, 56% females). Increasing age, rural status, Asian or Black/African American race, Hispanic ethnicity, and self-pay/uninsured status were significantly negatively associated with having a video visit. Digital literacy, measured by patient portal activation status, was significantly positively associated with having a video visit, as were Medicaid or Medicare as payer and American Indian/Alaskan Native race. Conclusion: Our findings reinforce previous evidence that older age, rural status, lower socioeconomic status, Asian race, Black/African American race, and Hispanic/Latino ethnicity are associated with lower rates of video-based telemedicine use. Health systems and policies should seek to mitigate such barriers to telemedicine when possible, with efforts such as digital literacy outreach and equitable distribution of telemedicine infrastructure.
MeSH term(s)	Adolescent ; Adult ; Aged ; COVID-19/epidemiology ; Cross-Sectional Studies ; Female ; Health Services Accessibility/statistics & numerical data ; Healthcare Disparities/statistics & numerical data ; Humans ; Male ; Middle Aged ; Pandemics/statistics & numerical data ; Retrospective Studies ; Telemedicine/statistics & numerical data ; Young Adult
Language	English
Publishing date	2021-06-09
Publishing country	Germany
Document type	Journal Article
ISSN	1869-0327
ISSN (online)	1869-0327
DOI	10.1055/s-0041-1730026
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Article ; Online: Factors associated with teletrauma utilization in rural areas: a review of the literature.

Wood, Timothy / Freeman, Shannon / Banner, Davina / Martin-Khan, Melinda / Hanlon, Neil / Flood, Frank

Rural and remote health

2021 Volume 21, Issue 1, Page(s) 6354

Abstract: Introduction: Trauma patients residing in rural areas face increased challenges to accessing timely and appropriate health services as a result of large geographic distances and limited resource availability. Virtual trauma supports, coined 'teletrauma', ...

Abstract	Introduction: Trauma patients residing in rural areas face increased challenges to accessing timely and appropriate health services as a result of large geographic distances and limited resource availability. Virtual trauma supports, coined 'teletrauma', are one solution offered to address gaps in rural trauma care. Teletrauma represents a new and innovative solution to addressing health system gaps and optimizing patient care within rural settings. Here, the authors synthesize the empirical evidence on teletrauma research. Methods: A review of literature, with no date limiters, was guided by Arksey and O'Malley's (2005) scoping review methodology. The aim of the review was to provide an overview of the current landscape of teletrauma research while identifying factors associated with utilization. Results: Following a systematic search of key health databases, 1484 articles were initially identified, of which 28 met the inclusion criteria and were included for final analysis. From the review of the literature, the benefits of teletrauma for rural and remote areas were well-recognized. Several factors were found to be significantly associated with teletrauma utilization, including younger patient age, penetrating injury, and higher injury or illness severity. Lack of access to resources and clinician characteristics were also identified as reasons that sites adopted teletrauma services. Conclusion: By identifying factors associated with teletrauma utilization, teletrauma programs may be used more judiciously and effectively in rural areas as a means of enhancing access to definitive trauma care in rural areas. Gaps in current knowledge were also identified, along with recommendations for future research.
MeSH term(s)	Humans ; Rural Population ; Telemedicine
Language	English
Publishing date	2021-03-15
Publishing country	Australia
Document type	Journal Article ; Review
ZDB-ID	2105620-1
ISSN	1445-6354 ; 1445-6354
ISSN (online)	1445-6354
ISSN	1445-6354
DOI	10.22605/RRH6354
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Article ; Online: Exploring user perspectives of factors associated with use of teletrauma in rural areas.

Wood, Timothy / Freeman, Shannon / Banner, Davina / Martin-Khan, Melinda / Hanlon, Neil / Flood, Frank

Australasian emergency care

2021 Volume 25, Issue 2, Page(s) 106–114

Abstract: Background: Despite the existence of universal health care for Canadians, health inequalities persist and those residing in rural regions experience disparities when accessing appropriate services. To enhance access, a teletrauma program was implemented ...

Abstract	Background: Despite the existence of universal health care for Canadians, health inequalities persist and those residing in rural regions experience disparities when accessing appropriate services. To enhance access, a teletrauma program was implemented in a rural northern region in western Canada, connecting rural clinicians to urban emergency physicians and trauma specialists during emergency cases. Objective: To explore reasons why teletrauma is used in rural contexts from the perspectives of service users and stakeholders. Methods: 14 semi-structured interviews were conducted with stakeholders, clinicians (physicians, specialists), management, and researchers. Interpretive description methodology guided the study and analysis, and findings were organized thematically. Results: Teletrauma was used to connect clinicians, manage complex cases when weather or distance delayed transfer, and to enable appropriate and timely treatment locally. Teletrauma was more likely to be activated when clinicians were uncomfortable with clinical management, when relationships were established, and when technology was familiar and easy to use. Conclusions: Teletrauma is more than just the technology that is deployed. The establishment of relationships between teletrauma users was vital to the success of teletrauma. To design effective, integrated, and sustainable services, rural clinicians must remain at the center of teletrauma models.
MeSH term(s)	Canada ; Humans ; Physicians ; Rural Population
Language	English
Publishing date	2021-05-08
Publishing country	Australia
Document type	Journal Article
ISSN	2588-994X
ISSN (online)	2588-994X
DOI	10.1016/j.auec.2021.04.001
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Community perspectives of end-of-life preparedness.

Banner, Davina / Freeman, Shannon / Kandola, Damanpreet K / Meikle, Madeline / Russell, Bridget K M / Sommerfeld, E Anne / Flood, Donna / Schiller, Catharine J

Death studies

2018 Volume 43, Issue 4, Page(s) 211–223

Abstract: While death is a universal human experience, the process of planning for death can be difficult and may be avoided altogether. To understand community perspectives of end-of-life preparedness, we undertook a multimethod study exploring the experiences of ...

Abstract	While death is a universal human experience, the process of planning for death can be difficult and may be avoided altogether. To understand community perspectives of end-of-life preparedness, we undertook a multimethod study exploring the experiences of 25 community members and 10 stakeholders engaged in end-of-life planning. In addition, card sorting activities and focused discussions with 97 older adults were undertaken to highlight perspectives and needs. Data were analyzed using descriptive statistics and qualitative description. Overall, the participants perceived many benefits to being end-of-life prepared, however, few community members had engaged in formal planning. Key barriers include concerns about the accessibility and accuracy of information, discomfort when engaging in end-of-life conversations, and perceptions about the cost associated with engaging in formal legal or financial preparations. Areas for further research include the need for studies that capture the cultural dimensions of end-of-life planning and explores the implementation and evaluation of community-based interventions to improve preparedness.
MeSH term(s)	Adult ; Advance Care Planning ; Aged ; Aged, 80 and over ; Attitude to Death ; Communication ; Family ; Female ; Focus Groups ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Middle Aged ; Qualitative Research ; Young Adult
Language	English
Publishing date	2018-05-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	632596-8
ISSN	1091-7683 ; 0748-1187
ISSN (online)	1091-7683
ISSN	0748-1187
DOI	10.1080/07481187.2018.1446060
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Article ; Online: A comparison of E. coli concentration estimates quantified by the EPA and a Michigan laboratory network using EPA Draft Method C.

Lane, Molly J / Rediske, Richard R / McNair, James N / Briggs, Shannon / Rhodes, Geoff / Dreelin, Erin / Sivy, Tami / Flood, Matthew / Scull, Brian / Szlag, David / Southwell, Benjamin / Isaacs, Natasha M / Pike, Schuyler

Journal of microbiological methods

2020 Volume 179, Page(s) 106086

Abstract: We evaluated data from 10 laboratories that analyzed water samples from 82 recreational water sites across the state of Michigan between 2016 and 2018. Water sample replicates were analyzed by experienced U.S. Environmental Protection Agency (EPA) ... ...

Abstract	We evaluated data from 10 laboratories that analyzed water samples from 82 recreational water sites across the state of Michigan between 2016 and 2018. Water sample replicates were analyzed by experienced U.S. Environmental Protection Agency (EPA) analysts and Michigan laboratories personnel, many of whom were newly trained, using EPA Draft Method C-a rapid quantitative polymerase chain reaction (qPCR) technique that provides same day Escherichia coli (E. coli) concentration results. Beach management decisions (i.e. remain open or issue an advisory or closure) based on E. coli concentration estimates obtained by Michigan labs and by the EPA were compared; the beach management decision agreed in 94% of the samples analyzed. We used the Wilcoxon one-sample signed rank test and nonparametric quantile regression to assess (1) the degree of agreement between E. coli concentrations quantified by Michigan labs versus the EPA and (2) Michigan lab E. coli measurement precision, relative to EPA results, in different years and water body types. The median quantile regression curve for Michigan labs versus EPA approximated the 1:1 line of perfect agreement more closely as years progressed. Similarly, Michigan lab E. coli estimates precision also demonstrated yearly improvements. No meaningful difference was observed in the degree of association between Michigan lab and EPA E. coli concentration estimates for inland lake and Great Lakes samples (median regression curve average slopes 0.93 and 0.95, respectively). Overall, our study shows that properly trained laboratory personnel can perform Draft Method C to a degree comparable with experienced EPA analysts. This allows health departments that oversee recreational water quality monitoring to be confident in qPCR results generated by the local laboratories responsible for analyzing the water samples.
MeSH term(s)	Bacterial Load/methods ; Bathing Beaches ; Escherichia coli/isolation & purification ; Fresh Water/microbiology ; Michigan ; Parks, Recreational ; Real-Time Polymerase Chain Reaction ; United States ; United States Environmental Protection Agency ; Water Microbiology
Language	English
Publishing date	2020-10-13
Publishing country	Netherlands
Document type	Comparative Study ; Journal Article
ZDB-ID	604916-3
ISSN	1872-8359 ; 0167-7012
ISSN (online)	1872-8359
ISSN	0167-7012
DOI	10.1016/j.mimet.2020.106086
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Article ; Online: Pharmacodynamics of Glyburide, Metformin, and Glyburide/Metformin Combination Therapy in the Treatment of Gestational Diabetes Mellitus.

Clinical pharmacology and therapeutics

2020 Volume 107, Issue 6, Page(s) 1362–1372

Abstract: In gestational diabetes mellitus (GDM), women are unable to compensate for the increased insulin resistance during pregnancy. Data are limited regarding the pharmacodynamic effects of metformin and glyburide during pregnancy. This study characterized ... ...

Abstract	In gestational diabetes mellitus (GDM), women are unable to compensate for the increased insulin resistance during pregnancy. Data are limited regarding the pharmacodynamic effects of metformin and glyburide during pregnancy. This study characterized insulin sensitivity (SI), β-cell responsivity, and disposition index (DI) in women with GDM utilizing a mixed-meal tolerance test (MMTT) before and during treatment with glyburide monotherapy (GLY, n = 38), metformin monotherapy (MET, n = 34), or GLY and MET combination therapy (COMBO; n = 36). GLY significantly decreased dynamic β-cell responsivity (31%). MET and COMBO significantly increased SI (121% and 83%, respectively). Whereas GLY, MET, and COMBO improved DI, metformin (MET and COMBO) demonstrated a larger increase in DI (P = 0.05) and a larger decrease in MMTT peak glucose concentrations (P = 0.03) than subjects taking only GLY. Maximizing SI with MET followed by increasing β-cell responsivity with GLY or supplementing with insulin might be a more optimal strategy for GDM management than monotherapy.
MeSH term(s)	Adolescent ; Adult ; Blood Glucose/drug effects ; Diabetes, Gestational/drug therapy ; Drug Therapy, Combination ; Female ; Glyburide/administration & dosage ; Glyburide/pharmacology ; Humans ; Hypoglycemic Agents/administration & dosage ; Hypoglycemic Agents/pharmacology ; Insulin Resistance ; Insulin-Secreting Cells/metabolism ; Longitudinal Studies ; Metformin/administration & dosage ; Metformin/pharmacology ; Pregnancy ; Prospective Studies ; Young Adult
Chemical Substances	Blood Glucose ; Hypoglycemic Agents ; Metformin (9100L32L2N) ; Glyburide (SX6K58TVWC)
Language	English
Publishing date	2020-01-25
Publishing country	United States
Document type	Clinical Trial, Phase I ; Clinical Trial, Phase II ; Comparative Study ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	123793-7
ISSN	1532-6535 ; 0009-9236
ISSN (online)	1532-6535
ISSN	0009-9236
DOI	10.1002/cpt.1749
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