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1. Transitioning From a Daily to a Block Didactic Format in a Pediatric Residency Program

Author

Walter Dehority, Amy Staples, Emily Macdonald, Jennifer Maito, Rebecca Rotello, and Benjamin Hoffman

Subjects
Didactic Instruction, School Format, Medicine (General), R5-920, Education
Abstract

Abstract Introduction Prior to 2009, both faculty and housestaff at the University of New Mexico were dissatisfied with the structure of didactic instruction. Housestaff frequently missed daily noon-hour didactic sessions secondary to ongoing clinical duties. If residents were able to attend, both they and faculty presenters were frequently distracted by frequent pages. In response to this global dissatisfaction from housestaff and faculty about these daily noon didactic sessions, we sought to implement an alternative that would allow for truly protected resident time, regular attendance, and improved resident and faculty satisfaction. As a result, didactic instruction was transitioned to a block or “resident school” format, consisting of 4 hours of teaching held 1 day a week. A weekly block didactic format for residents has been utilized by some residency programs to combat many of the challenges that conspire to decrease the efficacy of didactic sessions. Methods This resource describes the rationale and conceptual background for the transition into a block format, and provides instruction and guidance for programs interested in such a change. Example yearly and monthly templates, with the latter grouped by topic, are provided. A detailed discussion of the problems and limitations of the block format are also provided with potential solutions to common problems. Results The introduction of a block didactic format in our Pediatric residency program was associated with significantly increased overall satisfaction when compared with a traditional daily didactic format by both housestaff and faculty. In addition, we witnessed a significant improvement in passage rates for the American Board of Pediatrics Certification examination among our graduates following implementation of the block didactic format, as well as improvements in in-training examination scores. We also demonstrated a 67% improvement in resident attendance with the transition to a block format by insuring that every resident who was eligible to attend did so each week. We demonstrated a significant improvement in resident satisfaction with the quality of faculty presentations after the format change, as well as a significant preference for the block format overall amongst both housestaff and faculty. Discussion We believe our project is the first to assess the impact on faculty and housestaff of a transition from daily didactic sessions to a block didactic format, and the first to describe the implementation of a block didactic format in a program with intensive inpatient and outpatient service obligations. Such a format helps address several barriers to housestaff didactic education such as ongoing patient care and pager call, tasks identified in the literature to be the most likely to interfere with educational activities. This format also helps improve reported compliance with duty hour requirements, presumably because residents are able to focus on efficient clinical care without having to interrupt their workday to attend didactic sessions for all but one day of the week. Further, block didactics increased the punctuality of residents engaged in off-site clinical activities requiring extended travel time.

Published
2012
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2. The Impact of Fluid Balance on Outcomes in Premature Neonates: a report from the AWAKEN study group

Author

Louis Boohaker, Mina Hanna, Pia Wintermark, David T. Selewski, Ronnie Guillet, Kimberly J. Reidy, Catherine Joseph, Russell Griffin, Amy T. Nathan, Ayse Akcan-Arikan, Cherry Mammen, Elizabeth M. Bonachea, Neonatal Kidney Collaborative, Arwa Nada, Amy Staples, John D. Mahan, Katja M. Gist, David J. Askenazi, and Stuart L. Goldstein

Subjects
Male, medicine.medical_specialty, Canada, Time Factors, medicine.medical_treatment, Birth weight, Water-Electrolyte Imbalance, Gestational Age, Risk Assessment, Article, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, 030225 pediatrics, medicine, Retrospective analysis, Birth Weight, Humans, Postnatal day, Fluid Shifts, Balance (ability), Retrospective Studies, Mechanical ventilation, Obstetrics, business.industry, Infant, Newborn, Gestational age, Retrospective cohort study, Acute Kidney Injury, Water-Electrolyte Balance, Prognosis, Respiration, Artificial, United States, Pediatrics, Perinatology and Child Health, Cohort, Female, business, 030217 neurology & neurosurgery, Infant, Premature
Abstract

BACKGROUND: We evaluated the epidemiology of fluid balance (FB) over the first postnatal week and its impact on outcomes in a multi-center cohort of premature neonates from the AWAKEN study. METHODS: Retrospective analysis of infants

Published
2019

3. Assessment of a renal angina index for prediction of severe acute kidney injury in critically ill children: a multicentre, multinational, prospective observational study

Author

Rajit K Basu, Ahmad Kaddourah, Stuart L Goldstein, Ayse Akcan-Arikan, Megan Arnold, Cody Cruz, Michele Goldsworthy, Nancy Jaimon, Stephen Alexander, Marino Festa, Deirdre Hahn, Lauren Brown, Ari Jeon, Akash Deep, David Askenazi, Sean Bagshaw, Catherine Morgan, Rashid Alobaidi, Rajit Basu, David Cooper, Stuart Goldstein, Theresa Mottes, Tara Terrell, Patricia Arnold, Christina Metcalf, Shalayna Woodley, Radovan Bogdanović, Natasa Stajić, Branko Kovacevic, Amira Peco-Antic, Aleksandra Paripovic, Patrick Brophy, Timothy Bunchman, Duane Williams, Michelle Hoot, Vimal Chadha, Keefe Davis, Vikas Dharnidharka, Leslie Walther, Vincent Faustino, Janet Taft, Joana Tala, Katja Gist, Danielle Soranno, Il Soo Ha, Hee Gyung Kang, Richard Hackbarth, Mary Avendt-Reeber, Chloe Butler, Doug DeGraaf, Dawn Eding, Nathalie Hautala, Akunne Ndika, Eka Laksmi Hidayati, Songming Huang, Sean Kennedy, Madeleine Didsbury, Hari Kushartono, Risky Prasetyo, Cherry Mammen, Matthew Paden, Cheryl Stone, Stefano Picca, Federica Connola, James Schneider, Todd Sweberg, Aaron Kessel, David Selewski, Susan Hieber, Brankica Spasojević-Dimitrijeva, Ivana Ivanisevic, Jovana Putnik, Snezana Ristic, Scott Sutherland, Amy Staples, Craig Wong, Senan Hadid, Catherine Joseph, Robert Woroniecki, Michael Zappitelli, Noha Elsaerafy, and Joshua Zaritsky

Subjects
medicine.medical_specialty, medicine.medical_treatment, 030232 urology & nephrology, Renal function, Article, law.invention, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, law, Internal medicine, Developmental and Educational Psychology, medicine, 030212 general & internal medicine, Dialysis, Kidney transplantation, Renal angina, Creatinine, business.industry, Acute kidney injury, medicine.disease, Intensive care unit, chemistry, Pediatrics, Perinatology and Child Health, business, Kidney disease
Abstract

Summary Background Acute kidney injury occurs in one in four children admitted to an intensive care unit (ICU) and its severity is independently associated with increased patient morbidity and mortality. Early prediction of acute kidney injury has the potential to improve outcomes. In smaller, single-centre trial populations, we have previously derived and validated the performance of a renal angina index, a context-driven risk stratification system, to predict severe acute kidney injury in children and adolescents. Here, we tested the predictive accuracy of this index for severe acute kidney injury in a large heterogeneous population. Methods We did a prospective, observational study (AWARE) that recruited patients in the ICUs of 32 hospitals in nine countries across Asia, Australia, Europe, and North America. All patients aged between 3 months and 25 years who were admitted to an ICU at least 48 h previously were eligible. Exclusion criteria were a history of stage 5 chronic kidney disease (ie, estimated glomerular filtration rate 2 or on maintenance dialysis) or kidney transplantation in the preceding 90 days. Patients' medical records were reviewed to collect data up to 3 months before (serum creatinine only), daily during the first 7 days, and on day 28 after ICU admission. For the assessment of the renal angina index, we included patients from the AWARE study who had full data from the day of ICU admission, day 3, and day 28, including serum creatinine concentrations and urine output measurements. The primary outcome was the presence of severe acute kidney injury (stage 2–3 acute kidney injury, according to Kidney Disease Improving Global Outcomes [KDIGO] guidelines) on the third day after ICU admission. We compared the performance of the renal angina index with changes in serum creatinine relative to baseline for prediction of the primary outcome. A score of eight points or more on the renal angina index defined fulfilment of renal angina; serum creatinine concentration relative to baseline was calculated using maximum serum creatinine concentration in the first 12 h of ICU admission). This trial is registered with ClinicalTrials.gov, number NCT01987921. Findings Between Jan 1 and Dec 31, 2014, we obtained data for 1590 patients. 286 patients (18%) had fulfilment of renal angina. At day 3, severe acute kidney injury occurred in 121 (42%) patients positive for renal angina and 247 (19%) patients negative for renal angina (relative risk [RR] 2·23, 95% CI 1·87–2.66, p vs 18 [2%], p vs 53 [4%], p=0·01). Fulfilment of renal angina showed better prediction for severe acute kidney injury than serum creatinine greater than baseline (RR 1.61, 95% CI 1·33–1·93; p vs serum creatinine greater than baseline 0·68, 0·49–4·94). Interpretation Earlier and better prediction of severe acute kidney injury has the potential to improve patient outcomes associated with acute kidney injury. Compared with isolated, context-free changes in serum creatinine, renal angina risk assessment improved accuracy for prediction of severe acute kidney injury in critically ill children and young people. Funding US National Institutes of Health.

Published
2018

4. Orthostatic proteinuria and the spectrum of diurnal variability of urinary protein excretion in healthy children

Author

Hengameh H. Raissy, John R. Brandt, Ellen Kaufman, Amy Staples, Franceska Marie Kelly, Craig S. Wong, and Aaron Jacobs

Subjects
Male, medicine.medical_specialty, Supine position, Adolescent, Posture, Urology, Renal function, Urinalysis, Article, Excretion, chemistry.chemical_compound, Orthostatic vital signs, Young Adult, Internal medicine, medicine, Humans, Child, Morning, Creatinine, Proteinuria, business.industry, Endocrinology, chemistry, Nephrology, Pediatrics, Perinatology and Child Health, Female, medicine.symptom, business, Body mass index
Abstract

The aim of this study was to characterize the 24-h and diurnal variability of urinary protein excretion and identify the prevalence of orthostatic proteinuria (OP) in healthy children. Upright, supine, and 24-h total urinary protein (UrTP) and creatinine clearance (CrCl) were measured in 91 healthy children ages 6–19 years. Urinary protein and creatinine excretions were calculated and examined by gender, age, Tanner stage, and body mass index (BMI). Orthostatic proteinuria (OP) was defined as a 24-h UrTP >100 mg/m2 with a normal supine UrTP (10 years and BMI >85%. In children with OP, a first morning UPcr shows a value in the normal range, whereas a random daytime UPcr is elevated. There exists a diurnal variability in urinary protein excretion that is exaggerated in participants with OP. UPcr reliably estimates 24-h UrTP. Using current pediatric criteria, OP is very common, particularly in boys. A normal first morning UPcr ratio indicates that a child with elevated random urinary protein has OP.

Published
2010

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