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Background and Objectives: Patient and family violent outbursts toward staff, caregivers, or through self-harm, have increased during the ongoing behavioral health crisis. These health care-associated violence (HAV) episodes are likely under-reported. We sought to assess the feasibility of using nursing notes to identify under-reported HAV episodes., Methods: We extracted nursing notes across inpatient units at 2 hospitals for 2019: a pediatric tertiary care center and a community-based hospital. We used a workflow for narrative data processing using a natural language processing (NLP) assisted manual review process performed by domain experts (a nurse and a physician). We trained the NLP models on the tertiary care center data and validated it on the community hospital data. Finally, we applied these surveillance methods to real-time data for 2022 to assess reporting completeness of new cases., Results: We used 70 981 notes from the tertiary care center for model building and internal validation and 19 332 notes from the community hospital for external validation. The final community hospital model sensitivity was 96.8% (95% CI 90.6% to 100%) and a specificity of 47.1% (39.6% to 54.6%) compared with manual review. We identified 31 HAV episodes in July to December 2022, of which 26 were reportable in accordance with the hospital internal criteria. Only 7 of 26 cases were reported by employees using the self-reporting system, all of which were identified by our surveillance process., Conclusions: NLP-assisted review is a feasible method for surveillance of under-reported HAV episodes, with implementation and usability that can be achieved even at a low information technology-resourced hospital setting., (Copyright © 2024 by the American Academy of Pediatrics.)

Objective: This study assessed the feasibility of nursing handoff notes to identify underreported hospital-acquired pressure injury (HAPI) events., Methods: We have established a natural language processing-assisted manual review process and workflow for data extraction from a corpus of nursing notes across all medical inpatient and intensive care units in a tertiary care pediatric center. This system is trained by 2 domain experts. Our workflow started with keywords around HAPI and treatments, then regular expressions, distributive semantics, and finally a document classifier. We generated 3 models: a tri-gram classifier, binary logistic regression model using the regular expressions as predictors, and a random forest model using both models together. Our final output presented to the event screener was generated using a random forest model validated using derivation and validation sets., Results: Our initial corpus involved 70,981 notes during a 1-year period from 5484 unique admissions for 4220 patients. Our interrater human reviewer agreement on identifying HAPI was high ( κ = 0.67; 95% confidence interval [CI], 0.58-0.75). Our random forest model had 95% sensitivity (95% CI, 90.6%-99.3%), 71.2% specificity (95% CI, 65.1%-77.2%), and 78.7% accuracy (95% CI, 74.1%-83.2%). A total of 264 notes from 148 unique admissions (2.7% of all admissions) were identified describing likely HAPI. Sixty-one described new injuries, and 64 describe known yet possibly evolving injuries. Relative to the total patient population during our study period, HAPI incidence was 11.9 per 1000 discharges, and incidence rate was 1.2 per 1000 bed-days., Conclusions: Natural language processing-based surveillance is proven to be feasible and high yield using nursing handoff notes., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Low-value care provides little or no benefit to pediatric patients, has the potential to cause harm, waste healthcare resources, and increase healthcare costs. Nursing has a responsibility to identify and de-adopt low-value practices to help promote quality care., Purpose: 1) Describe the process of identifying and de-adopting low-value clinical practices guided by a conceptual model using a case study approach. 2) Identify facilitators and barriers to de-adoption practices, including levels of stakeholder engagement, organizational structures, and the quality of available scientific and non-scientific evidence., Methodology: An evidence-based practice (EBP) project investigating the efficacy of antihistamines in decreasing infusion reactions to infliximab identified a low-value practice within a pediatric infusion center. The Synthesis Model for the Process of De-adoption was then applied to guide the de-adoption of this low-value practice. Case study analysis highlighted facilitators and barriers to de-adoption efforts., Conclusions: The process for de-adopting care is an essential component of EBP and, as such, should be explicated through robust, standardized EBP processes and education., Practice Implications: Nurses are best positioned to identify, assess and prioritize low-value practices and facilitate the de-adoption of low-value practice that impact pediatric patients and families. Models to support de-adoption and a focus on site-specific practices including a prepared nursing workforce, continuous evaluation of care processes and the use of resources to assess for contextual determinants facilitates success and sustainability of this essential EBP approach., Competing Interests: Declaration of competing interest The authors have no conflict of interest to declare., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Inflammatory bowel diseases, including Crohn disease and ulcerative colitis, are most often diagnosed during adolescence and young adulthood, with a rising incidence in pediatric populations. Infliximab is an effective treatment option for Crohn disease and ulcerative colitis. The most common adverse event with infliximab is an infusion reaction. Patients are often treated prophylactically with combinations of acetaminophen, intravenous steroid, and an antihistamine to prevent an infusion reaction. There is a high degree of practice variation regarding pretreatment for infliximab infusions, the efficacy of pretreatment with an antihistamine is unproven in preventing infusion-related reactions, and there is no national clinical standard. Unnecessary pretreatment in adolescence and young adulthood may be harmful, as this is a time to focus on developing self-care management skills. Antihistamine side effects including somnolence and dizziness may adversely affect adolescents and/or young adults' ability to complete schoolwork, drive, and transition toward autonomous management of their chronic illness. This report presents the findings of an evidence-based practice project reviewing the efficacy of pretreatment with an antihistamine in patients with Crohn disease and ulcerative colitis receiving infliximab. Practice implications are discussed.

Large enrollment foundational courses are perceived as "high stakes" because of their potential to act as barriers for progression to the next course or admittance to a program. The nature of gateway courses makes them ideal settings to explore the relationship between anxiety, pedagogical interventions, and student performance. Here, two-stage collaborative examinations were implemented to improve test-taking skills and address widespread test anxiety in an introductory human anatomy course. Test anxiety data were collected (using the Motivated Strategies for Learning Questionnaire) before the first examination and last examination. Most students experienced decreased test anxiety over the course of the semester; however, some students may have experienced performance limiting conditions due to test anxiety at the end of the semester based on academic ability in the course (in "C" students when compared to "A" students: P < 0.00006 and "B" students: P < 0.05), overall academic ability (in academically weaker students: P < 0.025), and demographic factors (in women: P < 0.025). The strongest performances on examinations were primarily observed in already academically strong students (mean individual performance: P < 0.000, mean group performance: P < 0.000). Furthermore, changes in test anxiety were not significantly associated with the group portion of the examinations. Patterns of changes in test anxiety over the course of the semester underscore a complex interaction between test anxiety, student background, and student performance. Results suggest that pathways for test anxiety in "high stakes" courses may be separate from the mechanisms responsible for the benefits of collaborative testing. Anat Sci Educ 10: 409-422. © 2017 American Association of Anatomists., (© 2017 American Association of Anatomists.)

Background: Postural control deficits in individuals with Autism Spectrum Disorders (ASD) are widely acknowledged; however, the underlying biomechanical features of these deficits remain unknown. Nonlinear analyses provide insight into the nature of how movement is controlled and have the potential to provide new insight into the postural control abnormalities associated with ASD. The purpose of this study was to further investigate postural control deficits in children with ASD through linear and nonlinear analyses of center of pressure (COP) data., Methods: We evaluated COP data during quiet standing for 16 children with ASD and 17 age-matched typically developing (TD) children. The magnitude of COP fluctuations (COP ranges, velocity, and sway area) and complexity of postural control dynamics, quantified by multiscale entropy (MSE), were compared across groups., Results: Children with ASD displayed larger fluctuations in their COP data, observed in COP ranges (95.5% mediolaterally and 46.9% anteroposteriorly, p<0.05 respectively) and COP sway area (885%, p<0.05). Children with ASD also displayed less complexity in their COP data, observed in the MSE complexity index (CI) (32.4% mediolaterally and 35.7% anteroposteriorly, p<0.05 respectively)., Conclusions: The present study successfully revealed that children with ASD have more repetitive patterns in their COP data, indicating a less complex control of posture, on multiple time scales, during quiet stance. These findings suggest a more regular or restricted control of posture and may be an initial step in linking postural instability to stereotypic behavior and the neurobiology of ASD., (Published by Elsevier B.V.)

Restricted, repetitive behaviors (RRBs) are one of the core diagnostic criteria of autism spectrum disorders (ASD), and include simple repetitive motor behaviors and more complex cognitive behaviors, such as compulsions and restricted interests. In addition to the core symptoms, impaired movement is often observed in ASD. Research suggests that the postural system in individuals with ASD is immature and may never reach adult levels. RRBs have been related to postural sway in individuals with mental retardation. Our goals were to determine whether subjects with ASD had greater postural sway and whether RBS-R scores were related to the magnitude of postural sway. We compared the center of pressure (COP) sway area during quiet stance with scores on the Repetitive Behavior Scale-Revised (RBS-R) in children with ASD and typically developing (TD) controls ages 3-16. All subjects had Non-verbal IQ > 70. Subjects performed four quiet stance trials at a self-selected stance width for 20 s. Subjects with ASD had greater postural sway area compared to controls. Not surprisingly, subjects with ASD exhibited greater frequencies and intensities of RRBs overall and on all six subscales. Further, there was a positive correlation between postural sway area and presence of RRBs. Interestingly, results of the postural sway area for the ASD group suggests that roughly half of the ASD subjects scored comparable to TD controls, whereas the other half scored >2 SD worse. Motor impaired children did not have significantly worse IQ scores, but were younger and had more RRBs. Results support previous findings of relationships between RRBs and postural control. It appears that motor control impairments may characterize a subset of individuals with ASD. Better delineation of motor control abilities in individuals with ASD will be important to help explain variations of abilities in ASD, inform treatment, and guide examination of underlying neural involvement in this very diverse disorder.

Are motor coordination deficits an underlying cardinal feature of Autism Spectrum Disorders (ASD)? Database searches identified 83 ASD studies focused on motor coordination, arm movements, gait, or postural stability deficits. Data extraction involved between-group comparisons for ASD and typically developing controls (N = 51). Rigorous meta-analysis techniques including random effects models, forest and funnel plots, I (2), publication bias, fail-safe analysis, and moderator variable analyses determined a significant standardized mean difference effect equal to 1.20 (SE = 0.144; p <0.0001; Z = 10.49). This large effect indicated substantial motor coordination deficits in the ASD groups across a wide range of behaviors. The current overall findings portray motor coordination deficits as pervasive across diagnoses, thus, a cardinal feature of ASD.

Objective: To evaluate the impact of power assist wheels on the distance traveled by manual wheelchair users and analyze potential cofactors in the magnitude of response and to test the hypothesis that wheelers would travel significantly further with power assist wheels., Design: A 16-wk A (Preintervention)-B (Intervention)-A (Postintervention) repeated measures design. Seven women and 13 men (age, 43 +/- 15 yrs) full-time wheelers participated. During the pre- and postintervention phases (4 wks each), participants used their own unaltered manual wheelchairs. During the 8-wk intervention phase, the manual wheels were replaced with power assist wheels. Daily distance was measured with bicycle-style odometers. A composite score of laboratory wheelchair tasks was used to classify wheelchair performance. Mixed model repeated measures analysis of variance analyzed changes across phases of the trial. A post hoc analysis tabulated the amount of days wheelers exceeded their individual daily averages in each phase by two SDs., Results: Wheelers traveled significantly greater distances during the intervention phase compared with pre- or postintervention phases regardless of baseline wheelchair performance. Wheelers who demonstrated higher baseline wheelchair performance traveled lesser average distances in the first 2 wks after receiving power assist wheels than in the subsequent 6 wks. Wheelers exceeded their individual daily averages per phase on a significantly greater number of days during the intervention phase., Conclusions: Power assist wheels enabled wheelers to travel farther and to travel beyond their usual distances on more days. Further studies may be strengthened by taking into account the 2-wk "adjustment phase" for power assist wheels.

The purpose of this study was to investigate postural control in children with Autism Spectrum Disorders (ASD) during static and dynamic postural challenges. We evaluated postural sway during quiet stance and the center of pressure (COP) shift mechanism during gait initiation for 13 children with ASD and 12 age-matched typically developing (TD) children. Children with ASD produced 438% greater normalized mediolateral sway (p<0.05) and 104% greater normalized anteroposterior sway (p<0.05) than TD children. Consequently, normalized sway area was also significantly greater (p<0.05) in the group with ASD. Similarly, the maximum separation between the COP and center of mass (COM) during quiet stance was 100% greater in the anteroposterior direction (p<0.05) and 146% greater in the resultant direction (p<0.05) for children with ASD. No significant difference was observed in the mediolateral direction, in spite of the 123% greater separation detected in children with ASD. During gait initiation, no group differences were detected in the posterior COP shift mechanism, suggesting the mechanism for generating forward momentum is intact. However, significantly smaller lateral COP shifts (p<0.05) were observed in children with ASD, suggesting instability or an alternative strategy for generating momentum in the mediolateral direction. These results help to clarify some discrepancies in the literature, suggesting an impaired or immature control of posture, even under the most basic conditions when no afferent or sensory information have been removed or modified. Additionally, these findings provide new insight into dynamic balance in children with ASD., (Copyright 2010 Elsevier B.V. All rights reserved.)

Despite a history of a lateral ankle sprain, some individuals (copers) return to high-level activities (i.e. jumping, pivoting) without recurrent injury or loss of function while others develop chronic ankle instability (CAI). Understanding the differences between these groups may provide insight into the mechanisms of CAI. The objectives of this investigation were to: (1) compare traditional center of pressure [COP], time-to-boundary [TTB], and center of pressure-center of mass [COP-COM] moment arm measures of postural control among controls, established copers, and subjects with CAI and (2) determine the accuracy of these postural control measures at discriminating between established copers and subjects with CAI using receiving operating characteristic curves. 48 subjects (control=16, coper=16, CAI=16) completed two, 30-s trials of single-leg stance on a force plate with their eyes open. Coper and CAI subjects stood on their involved limb while controls stood on a matched limb. The results indicated that mediolateral (p<0.01) and anteroposterior (p<0.01) COP velocity was greater in individuals with CAI relative to both copers and controls. Similarly, the peak COP-COM moment arm in the anteroposterior direction (p<0.01) and the resultant mean COP-COM moment arm (p<0.01) were increased in individuals with CAI relative to copers. These measures also reached asymptotic significance (p<0.05) indicating that they successfully discriminated between established copers and individuals with CAI., (Copyright 2010 Elsevier B.V. All rights reserved.)

Although hip flexion is integral in sports, hip flexion exercises are seldom emphasized in strength and conditioning for sports performance. This study aimed to determine whether a hip flexor resistance-training program could improve performance on a variety of tasks. Thirteen men and 11 women completed an 8-week hip flexion resistance-training program. Eleven men and 13 women served as controls. Isometric hip flexion strength, 40-yd dash time and the time for the first 10-yds, 4 x 5.8-m shuttle run time, and vertical jump height were evaluated at the beginning and end of the training and control period. Improvements were observed in the training group but not in the control group. Individuals in the training group improved hip flexion strength by 12.2% and decreased their 40-yd and shuttle run times by 3.8% and 9.0%, respectively. An increase in hip flexion strength can help to improve sprint and agility performance for physically active, untrained individuals.