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Learners developing competency-based skills, attitudes, and knowledge through the achievement of defined milestones is a core feature of competency-based medical education. In 2017, a special interest study group of the American Academy of Child and Adolescent Psychiatry convened a panel of specialists to describe pediatric consultation-liaison psychiatry (CLP) best educational practices during child and adolescent psychiatry fellowship.

Postoperative bleeding is a major complication in patients who have been placed on extracorporeal circulatory support for various cardiac procedures (1). The increase in hemorrhage is well documented and is associated with various factors, which include, high-dose systemic heparinization, thrombocytopenia, and impaired platelet function. Platelets activate when exposed to the large foreign surface of the extracorpeal circuit, with the largest area being the oxygenator. Despite adequate heparinization, platelet levels continue to decrease. This aggregation phenomenon has also been extensively studied, and it cannot be attributed to the use of aminocarproic acid, aprotinin, propofol, or amicar (2). Other factors found to be unrelated include, the brand or type of oxygenator, the use of heparin coatings (3), activated clotting time (ACT) levels while on bypass, the operative procedure, preoperative medications, or the types of anesthetic agents used (2). Therefore, it may be beneficial to add nitric oxide to the sweep gas to decrease platelet loss, platelet damage, postoperative bleeding, and lessening the need for post-operative blood transfusions.

For English‐language learners, comprehension can be hindered by a lack of understanding of homonyms, homophones, and homographs, but the right instructional strategies can alleviate this problem. Following a discussion of issues such as the importance of being aware of a student's literacy skills in his or her home language and the need to preteach key vocabulary words, the authors provide examples of a structured approach to teaching homonyms, homophones, and homographs. This seven‐step instructional process, which incorporates reading, illustrating, comparing and contrasting words, and categorizing vocabulary by using symbols to represent grammatical structures, can be used to teach all students, but it accommodates particularly the challenges encountered by English‐language learners. The seven steps are 1Reading and/or listening to a story2Defining and visualizing words3Identifying parts of speech4Categorizing words5Completing cloze activities6Producing a skit or creating a visual7Playing a word game with new words Reading and/or listening to a story Defining and visualizing words Identifying parts of speech Categorizing words Completing cloze activities Producing a skit or creating a visual Playing a word game with new words The authors offer explicit examples of instruction at each step and conclude with a discussion of how to assess students' proficiencies as they discern word meanings and begin to use words efficiently.

AbstractThe clinical usefulness of sputum cultures depends on the quality of specimens submitted to the laboratory. In a community hospital, during two separate surveillance periods, we evaluated ordering practices and circumstances under which sputum specimens were obtained and techniques to improve the quality of the specimens. Physicians themselves rarely participated in obtaining specimens of sputum, and members of the nursing staff directly instructed patients or supervised specimen collection in only one third of cases. The mean elapsed time from collection at the bedside to processing in the laboratory was two hours, with a range from several minutes to 13 hours. One fifth of all the specimens in this study were obtained from patients with no discernible evidence of lower respiratory tract infection. Microscopic screening revealed that one half of the specimens were of poor or uncertain quality. After the first survey, inservice education of nursing personnel in the proper techniques of sputum collection, along with regular use of the screening procedure in the clinical laboratory, failed to effect any long-term change in ordering patterns or collection practices. However, the screening procedure did improve the quality of the sputum cultured, through rejection of unsatisfactory specimens [Infect Control 1981; 2(4):307-11.]

AbstractThe authors modified the Centers for Disease Control's guideline for disease-specific isolation precautions to a hospital computerized information system. Entering a suspected diagnosis selected from the isolation option on computer terminals generated: 1) a printout listing the isolation instructions, infective material(s), and persons who should avoid exposure; 2) an order for the appropriate supplies; 3) a patient charge based on the supplies required; and 4) an option for stopping, changing, or listing the orders. In order to implement this system, both extensive in-service training for nurses and efforts to change ordering practices of physicians were necessary.Prevalence surveys before and after computerization were used to evaluate the new system. Combined surveys showed that isolation was ordered for only 21% of patients when indicated. Failure to isolate was identified as a significant problem. As a consequence, continuous surveillance and consultation of all infected patients were instituted, resulting in isolation orders for 81% when indicated. The computerized disease-specific system has resulted in better and more accurate use of isolation, probably due to in service education and surveillance efforts.

Surveillance of hospital-acquired infections and antibiotic use is required of US hospitals. The time and cost needed to actively perform this surveillance can be extensive. We developed a computerized infectious disease monitor that automatically generates four types of surveillance "alerts" for patients (1) with hospital-acquired infections, (2) not receiving antibiotics to which their pathogens are susceptible, (3) who could be receiving less expensive antibiotics, or (4) who are receiving prophylactic antibiotics too long. Surveillance personnel using computer screening for two months found more hospital-acquired infections when compared with our traditional surveillance methods, while requiring only 35% of the time. In addition, alerts from the computer identified 37 patients not receiving appropriate antibiotics, 31 patients who could have been receiving less expensive antibiotics, and 142 patients, during one month, receiving prolonged cephalosporin prophylaxis. Computer screening can help focus the activities and improve the efficiency of hospital surveillance personnel.(JAMA 1986;256:1007-1011)

AbstractDuring a 30-month period in our 570-bed private community hospital, employees reported 218 injuries from needles and other sharp objects. Five of these injuries were from needles used on patients known to be hepatitis B surface antigens (HBsAg) positive. Four were from blades or scalpels used on HBsAg positive patients. A nother needle injury resulted in serious Staphylococcus aureusinfection. Thirty-three percent of the injuries were from improperly disposed objects, generally in trash baskets in patient rooms. Housekeeping employees were the “innocent victims” of more than one-half of the injuries from such improperly disposed objects. A survey of reporting practices revealed housekeepers reported all their injuries. Underreporting was identified as a problem with laboratory personnel and nurses who tended to make their own judgment concerning the extent of the injury. An effective innovation resulting from our survey was the use of plastic irrigation bottles as an inexpensive and readily available container for disposal of sharps.

A simple, rapid capillary tube test to discriminate between penicillin-resistant and -sensitive Staphylococcus aureusis presented. This test detects penicillinase in noninduced primary isolates from blood-agar plates.