Recent Publications by CFE Educators

OBJECTIVE

The primary objective of this study was to compare and contrast the characteristics and survival outcomes of cardiopulmonary resuscitation for "monitored" events in pediatric patients treated with chest compressions more than or equal to 1 minute in varied ICU settings.

DESIGN

Retrospective observational study.

SETTING

Three different specialized ICUs in a single, tertiary care, academic children's hospital.

PATIENTS

We collected demographic information, preexisting conditions, preevent characteristics, event characteristics, and outcome data. The primary outcome measure was survival to hospital discharge. Secondary outcome measures included return of spontaneous circulation, 24-hour survival, and survival with good neurologic outcome.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Four hundred eleven patients treated with chest compressions for more than or equal to 1 minute were included in the analysis: 170 patients were located in the cardiovascular ICU, 157 patients in the neonatal ICU, and 84 patients in the PICU. Arrest durations were longer in the cardiovascular ICU than other ICUs. Use of extracorporeal cardiopulmonary resuscitation was more prevalent in the cardiovascular ICU (cardiovascular ICU, 17%; neonatal ICU, 3%; PICU, 4%). Return of spontaneous circulation, 24-hour survival, survival to hospital discharge, and good neurologic outcome were highest among neonatal ICU patients (survival to discharge, 53%) followed by cardiovascular ICU patients (survival to discharge, 46%) and PICU patients (survival to discharge, 36%). In a multivariable model controlling for patient and event characteristics, using cardiovascular ICU as reference, adjusted odds of survival in PICU were 0.33 (95% CI, 0.14-0.76; p = 0.009) and odds of survival in neonatal ICU were 0.80 (95% CI, 0.31-2.11; p = 0.65).

CONCLUSIONS

Comparative analysis of pediatric patients undergoing cardiopulmonary resuscitation in three different ICU settings demonstrated a significant variation in baseline, preevent, and event characteristics. Although outcomes vary significantly among the three different ICUs, it was difficult to ascertain if this difference was due to variation in the disease process or variation in the location of the patient.

Evaluate the use of cone beam computed tomography among orthodontists in two areas of the Pacific Coast region via an electronic survey sent to the chairs of the orthodontic programs at the University of California, San Francisco, and A.T. Still University in Mesa, Ariz. The survey link was subsequently forwarded to each program's alumni. Overall, 85.7 percent of the orthodontists reported using CBCT scans. The scans were primarily used for impacted/supernumerary teeth and temporomandibular joint disorders analysis.

We describe the clinical course of a 14-month-old boy with suspected Buruli ulcer of the face treated nonsurgically with rifampin and ciprofloxacin. Our patient presented with comorbid AIDS, presumed tuberculosis (noncutaneous) and severe acute malnutrition. To our knowledge, this is the first report to describe the nonsurgical management of facial Buruli ulcer.

BACKGROUND

We examined the influence of race/ethnicity on appointment attendance, maternal psychiatric and medical diagnoses, and birth outcomes within a diverse, low income, high risk pregnant population to determine whether birth outcome disparities would be lessened in a sample with high biopsychosocial risk across all groups.

METHODS

Data were retrospectively obtained on all women scheduled for appointments in the San Francisco Genera Hospital (SFGH) High-Risk Obstetrics (HROB) clinic during a three-month period. General linear model and logistic regression procedures were used to examine the associations of race/ethnicity with maternal characteristics, clinic attendance, and birth outcomes.

RESULTS

Our sample included 202 maternal-infant pairs (Hispanic 57%, Black 16%, Asian 15%, White 12%). Racial/ethnic differences were seen in language (p .001), gravidity (p .001), parity (p = .005), appointment attendance (p .001), diabetes (p = .005), psychiatric diagnosis (p = .02), illicit drug use (p .001), smoking (p .001). These maternal characteristics, including rate of attendance at specialized prenatal appointments, did not predict birth outcomes with the exception of an association between diabetes and earlier gestational age (p = .03). In contrast, Black maternal race/ethnicity was associated with earlier gestational age at birth (p = .004) and lower birth weight (p .001) compared to Whites.

CONCLUSIONS

Within a diverse maternal population of high biopsychosocial risk, racial/ethnic disparities in birth outcomes persist. These disparities have implications for infant health trajectory throughout the lifecourse and for intervention implementation in high risk groups.

IMPORTANCE

Tonsillectomy is one of the most commonly performed otolaryngology procedures. The safety of this procedure in adults is based on small case series. To our knowledge, we report the first population-level analysis of the safety of adult tonsillectomies in the United States.

OBJECTIVE

To characterize the mortality, complication, and reoperation rate in adult tonsillectomy.

DESIGN, SETTING, AND PARTICIPANTS

Retrospective cohort study of 5968 adult patients who underwent tonsillectomy with records in the database of the American College of Surgeons National Surgical Quality Improvement Program (2005 to 2011).

INTERVENTION

Tonsillectomy.

MAIN OUTCOMES AND MEASURES

Outcomes of interest included mortality, complications, and reoperation in the 30-day postoperative period. Statistical analysis included χ² test, t test, and multivariate logistic regression.

RESULTS

The 30-day mortality rate was 0.03%, the complication rate was 1.2%, and the reoperation rate was 3.2%. Most patients had a primary diagnosis of chronic tonsillitis and/or adenoiditis (82.9%), and the most common complications were pneumonia (27% of all complications), urinary tract infection (27%), and superficial site infections (16%). Patients who underwent reoperation were more likely to be male (54.0% vs 32.4%; P  .001), white (84.8% vs 75.3%; P = .02), or inpatients (24.3% vs 14.3%; P  .001) and to have postoperative complications (5.3% vs 1.1%; P  .001) than those who did not return to the operating room. On multivariate analysis, male sex (odds ratio [OR], 2.30 [95% CI, 1.67-3.15]), inpatient status (OR, 1.52 [95% CI, 1.04-2.22]), and the presence of a postoperative complication (OR, 4.58 [95% CI, 2.11-9.93]) were independent risk factors for reoperation.

CONCLUSIONS AND RELEVANCE

In the United States, adult tonsillectomy is a safe procedure with low rates of mortality and morbidity. The most common posttonsillectomy complications were infectious in etiology, and complications were independently associated with the need for reoperation.

BACKGROUND

Faculty in graduate medical education programs may not have uniform approaches to differentiating the quality of residents, and reviews of evaluations suggest that faculty use different standards when assessing residents. Standards for assessing residents also do not consistently map to items on evaluation forms. One way to improve assessment is to reach consensus on the traits and behaviors that are (or should be) present in the best residents.

METHODS

A trained interviewer conducted semistructured interviews with faculty affiliated with 2 pediatrics residency programs until content saturation was achieved. Interviewees were asked to describe specific traits present in residents they identify as the best. Interviews were recorded and transcribed. We used an iterative, inductive approach to generate a coding scheme and identify common themes.

RESULTS

From 23 interviews, we identified 7 thematic categories of traits and behaviors: personality, energy, professionalism, team behaviors, self-improvement behaviors, patient-interaction behaviors, and medical knowledge and clinical skills (including a subcategory, knowledge integration). Most faculty interviewees focused on traits like passion, enthusiasm, maturity, and reliability. Examination score or intelligence was mentioned less frequently than traits and behaviors categorized under personality and professionalism.

CONCLUSIONS

Faculty identified many traits and behaviors in the residents they define as the best. The thematic categories had incomplete overlap with Accreditation Council for Graduate Medical Education (ACGME) and CanMEDS competencies. This research highlights the ongoing need to review our assessment strategies, and may have implications for the ACGME Milestone Project.