Krogivey1183

ositive rate is a challenge. Ongoing work is needed to reduce the false positive diagnoses and avoid electrographic seizure detection delays. A comprehensive training program and regular refresher updates for clinical staff are key components of the program.OBJECTIVES Extracorporeal cardiopulmonary resuscitation in children with refractory cardiac arrest has been shown to improve survival, however, risk factors associated with mortality and neurologic impairments are not well defined. We analyzed our recent institutional experience with pediatric extracorporeal cardiopulmonary resuscitation to identify variables associated with survival and neurocognitive outcome. DESIGN Retrospective observational study. SETTING Pediatric cardiology and congenital heart surgery departments of a tertiary referral heart center. Z-VAD-FMK concentration PATIENTS Seventy-two consecutive children (median age, 0.3 yr [0.0-1.9 yr]) who underwent extracorporeal cardiopulmonary resuscitation at our institution during the study period from 2005 to 2016. INTERVENTIONS Not applicable. MEASUREMENTS AND MAIN RESULTS Median duration of resuscitation was 60 minutes (42-80 min) and median extracorporeal support duration was 5.4 days (2.2-7.9 d). Forty-three (59.7%) extracorporeal cardiopulmonary resuscitation events ocvaluable tool for the treatment of children with refractory cardiac arrest and a favorable neurologic outcome can be achieved in the majority of survivors even after prolonged resuscitation. Mortality after extracorporeal cardiopulmonary resuscitation in postcardiac surgery children is associated with procedural complexity.OBJECTIVES To describe the implementation process of a nutrition risk screening and assessment guideline for infants with congenital heart disease and to assess the impact of nurses' behavior and the effect on infants' outcomes. DESIGN A controlled before-and-after implementation study. The three dimensions of the integrated-Promoting Action on Research Implementation in Health Services framework were used to assess barriers and promoting factors. SETTING Cardiac center at Children's Hospital of Fudan University, Shanghai, China. PATIENTS Infants with congenital heart disease (n = 142) and nurses (n = 100). INTERVENTIONS Implementation of an evidenced-based nutrition risk screening and assessment guideline. MEASUREMENTS AND MAIN RESULTS Implementation processes were assessed on nurses' knowledge, attitude, behavior, and compliance of the guideline. Infants' clinical outcomes were evaluated before-and-after the implementation. Knowledge, attitude, and behavior of nurses about nutrition risk screening and assesplementation of the nutrition guideline. The nurses' knowledge, attitude, and behavior toward the nutrition guideline were positive resulting in a significantly higher nutrition assessments in infants with moderate or high nutritional risk.OBJECTIVES Improve medication-related variable ICU costs by increasing value related to a locally identified high-frequency/high-cost medication, IV acetaminophen. DESIGN Structured quality improvement initiative using the Institute for Healthcare Improvement's Model for Improvement. SETTING Twenty-three-bed tertiary PICU. PATIENTS All patients admitted to the PICU receiving IV acetaminophen during the study period of 2015-2018. INTERVENTIONS PICU staff survey, education to close nurse/provider knowledge gap, optimization of order sets and electronic health record order entry, improving oral/enteral medication transition, and optimization of pharmacy dispensing. MEASUREMENTS AND MAIN RESULTS The primary outcome of interest was IV acetaminophen doses per patient day reported as a 12-month rolling average. Baseline IV acetaminophen prescribing prior to the study period was initially 0.55 doses per patient day, and in 2014, there were 3,042 doses administered. IV acetaminophen is $43 per dose. The rolling 12-month average post intervention was 0.33 doses per patient day. Enteral and rectal doses increased from 0.42 to 0.58 doses per patient day. Opioid utilization varied throughout the study. A 40% reduction in IV acetaminophen equated to a $35,507 cost savings in a single year. CONCLUSIONS IV acetaminophen is prescribed with high frequency and impacts variable PICU costs. Value can be improved by optimizing IV acetaminophen prescribing.OBJECTIVES Critically ill children with cardiac disease are at significant risk for hospital-associated venous thromboembolism, which is associated with increased morbidity, hospital length of stay, and cost. Currently, there are no widely accepted guidelines for prevention of hospital-associated venous thromboembolism in pediatrics. We aimed to develop a predictive algorithm for identifying critically ill children with cardiac disease who are at increased risk for hospital-associated venous thromboembolism as a first step to reducing hospital-associated venous thromboembolism in this population. DESIGN This is a prospective observational single-center study. SETTING Tertiary care referral children's hospital cardiac ICU. PATIENTS Children less than or equal to18 years old admitted to the cardiac ICU who developed a hospital-associated venous thromboembolism from December 2013 to June 2017 were included. Odds ratios and 95% CIs are reported for multivariable predictors. MEASUREMENTS AND MAIN RESULTS A total od venous thromboembolism in the pediatric cardiac ICU.OBJECTIVES Neurologic complications occur in up to 40% of adult abdominal solid organ transplant recipients and are associated with increased mortality. Comparable pediatric data are sparse. This study describes the occurrence of neurologic and behavioral complications (neurobehavioral complications) in pediatric abdominal solid organ transplant recipients. We examine the association of these complications with length of stay, mortality, and tacrolimus levels. DESIGN The electronic health record was interrogated for inpatient readmissions of pediatric abdominal solid organ transplant recipients from 2009 to 2017. A computable composite definition of neurobehavioral complication, defined using structured electronic data for neurologic and/or behavioral phenotypes, was created. SETTING Quaternary children's hospital with an active transplant program. PATIENTS Pediatric abdominal solid organ transplant recipients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Computable phenotypes demonstrated a specificity 98.