An 8-Month Old With Choking Episodes.

This case report presents a female infant whose chief complaint of choking episodes resulted in a diagnosis of Chiari malformation type I and subsequent neurosurgical decompression. Although feeding difficulties and irritability are common complaints in pediatric primary care, dysphagia requires a more significant workup to identify a cause. This case report highlights red flags in the history and diagnostic studies and provides details for managing an unusual presentation of Chiari malformation type I.

Randomized Controlled Simulation Trial to Compare Transfer Procedures for Emergency Cesarean.

OBJECTIVE: To test the hypothesis that capping intravenous and epidural lines would reduce time to transfer women in labor to the operating room and time to readiness for general anesthesia for emergency cesarean. The secondary purpose was to identify latent threats to patient safety. DESIGN: Mixed methods analysis of a randomized, controlled, in situ simulation trial. SETTING: Labor and delivery unit at high-risk referral center. PARTICIPANTS: Fifteen interprofessional teams that included labor and delivery nurses and anesthesiology residents. METHODS: Immediately before simulation, we randomized bedside nurses and anesthesiology residents to one of two groups: usual transfer or the cap and run procedure. Simulation scenarios started with fetal heart rate decelerations that necessitated position changes followed by emergency cesarean. An embedded simulated obstetrician announced the decision for cesarean; completion of an OR checklist confirmed team readiness to induce general anesthesia. Postsimulation debriefing was focused on teamwork and opportunities to improve safety, and we used qualitative analysis to synthesize results. RESULTS: We found no statistically significant difference in the overall time from decision for cesarean to readiness for general anesthesia between the two groups (usual transfer median = 445 seconds [interquartile range, 425-465] vs. cap and run 390 seconds [interquartile range, 383-443], p = .12). The time in the operating room was less in the cap and run group than in the usual transfer group (median = 300 seconds vs. 250 seconds, p = .038). Qualitative analysis of the debriefing data indicated advantages of the capping procedure, including better bed maneuverability and fewer tangled lines. CONCLUSION: We found no evidence of decreased overall time from decision for cesarean to readiness for general anesthesia based on whether the nurse capped the intravenous and epidural lines or pushed the intravenous pole alongside the bed. However, nurses perceived improved patient safety with the cap and run procedure.

An innovative technique to promote understanding of anatomy for nurse practitioner students.

ABSTRACT: Nurse practitioner (NP) students are required to have a clear understanding of the complexities of the human body. Students enter graduate studies with varying experiences and backgrounds in anatomy and physiology. Evidence suggests that human anatomy laboratories increase learning outcomes when compared with comparative anatomy modalities. The purpose of this evaluation was to determine if teaching with a computed tomography (CT)-based three-dimensional (3D) anatomy table and cadaveric specimens improves Doctor of Nursing Practice (DNP) and NP students' understanding of anatomy in health assessment. Students participated in a hands-on anatomy review using a 3D anatomy table and human cadavers to master the five included body systems. Presurveys and postsurveys were administered to determine how much time had lapsed since our students' most recent anatomy class and the type of dissection laboratory provided within that class; to assess knowledge confidence in pediatric Head, Eyes, Ears, Nose and Throat (HEENT) anatomy; and to assess students' confidence in pediatric anatomical knowledge for all five body systems. Data were analyzed using a Mann-Whitney U test with independent samples. All areas with the exception of HEENT showed clinically significant improvement, including overall scores. Many positive themes were identified using qualitative thematic analysis. Teaching with a CT-based, 3D anatomy table with cadaveric specimens improved DNP and NP students' confidence levels in pediatric anatomy knowledge for all five systems. This innovative combination of human cadavers and virtual technology has the potential to produce advanced anatomical understanding for prospective health care professionals and to validate their capacity to conduct complex health assessments and procedures.

Sitting and cardiometabolic risk factors in U.S. adolescents.

PURPOSE: To examine sitting time and cardiometabolic disease risk in US adolescents. METHODS: Data from the 2007-2008 National Health and Nutrition Examination Survey (NHANES) were utilized. Self-reported daily sitting was ascertained by total time in seated activities. Cardiometabolic disease risk was defined by using age- and sex-specific metabolic syndrome (MetS), continuous metabolic risk score, and individual risk factors. RESULTS: There were 394 adolescents (12-20 yrs) meeting the inclusion criteria. Mean age (± SE) was 16.1 ± 0.1 yrs and 51% were male. Mean daily sitting time (± SE) was 407 ± 11 min/day(6.8 hrs/day) and prevalence of MetS was 8.3%. Adolescents in the highest tertile for sitting time were more likely to be overweight/obese (42%) than adolescents in the other tertiles (22-28%). Multivariate regression analyses revealed that daily sitting time was not associated with MetS (odds ratio 0.94, 95%CI 0.80-1.11) or the continuous risk score (b=0.02, SE=0.03, p=0.44). However, daily sitting time was positively correlated with insulin resistance (HOMA-IR) (b=0.03, SE=0.04, p=0.04); this association was attenuated after accounting for adiposity (sum of skinfolds), diet, and physical activity (b=0.04, SE=0.03, p=0.21). CONCLUSION: In adolescents, daily sitting time was not associated with MetS but was positively associated with fasting insulin resistance, although this relationship appears to be secondary to the influence of adiposity.

Light activity following a meal and postprandial cardiometabolic risk in adolescents.

The purpose of this study was to determine if light physical activity (LPA) minimizes the impairment of cardiometabolic risk factors following a typical meal in adolescents. Eighteen adolescents (50% male, 14.8 ± 2.3 yrs) consumed a meal (32% fat, 14% protein, 53% carbohydrate), then completed a walking (1.5 mph for 45 min of each hour) or sitting treatment for 3 hr in randomized order on separate days. Following the meal, HDL cholesterol declined 4.8% but remained higher during walking at 3 hr (42.1 mg/dl ± 9.3) than sitting (8.4% decline; 40.5 mg/dL ± 9.9; treatment x time interaction, p < .03). The 3-hr insulin was lower after walking (24.8 µIU/ml ± 33.4) than sitting (37.8 µIU/ml ± 34.7; treatment x time interaction, p < .0001). Triglycerides increased by ~40% above baseline at 1 and 2 hr, with higher values for walking (treatment x time interaction, p < .02). However by 3 hr, triglycerides were not different from baseline. Area under the curve (AUC) analyses were not significantly different between treatments for any outcomes. Although minor, LPA appears to mitigate the undesirable postprandial changes in HDL cholesterol and insulin but not triglycerides, following a typical meal in adolescents.