34 results on '"Ludwig S"'
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2. Domain of competence: Professionalism.
- Author
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Ludwig S
- Subjects
- Competency-Based Education standards, Education, Medical, Graduate standards, Humanism, Humans, Pediatrics education, Cultural Competency, Pediatrics standards, Professional Competence standards
- Published
- 2014
- Full Text
- View/download PDF
3. The pediatrics milestones: initial evidence for their use as learning road maps for residents.
- Author
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Schumacher DJ, Lewis KO, Burke AE, Smith ML, Schumacher JB, Pitman MA, Ludwig S, Hicks PJ, Guralnick S, Englander R, Benson B, and Carraccio C
- Subjects
- Humans, Learning, Qualitative Research, Competency-Based Education methods, Education, Medical, Graduate methods, Internship and Residency methods, Pediatrics education
- Abstract
Objective: As the next step in competency-based medical education, the Pediatrics Milestone Project seeks to provide a learner-centered approach to training and assessment. To help accomplish this goal, this study sought to determine how pediatric residents understand, interpret, and respond to the Pediatrics Milestones., Methods: Cognitive interviews with 48 pediatric residents from all training levels at 2 training programs were conducted. Each participant reviewed one Pediatrics Milestone document (PMD). Eight total Pediatrics Milestones, chosen for their range of complexity, length, competency domain, and primary author, were included in this study. Six residents, 2 from each year of residency training, reviewed each PMD. Interviews were transcribed and coded using inductive methods, and codes were grouped into themes that emerged., Results: Four major themes emerged through coding and analysis: 1) the participants' degree of understanding of the PMDs is sufficient, often deep; 2) the etiology of participants' understanding is rooted in their experiences; 3) there are qualities of the PMD that may contribute to or detract from understanding; and 4) participants apply their understanding by noting the PMD describes a developmental progression that can provide a road map for learning. Additionally, we learned that residents are generally comfortable being placed in the middle of a series of developmental milestones. Two minor themes focusing on interest and practicality were also identified., Conclusions: This study provides initial evidence for the Pediatrics Milestones as learner-centered documents that can be used for orientation, education, formative feedback, and, ultimately, assessment., (Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
4. The pediatrics milestones: a continuous quality improvement project is launched-now the hard work begins!
- Author
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Englander R, Burke AE, Guralnick S, Benson B, Hicks PJ, Ludwig S, Schumacher D, Johnson L, and Carraccio C
- Subjects
- Humans, Pediatrics standards, Clinical Competence standards, Education, Medical, Graduate standards, Pediatrics education, Quality Improvement
- Published
- 2012
- Full Text
- View/download PDF
5. Health care delivery: searching for integration.
- Author
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Ludwig S
- Subjects
- Career Choice, Hospitalists, Humans, Office Visits statistics & numerical data, Patient-Centered Care organization & administration, Pediatrics trends, Societies, Medical, Specialization trends, Delivery of Health Care organization & administration, Pediatrics organization & administration
- Published
- 2011
- Full Text
- View/download PDF
6. Birth of a new publication in pediatric emergency medicine.
- Author
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Goldman R, Babl F, Barata I, Davies F, Gravel J, Ludwig S, Mace S, Ruddy R, Shavit I, Shimizu N, and Woodward T
- Subjects
- Emergency Medicine, Pediatrics, Periodicals as Topic, Publishing
- Published
- 2010
- Full Text
- View/download PDF
7. Strategies to design an effective mentoring program.
- Author
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Gusic ME, Zenni EA, Ludwig S, and First LR
- Subjects
- Humans, Program Development, United States, Faculty, Medical, Mentors, Pediatrics education, Staff Development
- Published
- 2010
- Full Text
- View/download PDF
8. Anatomy of mentoring.
- Author
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Ludwig S and Stein RE
- Subjects
- Focus Groups, Humans, Interprofessional Relations, Education, Medical, Graduate methods, Mentors, Pediatrics education, Pediatrics organization & administration
- Published
- 2008
- Full Text
- View/download PDF
9. Pediatric residents' and continuity clinic preceptors' perceptions of the effects of restricted work hours on their learning relationship.
- Author
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Balmer D, Ruzek S, Ludwig S, and Giardino A
- Subjects
- Humans, Interprofessional Relations, Longitudinal Studies, Time Factors, Attitude of Health Personnel, Internship and Residency organization & administration, Pediatrics education, Preceptorship organization & administration, Students, Medical psychology, Workload
- Abstract
Objective: The effects of the Work Hour Standard (WHS) on continuity of care and quality of education has stimulated much discussion, yet little is known about how it affects the resident-continuity clinic preceptor (CCP) dyad, the only longitudinal learning relationship in pediatric residency. This case study explored residents' and CCPs' perceptions of the effects of restricted work hours on their learning relationship., Methods: Direct observation of third-year pediatric residents (n = 10) and their CCPs (n = 10) was carried out in continuity clinic (CC) for 5 months; both groups attended clinic before and after the WHS. Semistructured, audiotaped interviews were conducted with residents before and after observation, and with CCPs after resident data were collected. Data from interview transcripts and observational notes were analyzed for major themes., Results: To comply with the WHS, postcall clinic was eliminated and residents were rescheduled to another afternoon CC. The consequence of eliminating postcall clinic, disruption in the resident-CCP relationship, was perceived differently by residents and CCPs. From the residents' perspective, rescheduling CC in response to the WHS benefited their learning because it exposed them to different CCPs with different practice styles. From the CCPs' perspective, rescheduling CC frustrated their efforts to be learner-centered teachers and effective mentors., Conclusions: Intended changes to limit excessive work hours had unintended effects that were viewed more favorably by residents than by CCPs. Understanding the shared and different perspectives of residents and preceptors regarding WHS-related changes in CC extends the discussion of the effect of restricted work hours.
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- 2007
- Full Text
- View/download PDF
10. Academic general pediatric fellowships: curriculum design and educational goals and objectives.
- Author
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Baldwin CD, Dreyer BP, Szilagyi PG, Bell LM, Baker RC, Cheng TL, Coury DL, DeWitt TG, Darden PM, Duggan A, and Ludwig S
- Subjects
- Humans, United States, Education, Medical, Graduate organization & administration, Faculty, Medical, Fellowships and Scholarships organization & administration, Pediatrics education
- Abstract
Academic generalists are unique and important members of the pediatric landscape.(1) Academic general pediatrics (AGP) is not considered a subspecialty, because it adheres to generalist values and embraces a wide range of clinical activities. Nonetheless, academic generalists engage in important scholarly efforts, contribute extensively to the education of new pediatricians, and must be prepared to survive in academia. Academic general pediatric faculty positions are subject to the same appointment and promotion requirements as those of subspecialist faculty.
- Published
- 2007
- Full Text
- View/download PDF
11. Strengthening the academic base of general pediatrics fellowship programs: a national program and curriculum development project.
- Author
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Baldwin CD, Szilagyi PG, Dreyer BP, Bell LM, Baker RC, Cheng TL, Coury DL, DeWitt TG, Darden PM, Duggan A, and Ludwig S
- Subjects
- Humans, Program Development, Program Evaluation, United States, Curriculum standards, Education, Medical, Graduate organization & administration, Fellowships and Scholarships organization & administration, Pediatrics education
- Abstract
Objective: To improve academic general pediatrics (AGP) fellowship programs by 1) developing curriculum guidelines and program standards and 2) creating a process for program review and consultation that might later be used for accreditation of AGP fellowship programs., Methods: This project of the Ambulatory Pediatric Association (APA) created 4 documents: AGP fellowship program requirements, core curriculum, educational goals and objectives, and a standardized form to describe required program characteristics. Site visits were conducted at 7 volunteer AGP fellowship programs, selected for diversity of content, structure, and location. Evaluations were conducted using a uniform checklist of requirements that combined numerical ratings with a written evaluation summary. Feedback from programs on the review process enabled refinement of the documents., Results: The site visits revealed great variety in emphasis among the 7 programs. In general, faculty were dedicated and capable, and programs showed considerable educational strengths. Typical problems were lack of integration of the program within departmental structures, overburdened faculty, and uncertain funding. Many programs demonstrated suboptimal curriculum planning and weak evaluation methods. Most program leaders felt that the project materials helped to improve the quality of their programs, and 5 of 7 programs expressed willingness to be involved in formal accreditation review in the future., Conclusions: AGP fellowship programs that volunteered for piloting of an accreditation process were diverse and vital, with rich educational offerings despite a lack of optimal curriculum structure, minimal evaluation, limited faculty resources, and tenuous funding. An APA accreditation process appears to be feasible and may enhance AGP fellowship programs.
- Published
- 2007
- Full Text
- View/download PDF
12. Learning about systems-based practice in the informal curriculum: a case study in an academic pediatric continuity clinic.
- Author
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Balmer D, Ruzek S, Ludwig S, and Giardino AP
- Subjects
- Continuity of Patient Care, Female, Humans, Male, Curriculum, Delivery of Health Care, Internship and Residency, Pediatrics education
- Abstract
Objective: Pediatric residents learn about systems-based practice (SBP) explicitly in the formal curriculum and implicitly in the informal curriculum as they engage in practice alongside physician faculty. Recent studies describe innovative ways to address SBP in the formal curriculum for SBP, but the informal curriculum has not been explored. We examined what, and how, third-year pediatric residents learn about SBP in the informal curriculum at one continuity clinic, and to consider how this learning aligns with the formal curriculum., Methods: A case study involving 10 third-year pediatric residents and 10 continuity preceptors was conducted at one continuity clinic, housed in a community-based, pediatric primary care center. Data were derived from 5 months (100 hours) of direct observation in the precepting room at the case clinic, semistructured interviews with residents (before and after observation) and with preceptors (after observation). Interview transcripts and notes from observation were inductively coded and analyzed for major themes., Results: Two themes emerged in the informal curriculum. Residents perceived "our system," the academic health system in which they trained and practiced as separate and distinct from the "real system," the larger, societal context of health care. Residents also understood SBP as a commitment to helping individual patients and families navigate the complexities of "our system," dealing with issues that concerned them., Conclusions: Residents learn important lessons about SBP in the informal curriculum in continuity clinic. These lessons may reinforce some elements of the competency-based formal curriculum for SBP, but challenge others.
- Published
- 2007
- Full Text
- View/download PDF
13. Learning behind the scenes: perceptions and observations of role modeling in pediatric residents' continuity experience.
- Author
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Balmer D, Serwint JR, Ruzek SB, Ludwig S, and Giardino AP
- Subjects
- Female, Humans, Male, Private Practice standards, Community Health Services, Internship and Residency, Learning, Pediatrics education, Physician's Role psychology, Social Perception
- Abstract
Objective: Little is known about what residents learn from "everyday" physician role models, who, in the course of their ordinary work, serve as real-life examples of residents' future roles. The purpose of this research was to analyze what and how pediatric residents learn through role modeling during their continuity experience., Design: We conducted a case study of 10 third-year pediatric residents and their 10 continuity clinic preceptors (CCP) in a community-based continuity clinic. Data were derived from 5 months (100 hours) of direct observation in clinic; semistructured interviews with residents before and after observation; and semistructured interviews with CCPs after resident data were collected. Interview transcripts and notes from observation were inductively coded and thematically analyzed., Results: From the residents' perspective, role modeling was an implicit and intentional learning strategy that was linked to routine clinical practice in continuity clinic. Residents learned, through modeling their CCPs, "how to talk" and "how to think things through." Residents did not directly report modeling professional behavior. For residents, learning through modeling was not contingent on CCPs' awareness of being a role model., Conclusions: Role modeling is a nuanced, deliberate learning strategy that provides pediatric residents with templates for interpersonal communication and clinical decision making that have both immediate and long-term relevance. Understanding residents' perspective on role modeling, and how it aligns with their CCPs' perspective, presents opportunities for improving residents' learning experiences, faculty development, and future research.
- Published
- 2007
- Full Text
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14. Pediatric hospitalists: report of a leadership conference.
- Author
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Lye PS, Rauch DA, Ottolini MC, Landrigan CP, Chiang VW, Srivastava R, Muret-Wagstaff S, and Ludwig S
- Subjects
- Humans, Research, Hospitalists economics, Hospitalists education, Hospitalists organization & administration, Pediatrics economics, Pediatrics education, Pediatrics organization & administration
- Abstract
Objectives: To summarize a meeting of academic pediatric hospitalists and to describe the current state of the field., Methods: The Ambulatory Pediatric Association sponsored a meeting for academic pediatric hospitalists in November 2003. The purpose of the meeting was to discuss and to define roles of academic pediatric hospitalists, including their roles as clinicians, educators, and researchers, and to discuss organizational issues and unique hospitalist issues within general academic pediatrics. Workshops were held in the areas of organization and administration, academic life, research, and education. A literature review was also conducted in the areas discussed., Results: More than 130 physicians attended. Thirteen workshops were held, and all information was summarized in large-group sessions for all attendees., Conclusions: Pediatric hospital medicine is a rapidly growing field, with an estimated 800 to 1000 pediatric hospitalists currently practicing. Initial work has defined the clinical environment and has begun to stake out a unique knowledge and skill set. The Pediatric Hospitalists in Academic Settings conference demonstrated the audience for additional development and the resources to move forward.
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- 2006
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15. Armstrong lecture 2005: if I were king of pediatrics.
- Author
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Ludwig S
- Subjects
- Academic Medical Centers, Biomedical Research, Fellowships and Scholarships, Humans, Interprofessional Relations, Poverty, United States, Pediatrics education, Pediatrics organization & administration
- Published
- 2005
- Full Text
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16. The impact of the interview in pediatric residency selection.
- Author
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Swanson WS, Harris MC, Master C, Gallagher PR, Mauro AE, and Ludwig S
- Subjects
- Adult, Child, Clinical Competence, Humans, Interviews as Topic standards, Job Application, Personnel Selection methods, Philadelphia, Professional Staff Committees, Specialty Boards, Workforce, Hospitals, Pediatric organization & administration, Internship and Residency standards, Interviews as Topic methods, Pediatrics education, Personnel Selection standards, School Admission Criteria
- Abstract
Objective: To better understand the impact of USMLE scores and interview scores on the National Resident Matching Program (NRMP) rank of applicants to the residency program at The Children's Hospital of Philadelphia., Methodology: We evaluated 935 applicants' files from 2000, 2001, and 2002. For each candidate, one interviewer had access to the full application, while the other interviewer was blinded to USMLE scores and grades. Interview scores were generated by both interviewers. Statistical analysis was performed to evaluate relationships between USMLE scores, interview scores, and NRMP rank list number., Results: There were a wide range of USMLE scores among candidates who interviewed (range 181 to 269, 227.7 +/- 17.1, M +/- standard deviation). USMLE scores were weakly correlated to nonblinded interview scores (r = -0.17), final committee scores (r = -0.26), and NRMP ranking (r = -0.21): P < .0005. Blinded interviews did not correlate with USMLE scores. Both nonblinded and blinded interviews had stronger correlations with NRMP rank list number (r = 0.49, P < .0005 and r = 0.36, P < .0005, respectively). The nonblinded interview accounted for 20.6% of variance in the NRMP rank list order., Conclusions: Interview scores were the most important variable for candidate ranking on the NRMP list. Furthermore, when interviewers had access to board scores, there was a modest correlation to performance on the USMLE. While interviews may reflect a candidate's personality, they may not effectively measure desired characteristics when access to academic markers is unrestricted. We suggest incorporating blinded interviews into the selection process to give candidates a better opportunity to display communication skills, emotional stability, and "fit" for the program.
- Published
- 2005
- Full Text
- View/download PDF
17. General vs subspecialty pediatrics: factors leading to residents' career decisions over a 12-year period.
- Author
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Harris MC, Marx J, Gallagher PR, and Ludwig S
- Subjects
- Adult, Female, Humans, Life Style, Male, Motivation, Research, Salaries and Fringe Benefits, Sex Distribution, Surveys and Questionnaires, Teaching, United States, Career Choice, Internship and Residency, Pediatrics
- Abstract
Objectives: To determine factors motivating residents' career choices and to examine changes in these priorities over the last 12 years. During the last decade, surveys of pediatric training programs have shown trends toward residents choosing careers in general pediatrics rather than in subspecialties. Most recently, there is evidence of a shift back toward subspecialty careers., Design: We surveyed past and present residents at The Children's Hospital of Philadelphia, Philadelphia, Pa, (training completion dates, 1991-2002) via an anonymous written questionnaire., Results: The sample comprised 238 residents (mean +/- SD age, 30 +/- 3 years; 59% female, 41% male; 47% subspecialists, 53% generalists). Among the group as a whole, subject matter, role models, lifestyle issues, and teaching were the most important determinants for career choices. Less important were national trends, job openings, and research. When subspecialists and generalists were compared, both groups found subject matter to be their highest priority. Among residents interested in subspecialties, teaching, research, and technical skills were significant (P<.001), compared with generalists, who considered lifestyle and personal/financial issues more important (P<.001). Lifestyle issues were also more important to female residents, those 30 years of age or younger, and those completing training recently (P<.05)., Conclusions: Career decisions for pediatric residents today are motivated by complex factors. For those choosing generalist careers, lifestyle and personal/financial considerations predominate, while teaching, research, and technical skills are key factors for subspecialists. Over the last decade, lifestyle issues have become a more dominant factor, particularly for women entering the pediatric workforce.
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- 2005
- Full Text
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18. Academic general pediatrics: from endangered species to advanced scholars of general pediatrics: the report of a consensus conference.
- Author
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Ludwig S
- Subjects
- Forecasting, Humans, Pediatrics education, Research, Societies, Medical organization & administration, Teaching, Pediatrics trends, Professional Role
- Abstract
The discipline of academic general pediatrics (AGP) has been the foundation of the medical specialty of pediatrics since those caring for children became differentiated from practitioners of internal medicine. Virtually every academic medical center has been populated with generalist physicians who engage in patient care, teaching, research, administration, and advocacy. Often these individuals served as wise mentors who saw the need for further subspecialization in pediatrics and encouraged the development of academic careers that have resulted in advancing care for infants, children, and adolescents. Beginning with the certification of pediatric cardiology in 1961 to the certification of developmental-behavioral pediatrics in 2000, pediatrics has become increasingly subspecialized and focused. Yet however beneficial the forces of medical specialization have been,1 the value of those pediatricians who have maintained a generalist approach to their work has also been recognized. The role of the academic generalist has undergone change and challenge. A consensus conference was held to explore the evolution of AGP and to plan future directions of the discipline.
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- 2004
- Full Text
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19. Pediatric emergency medicine research: a critical evaluation.
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Spandorfer PR, Alessandrini EA, Shaw KN, and Ludwig S
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- Clinical Trials as Topic statistics & numerical data, Congresses as Topic statistics & numerical data, Health Surveys, Humans, Multicenter Studies as Topic statistics & numerical data, Prospective Studies, Research standards, Societies, Medical statistics & numerical data, Statistics as Topic methods, Statistics as Topic trends, United States, Bibliometrics, Emergency Medicine, Pediatrics, Research statistics & numerical data
- Abstract
Objective: A measure of research activity is an important way to gauge knowledge advances. We designed this study to analyze trends in pediatric emergency medicine (PEM) research, particularly focusing on the amount of research presented, topics investigated, location of research presentation, study design, and use of statistical analysis., Methods: Every abstract presented between January 1987 and December 1999 from 4 national scientific meetings [Ambulatory Pediatric Association (APA), American Academy of Pediatrics (AAP), American College of Emergency Physicians (ACEP), and Society for Academic Emergency Medicine (SAEM)] was evaluated. Those abstracts that met study criteria were evaluated for research topic, year of presentation, and sponsoring organization. Abstracts from the first and last 5 years of the study period were assessed for study design and use of statistical analysis. Trends over time were examined., Results: There were 1675 abstracts presented over the 13-year study period: 41% at APA, 27% at AAP, 7% at ACEP, and 25% at AEM. Medical topics were most frequently investigated (36%) followed by trauma (20%), administrative (17%), procedural (14%), life-threatening emergencies (12%), and surgical (3%). Two percent of abstracts was presented in the first year and the greatest proportion (14%) was presented in 1999 (P < 0.001). Eighty percent of the abstracts was assessed for study design and use of statistics. There was no change in the proportion of abstracts that were prospective [odds ratio (OR) = 0.98 (95% confidence interval (CI) = 0.76-1.26)] or analytic [OR = 1.06 (95% CI = 0.83-1.35)] between the early and the later years. Descriptive surveys increased in frequency from the early to the later years [OR = 1.92 (95% CI = 1.29-2.92)] as did multicentered clinical trials [OR = 7.71 (95% CI = 1.97-66.38)]. Case series decreased in frequency [OR = 0.71 (95% CI = 0.54-0.93)] as did bench research [OR = 0.21 (95% CI = 0.11-0.40)]. The use of statistics increased with time [OR = 1.99 (95% CI = 1.54-2.58)] as did the use of CIs [OR = 4.40 (95% CI = 2.76-7.29)]., Conclusions: There was a substantial increase in the amount of research conducted in PEM. The topics investigated correspond to national recommendations. There was not an increase in the amount of research that was prospective or analytic in nature; however, there was increased statistical sophistication with time.
- Published
- 2003
20. Pediatric phylogeny and lessons learned in the garden.
- Author
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Ludwig S
- Subjects
- Pediatrics classification
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- 2003
- Full Text
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21. Factors influencing termination of resuscitative efforts in children: a comparison of pediatric emergency medicine and adult emergency medicine physicians.
- Author
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Scribano PV, Baker MD, and Ludwig S
- Subjects
- Adolescent, Adult, Attitude of Health Personnel, Cardiopulmonary Resuscitation standards, Child, Child, Preschool, Cross-Sectional Studies, Death, Decision Making, Emergency Treatment, Humans, Infant, Medical Futility, Practice Guidelines as Topic, Time Factors, United States, Cardiopulmonary Resuscitation statistics & numerical data, Emergency Medicine, Pediatrics
- Abstract
Objectives: To examine factors that influence termination of resuscitative efforts (TORE) and compare pediatric emergency medicine (PEM) and general emergency medicine (GEM) physicians regarding TORE in children., Design: Cross-sectional survey., Participants: All physicians board-certified in PEM as of November 1993 and a random sample of board-certified GEM physicians listed in the 1993 American College of Emergency Physicians directory., Interventions: Self-administered questionnaires were mailed to participants who were asked about experience providing pediatric cardiopulmonary resuscitation (CPR) and demographic information. We posed a series of management questions eliciting factors that influence TORE decision-making in single context and case scenario format. Specific emphasis was placed on the influence of time and epinephrine dosing., Results: One hundred and sixty (70%) PEM and 127 (62%) GEM responded. These groups differed significantly in years of experience (PEM 8.2, GEM 11.8), urban practice setting (PEM 84%, GEM 32%) and number of pediatric cardiopulmonary resuscitations per year (PEM 10.6, GEM 4.8), P < 0.001 for all. There were no significant differences between groups regarding features pathognomonic of death. PEM were more likely to consider low blood pH and iatrogenic causes of arrest as factors influencing TORE; GEM were more likely to consider co-morbid conditions (P < 0.05 for all). Medians for time estimates of minimum minutes of pulselessness that influence TORE were: PEM 26 to 30 minutes, GEM 31 to 35 minutes for both prehospital and emergency department settings (P < 0.05 for each). Approximately 20% of all respondents did not place a strict limit on time of pulselessness when determining TORE. No difference was observed between groups regarding maximum doses of epinephrine used prior to TORE. However, fewer GEM (50%) than PEM (75%) utilize "high dose" epinephrine according to current Pediatric Advanced Life Support (PALS) guidelines (P < 0.05). PEM physicians were more than two times more likely to terminate resuscitative efforts if return of spontaneous circulation was not achieved by 25 minutes compared to GEM physicians for both prehospital time of pulselessness [odds ratio 2.1, 95% confidence interval (1.01, 4.5)] and emergency department time of pulselessness [odds ratio 2.2, confidence interval (1.1, 4.6)]., Conclusions: 1) Several laboratory and clinical factors significantly influence physician's decisions regarding TORE; 2) regardless of setting, time of pulselessness does appear to be an influential factor in determining when to terminate resuscitation in children for most physicians; 3) PEM physicians are more likely to terminate resuscitative efforts than are GEM physicians if return of spontaneous circulation is not achieved by 25 minutes; 4) a significant number of PEM and GEM physicians do not use high dose epinephrine in accordance with current PALS recommendations.
- Published
- 1997
- Full Text
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22. Recognition and management of the ill child.
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Lavelle JM, Costarino AT Jr, and Ludwig S
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- Cardiovascular Diseases diagnosis, Cardiovascular Diseases therapy, Central Nervous System Diseases diagnosis, Central Nervous System Diseases therapy, Child, Humans, Respiratory Tract Diseases diagnosis, Respiratory Tract Diseases therapy, Critical Illness, Pediatrics methods
- Abstract
Children account for 30% of visits to emergency departments, and approximately 5% of these children have serious illness requiring immediate intervention. Over the past decades, as medical knowledge and application have eradicated many illness and rendered others curable, trauma has emerged as the leading cause of morbidity and mortality after the first year of life. However, all children remain vulnerable to infection and its consequences in the first year and beyond the first year. Additionally, over this time span, there are more children with chronic complicated health problems who survive yet remain dependent on sophisticated medical care. Intuitively, prompt recognition of the very ill child and the execution of the immediate and necessary interventions may be life saving. The ability to accomplish this requires a knowledge of the common culprits resulting in serious illness, an understanding of how they manifest in the physical examination, and an array of technical skills utilizing appropriate specially sized equipment. Furthermore, an understanding of child development and the ability to interpret the physical examination of the children of different ages is essential. This article will attempt to simplify this seemingly overwhelming task by considering a common thread in all critical illness.
- Published
- 1995
23. Pediatric emergency medicine training.
- Author
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Schafermeyer RW and Ludwig S
- Subjects
- Child, Child, Preschool, Humans, Workforce, Emergency Medicine education, Pediatrics education
- Published
- 1995
- Full Text
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24. Contempo: pediatrics.
- Author
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Shapiro BS, Schwarz DF, and Ludwig S
- Subjects
- Pediatrics trends
- Published
- 1994
25. Pediatric education in emergency medicine residency programs--10 years later.
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Ros SP, Cetta F, and Ludwig S
- Subjects
- Child, Child, Preschool, Humans, Internship and Residency statistics & numerical data, Surveys and Questionnaires, United States, Workforce, Emergency Medicine education, Internship and Residency trends, Pediatrics education
- Abstract
The purpose of this study is to examine the changes in the pediatric emergency medicine education of emergency medicine (EM) residents over the last decade. Questionnaires were mailed to the training directors of all EM residency programs. Sixty-five programs (79%) responded. While children represent 29 +/- 2% of all patients seen in the institutions surveyed, only 17 programs (26%) provide more than six months of pediatric education, ie, no increase in the last decade. EM residents frequently rotate through pediatric emergency departments (72%), inpatient pediatric wards (51%), and pediatric intensive care units (88%). Most physicians in charge of pediatric emergency medicine education are emergency medicine trained (75% vs 29% in 1981), and only 12% are pediatric emergency medicine fellowship trained. Despite several improvements and the increased satisfaction of program directors, the pediatric component of EM residents' training continues to be disproportionate to the number of children in the emergency medicine patient population. Specialists in pediatric emergency medicine should strive to play a more significant role in the pediatric education of EM residents.
- Published
- 1993
- Full Text
- View/download PDF
26. Proposed fellowship training program in pediatric emergency medicine for emergency medicine graduates.
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King C, Nilsen GJ, Henretig FM, Selbst S, Ludwig S, and Wagner DK
- Subjects
- Algorithms, Curriculum, Philadelphia, Education, Medical, Continuing, Emergency Medicine education, Fellowships and Scholarships, Pediatrics education
- Abstract
Interest in pediatric emergency medicine has grown steadily during the past decade among pediatricians and emergency physicians. With the rapid proliferation of pediatric emergency medicine programs for pediatricians has come extensive and valuable experience with this type of fellowship education. As a result, the structure and scope of these programs have become increasingly well established. Because the number of pediatric emergency medicine fellowship programs for emergency physicians has yet to reach "critical mass," no similar de facto standards exist for these programs. The recent establishment of guidelines for pediatric emergency medicine subspecialty certification by the American Board of Emergency Medicine and the American Board of Pediatrics brings new importance to fostering such standards for the training for emergency physicians. To this end, we present a proposed pediatric emergency medicine fellowship program developed during a retreat that included physicians from an emergency medicine program and two pediatric hospitals. We also review some of the significant events that have occurred in the evolution of pediatric emergency care.
- Published
- 1993
- Full Text
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27. Interfacing with police in the pediatric emergency department.
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Selbst SM, King C, Ludwig S, Schwartz GR, and Barcliff C
- Subjects
- Adolescent, Child, Female, Humans, Male, Emergency Service, Hospital, Interprofessional Relations, Pediatrics, Police
- Abstract
In summary, ED staff and local police departments should make a concerted effort to work together. The ED director should develop management protocols in conjunction with local police chiefs to plan strategies in advance. It is helpful to provide "orientation sessions," so that each group of professionals knows what to expect of the other. It may also be helpful to arrange tours of the ED so that police know where to go when they are called to the ED. All of these efforts should foster better care of children in the ED and will reduce tensions between the dedicated groups who work with such children.
- Published
- 1992
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28. Pediatric emergency transport and the private practitioner.
- Author
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Baker MD and Ludwig S
- Subjects
- Child, Child, Preschool, Humans, Infant, Pennsylvania, Private Practice, Referral and Consultation, Surveys and Questionnaires, Emergencies, Family Practice, Pediatrics, Transportation of Patients
- Abstract
A mail survey of 182 pediatricians and 92 family practitioners in Pennsylvania was conducted to determine their methods of transport of seriously ill children from their offices to referral centers and their involvement with professional transport services. Although most physicians (93.1%) stated that they had professional services available to them (at their office location), more than half (53.8%) indicated that the patient's family automobile was their most commonly used method of transport of ill children to tertiary care centers. This was true regardless of the disease entity involved, including suspected epiglottitis. Practice setting had little influence on transport method. However, in general, younger children were judged to need ambulance transport more often than older children. Reasons cited for not using professional transport from the office included a perceived better efficiency of the family car (61.8%), the prohibitively high expense of professional transport (9.8%), and failure to consider professional transport (6.5%). Further study of this component of office preparedness is suggested.
- Published
- 1991
29. Pediatric cardiopulmonary resuscitation: a review and a proposal.
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Ludwig S and Fleisher G
- Subjects
- Adolescent, Child, Preschool, Emergency Service, Hospital, Female, Humans, Infant, Infant, Newborn, Male, Medical Records, Pediatrics, Resuscitation mortality
- Published
- 1985
- Full Text
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30. Fellowship training in pediatric emergency care: a sample curriculum.
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Jaffe DM, Ludwig S, Zieserl EJ, and Fleisher G
- Subjects
- United States, Curriculum, Emergency Medicine education, Fellowships and Scholarships, Pediatrics education
- Published
- 1986
- Full Text
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31. Interpretation of pediatric x-ray films by emergency department pediatricians.
- Author
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Fleisher G, Ludwig S, and McSorley M
- Subjects
- Adolescent, Adult, Child, Child, Preschool, Diagnostic Errors, Hospital Bed Capacity, 100 to 299, Humans, Infant, Infant, Newborn, Pennsylvania, Emergency Service, Hospital, Outcome and Process Assessment, Health Care, Pediatrics standards, Radiography, Radiology standards
- Abstract
This study compared the interpretation of pediatric roentgenograms by emergency department pediatricians and radiologists. Data were available from 532 of 600 children who had 564 radiographic studies during a six-week period: 217 examinations of the chest, 200 of the extremities, 74 of the skull, 35 of the abdomen, and 38 of miscellaneous structures. The emergency department pediatricians and the radiologists were in agreement in 91.1% of the cases. Among the 50 of 564 (8.9%) discordant studies, only seven (1.2%) required changes in therapy. The results attest to the accuracy of emergency department pediatricians in interpreting the usual types of films ordered in their department. However, this group specifically erred in the identification of subtle fractures and the detection of abnormalities incidental to the primary purpose for which the film was obtained. Future educational programs should address these areas of deficiency.
- Published
- 1983
- Full Text
- View/download PDF
32. Teaching technical skills in pediatrics.
- Author
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Selbst SM, Baker MD, Bell LM, Shaw KN, Briede C, Woodward GA, and Ludwig S
- Subjects
- Emergency Medicine education, Humans, Clinical Competence standards, Pediatrics education, Teaching methods
- Abstract
Technical skills are an important and difficult part of managing a very sick or injured child. However, technical procedures are more often learned from experience than practice. This article reviews a variety of technical skills and procedures commonly performed in a pediatric emergency department. Each technical procedure can be practiced using live or artificial model for simulation.
- Published
- 1989
- Full Text
- View/download PDF
33. Pediatric training in emergency medicine residency programs.
- Author
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Ludwig S, Fleisher G, Henretig F, and Ruddy R
- Subjects
- Surveys and Questionnaires, United States, Emergency Medicine education, Internship and Residency, Pediatrics education
- Abstract
Endorsed emergency medicine (EM) residency programs were surveyed as to the nature and extent of training they provided in pediatric emergency care (PEC). In the surveys returned (82%) there were several important findings. The amount of time in PEC training was generally two months per year of training. This accounted for 16% of training time. However, the volume of pediatric patients was 25% of the overall patient population. There was wide variation in the sites of PEC training. Didactic sessions often did not cover even core topics. The training program directors were equally divided in their satisfaction with this aspect of their programs. Changes were recommended by 80% of the directors. Changes most often suggested were increasing pediatric patient exposure and obtaining PEC specialists as trainers.
- Published
- 1982
- Full Text
- View/download PDF
34. Surveillance of Acute SARS-CoV-2 Infections in Elementary Schools and Daycare Facilities in Bavaria, Germany (09/2020–03/2021)
- Author
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Anna Kern, Pia H. Kuhlmann, Stefan Matl, Markus Ege, Nicole Maison, Jana Eckert, Ulrich von Both, Uta Behrends, Melanie Anger, Michael C. Frühwald, Michael Gerstlauer, Joachim Woelfle, Antje Neubert, Michael Melter, Johannes Liese, David Goettler, Andreas Sing, Bernhard Liebl, Johannes Hübner, Christoph Klein, the COVID Kids Bavaria Consortium, Hannah Kindermann, Tilmann Schober, Patricia Schmied, Alexander Neuner, Laura Dech, Nikolaus Rieber, Jonas Geisperger, Philip Oehler, Anna Mittermeier, Katrin Moritz, Christopher Schulze, Irmgard Toni, Ludwig Seebauer, Christoph Härtel, Andrea Streng, Patricia Niekler, Ute Eberle, Nikolaus Ackermann, Andreas Wieser, and Raquel Rubio Acero
- Subjects
SARS-CoV-2 ,surveillance ,children ,elementary school ,preschool ,PCR ,Pediatrics ,RJ1-570 - Abstract
IntroductionHere we report our results of a multi-center, open cohort study (“COVID-Kids-Bavaria”) investigating the distribution of acute SARS-CoV-2 infections among children and staff in 99 daycare facilities and 48 elementary schools in Bavaria, Germany.Materials and MethodsOverall, 2,568 children (1,337 school children, 1,231 preschool children) and 1,288 adults (466 teachers, 822 daycare staff) consented to participate in the study and were randomly tested in three consecutive phases (September/October 2020, November/December 2020, March 2021). In total, 7,062 throat swabs were analyzed for SARS-CoV-2 by commercial RT-PCR kits.ResultsIn phase I, only one daycare worker tested positive. In phase II, SARS-CoV-2 was detected in three daycare workers, two preschool children, and seven school children. In phase III, no sample tested positive. This corresponds to a positive test rate of 0.05% in phase I, 0.4% in phase II and 0% in phase III. Correlation of a positive PCR test result with the local-7-day incidence values showed a strong association of a 7-day-incidence of more than 100/100,000 as compared to
- Published
- 2022
- Full Text
- View/download PDF
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