A Community Initiative to Help Children Who Are Homeless.

Children experiencing homelessness (CEH) have several health-related needs. It is necessary to address barriers posed by homelessness to improve health outcomes. Our objectives were to (1) conduct a health-related needs assessment and (2) determine acceptability/feasibility of the community-based initiative designed to identify and address health-related needs for CEH. The initiative involved a mobile care center, a health-focused education series for CEH, and resource provision, which included establishing connections with a stable source of health care. The needs assessment included standardized screening questions assessing health-related needs. We surveyed guardians of CEH who attended Summer360 between June and July 2022. Guardians were invited to evaluate our intervention via survey. We used descriptive statistics to characterize health-related needs. A needs assessment was completed on 36 of 100 children (42% white persons, 64% male), with 94% reporting at least 1 health-related need, and 61% with ≥3 needs. The most common needs identified were dental health and food insecurity. Twenty-four (24%) campers participated in a mobile health clinic that included hearing and vision screening, fluoride application, and vaccinations. The education series included dental hygiene, nutrition, and mental health. All families who desired assistance (73%) were connected to resources, and 91% of guardians agreed that the initiative helped meet their children's health-related needs and provided helpful resources. Implementation required planning with contributors including dental partners, mobile clinic operators, and school leadership. A community-based health initiative may serve as a unique opportunity to identify and address health-related needs for CEH.

The Success of Resident-Associated Lumbar Punctures at a Large, Single-Center Children's Hospital.

OBJECTIVES: The frequency of lumbar punctures (LPs) has declined across US children's hospitals over the past decade, potentially decreasing procedural learning opportunities for pediatric resident trainees. Our study sought to determine whether the proportion of successful LPs performed by our pediatric residents has significantly changed over time. METHODS: This study is a single-center retrospective study to evaluate our pediatric resident LP success. We evaluated our primary outcome, proportion of overall LP success over time, using linear regression. We similarly used linear regression for proportion of successful resident-associated LPs over time. We calculated the median number of LPs of all pediatric residents during the study period. RESULTS: We analyzed 3143 LPs from April 2012 to December 2019. Both the overall number of LPs performed and the proportion of LPs that were successful have not significantly changed over an 8-year period ( P > 0.05, P > 0.05). Similarly, the number of our resident-associated LPs and the proportion of successful resident-associated LPs have not changed over the study period ( P > 0.05, P > 0.05). Our pediatric residents performed a median of 3 LPs (interquartile range: 2-4) in the pediatric emergency department (PED) over residency. CONCLUSIONS: Despite national trends showing decreased LP rates at pediatric hospitals, we demonstrated stable proportions of LPs and success by our pediatric residents. Pediatric residents perform a relatively low number of LPs in the PED setting alone. Future research is needed to demonstrate whether these overall low numbers in the PED translate to procedural competency after residency graduation.

Identifying Health-Related Social and Unintentional Injury Risks Among Patients Presenting to a Pediatric Urgent Care.

OBJECTIVE: Many families seek medical care at pediatric urgent care centers. The objective of this study was to determine social and unintentional injury risks reported by these families. METHODS: This cross-sectional study surveyed a convenience sample of guardians of patients 1 to 5 years of age presenting to our pediatric urgent care, 9/10/21 to 2/25/22. Outcomes were the number of reported social and unintentional injury risks. Predictors and covariates included child and parent demographic characteristics and a neighborhood socioeconomic deprivation index. Chi-square, Student's t test, Pearson's correlation tests, and multinominal regression were used. RESULTS: A total of 273 guardians (and children) were included; 245 of guardians (89.7%) were female; 137 (50.2%) of included children identified as Black. Approximately 60% reported ≥1 social risk; 31.5% reported ≥3. Approximately 90% reported ≥1 unintentional injury risk; 57.9% reported ≥3. There were significant associations between social risk presence and Black race, public/no insurance, and neighborhood deprivation (all P < .05). There were no significant associations between unintentional injury risks and assessed predictors. Black guardians were more likely than those of other races to report a greater number of social risks (adjusted odds ratio [AOR] 2.90, 95% confidence interval [CI] 1.50, 5.58 for ≥3 vs 0 risk). Children with public/no insurance compared to private insurance were more likely to experience a greater number of social risks (AOR 3.34, 95% CI 1.42, 7.84 for ≥3 vs 0 risks). CONCLUSIONS: Many presenting to pediatric urgent cares experience social and unintentional injury risks. Risk identification may guide equitable responses.

Coaching the Fundamentals: Exploring the Applicability and Usefulness of a Novel Skills-Based Feedback Modality.

OBJECTIVE: Receiving and integrating feedback is a key to medical trainee development. To assist trainees seeking improvement through daily formative feedback and deliberate practice, the authors created a new skills-based framework called microskills, derived from the Accreditation Council for Graduate Medical Education (ACMGE) milestones and entrustable professional activities. The authors then explored pediatric resident perceptions around the applicability and usefulness of microskills. METHODS: The authors conducted 4 qualitative semistructured focus groups of 28 pediatric residents. Focus group prompts asked participants to reflect on microskills as a new feedback modality and microskills in relation to existing feedback and assessment approaches. Focus group transcripts were analyzed through inductive thematic analysis through an iterative process until theoretical saturation was reached. RESULTS: Participants felt microskills could facilitate skill-building and improvement, allow for consistent, targeted feedback, and establish a practice of coaching. Participants also perceived microskills' future success to be dependent on how the modality is adopted and utilized alongside existing assessment tools. CONCLUSIONS: Trainees found microskills to be a granular, context-based, coaching tool that could improve skill-building and the feedback process. Microskills' emphasis on feedback and their delineation of clinical skills that can be repeatedly practiced has the potential to provide a roadmap for trainee growth. Though microskills could fill a current need in the medical training landscape, they are not a substitute for existing assessment frameworks.

Efficacy of the saponin component of Impatiens capensis Meerb.in preventing urushiol-induced contact dermatitis.

ETHNOPHARMACOLOGICAL RELEVANCE: Many different tribes of American Indians used jewelweed, Impatiens capensis Meerb, as a plant mash to reduce development of poison ivy dermatitis. Saponins are a natural soapy constituent found within plants. A 2012 study suggested that saponins may be present in jewelweed which could be responsible for its efficacy in preventing rash development following contact with Toxicodendron radicans (L.) Kuntze (poison ivy). This study validated this hypothesis and demonstrated additional biological activity of the jewelweed saponin containing extract. MATERIALS AND METHODS: Fresh I. capensis leaves were extracted with methanol and further partitioned between ethyl acetate and water, with a final separation between water and n-butanol, to obtain a saponin containing extract. The presence of saponins in the extract was demonstrated by the observation of foaming and using a vanillin colorimetric assay for total saponins. Efficacy of the saponin containing extracts in rash reduction was tested by brushing poison ivy (PI) onto the forearms of volunteers (N=23) in six locations and treating these PI exposed areas with distilled water (control), saponin containing extracts, fresh plant mashes, and soaps made with and without plant extracts. Saponin containing extracts were further tested for biological activity against both gram negative and gram positive bacteria and against cancer cell lines A-375, HT-29, and MCF-7. Additionally, because saponins have been shown to have a stimulatory effect in cardiac muscle 2 µl saponin extract was applied superficially to black worms, Lumbriculus variegatus (N=5). RESULTS, AND CONCLUSIONS: Both saponin containing extracts and all soaps tested were effective in reducing poison ivy dermatitis; thus, saponin content correlates with PI rash prevention. No apparent antibiosis was observed against any bacteria tested; however, dose response cytotoxicity was documented against MCF-7 breast cancer cells and cytostatic activity was seen against the HT-29 colon cancer cell lines. Lumbriculus variegatus exhibited a 138% increase in heart rate over baseline rate five minutes post treatment implying a possible positive chronotropic effect.