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A health care transition focused quality improvement project was implemented in a large urban pediatric endocrinology clinic to evaluate the effectiveness of the administration of the Transition Readiness Assessment Questionnaire (TRAQ) by identifying barriers to implementation and creating a more sustainable format. A pre- and post-intervention evaluation design was used in this quality improvement project. A twelve-month chart review of pediatric endocrine clinic patients diagnosed with diabetes who were 14 years of age or older and met eligibility criteria was conducted. Patients given the TRAQ tool were identified and assessed for documentation of goals and goal achievement. Discussions regarding the implementation of the TRAQ tool were conducted with clinic staff to identify process barriers and develop solutions. A post-implementation twelve-month review was conducted to evaluate for improved documentation and achievement of transition focused goals. Several barriers were identified that minimizedol protocol in the clinic setting is recommended in order to support pediatric patients' successful transition to adult care. The incidence of acute kidney injury (AKI) in coronavirus disease 2019 (COVID-19) patients ranges from 0.5% to 35% and has been associated with worse prognosis. The purpose of this study was to evaluate the incidence, severity, duration, risk factors and prognosis of AKI in hospitalized patients with COVID-19. We conducted a retrospective single-center analysis of 192 hospitalized COVID-19 patients from March to May of 2020. AKI was diagnosed using the Kidney Disease Improving Global Outcome (KDIGO) classification based on serum creatinine (SCr) criteria. https://www.selleckchem.com/MEK.html Persistent and transient AKI were defined according to the Acute Disease Quality Initiative (ADQI) workgroup definitions. In this cohort of COVID-19 patients, 55.2% developed AKI (n=106). The majority of AKI patients had persistent AKI (n=64, 60.4%). Overall, in-hospital mortality was 18.2% (n=35) and was higher in AKI patients (28.3% vs. 5.9%, p<0.001, unadjusted OR 6.03 (2.22-16.37), p<0.001). In this multivariate analysis, older age (adjusted OR 1.07 (95% CI 1.02-1.11), p=0.004), lower Hb level (adjusted OR 0.78 (95% CI 0.60-0.98), p=0.035), duration of AKI (adjusted OR 7.34 for persistent AKI (95% CI 2.37-22.72), p=0.001) and severity of AKI (adjusted OR 2.65 per increase in KDIGO stage (95% CI 1.32-5.33), p=0.006) were independent predictors of mortality. AKI was frequent in hospitalized patients with COVID-19. Persistent AKI and higher severity of AKI were independent predictors of in-hospital mortality.AKI was frequent in hospitalized patients with COVID-19. Persistent AKI and higher severity of AKI were independent predictors of in-hospital mortality. Chronic kidney disease remains an important risk factor for morbidity and mortality among LT recipients, but its exact incidence and risk factors are still unclear. We carried out a retrospective cohort study of consecutive adults who underwent liver transplant (January 2009-December 2018) and were followed (at least 6 months) at our institution. CKD was defined following the Kidney Disease Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guidelines. Long-term kidney function was classified into 4 groups no CKD (eGFR, ≥60mL/min/1.73m ), mild CKD (eGFR, 30-59mL/min/1.73m ), severe CKD (eGFR, 15-29mL/min/1.73m ), and end-stage renal disease (ESRD). We enrolled 410 patients followed for 53.2±32.6 months. 39 had CKD at baseline, and 95 developed de novo CKD over the observation period. There were 184 (44.9%) anti-HCV positive, 47 (11.5%) HBsAg positive, and 33 (8.1%) HBV/HDV positive recipients. Recipient risk factors for baseline CKD were advanced age (P=0.044), raised levels of serum uric acid a slight decline in kidney function over time was recorded. Prevention of post-transplant AKI will improve kidney function in the long run. We need more studies to analyze the function of kidneys among LT recipients over extended follow-ups and their impact on mortality. Health care workers, especially those in pediatrics, have a high risk for compassion fatigue (CF). A wellness program (WP) might help decrease CF and increase compassion satisfaction (CS). This project implemented and evaluated a WP in a pediatric postanesthesia care unit at a large children's hospital. The project evaluated the effectiveness of a WP using pre- and post-WP surveys, which assessed CF (i.e., burnout and secondary traumatic stress), CS, and overall satisfaction with the WP. Overall results demonstrated decreases in CF and increases in CS, self-care, healthy behaviors, and knowledge of CF. The perceived level of teamwork, morale, recognition, social support, and positive coworker interactions also increased. Overall, 77% of the respondents thought the WP helped decrease CF. Implementing a WP that incorporates social support, education, and healthy behaviors had significant benefits, including a reduction in CF.Implementing a WP that incorporates social support, education, and healthy behaviors had significant benefits, including a reduction in CF. To compare the performance of CT and MRI radiomics for predicting the malignant potential of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas, and to investigate their value compared to the revised 2017 international consensus Fukuoka guidelines. Sixty patients with surgically confirmed IPMNs (37 malignant and 23 benign) were included. Radiomics features were extracted from arterial and venous phase images of CT and T2-weighted images of MRI, respectively. Intraclass correlation coefficients for the radiomics features were calculated to assess the interobserver reproducibility. The least absolute shrinkage and selection operator algorithm was used for feature selection. Radiomics models were constructed based on selected features with logistic regression (LR) and support vector machine (SVM). A clinical and imaging model was constructed based on independent predictors of the revised 2017 Fukuoka guidelines determined in multivariate logistic regression with forward elimination. The reproducibility of MRI radiomics features was higher than that of CT radiomics features, regardless of arterial or venous phase features (all p < 0.001). MRI radiomics models achieved improved AUCs (0.879 with LR and 0.940 with SVM, respectively), than that of CT radiomics models (0.811 with LR and 0.864 with SVM, respectively). All radiomics models provided better predictive performance than the clinical and imaging model (AUC=0.764). The MRI radiomics models with higher reproducibility radiomics features performed better than CT radiomics models for predicting the malignant potential of IPMNs. The performance of radiomics models was superior to the clinical and imaging model based on Fukuoka guidelines.The MRI radiomics models with higher reproducibility radiomics features performed better than CT radiomics models for predicting the malignant potential of IPMNs. The performance of radiomics models was superior to the clinical and imaging model based on Fukuoka guidelines. The geographic location of birth has implications for low-income children's upward economic mobility, as Chetty, Hendren, Kline, and Saez (2014) found in an examination of millions of income tax records from each county in the US. Additional work indicates that low income children in higher economic mobility counties have higher language scores and fewer behavioral problems (Donnelly et al., 2017). However, the processes by which the geography of opportunity influences parenting are less well-understood. This study examines whether living in higher intergenerational mobility counties is associated with less harsh parenting, material hardship, household violence and substance use, and low child supervision - parenting behaviors that increase the risk for child maltreatment - for low-income families. Data come from the Fragile Families and Child Wellbeing Study, a longitudinal birth cohort of low income families in 20 cities in the U.S (N ~, 2841; 76% lower (household income of $41,994 or less) and 24% hincome groups.For low-income children, higher intergenerational mobility is associated with decreased risk of harsh parenting, particularly at younger ages, as is longer exposure to high intergenerational mobility areas. That lower-income families are less likely to live in economically mobile geographies may exacerbate inequalities among income groups. Diversity in the workplace is crucial. As the United States population continues to diversify, the composition of graduate medical trainees (GMTs) among various medical specialties is not diversifying at nearly the same rate. This study aims to identify gender and ethnic minority disparities present in medicine, specifically among GMTs in the field of plastic surgery. The field of plastic surgery is vast, with the patient population ranging from newborns to elders of all different races, religions, and ethnicities. However, the representation of women and minorities among the current plastic surgery trainees is not equivalent to the population they serve. Data from the Graduate Medical Education (GME) census published in the Journal of the American Medical Association (JAMA) was analyzed to compare trends of female and underrepresented ethnic minorities over the academic period from 2015 through 2019. Data regarding all GMTs and specifically those in the integrated plastic surgery (IPS) program was collected. Over the five-year study period, females were consistently underrepresented in plastic surgery when compared to the total number of female medical trainees. Currently, females represent 42.7% of GMTs in IPS, a small increase from 40.9% in 2015. Furthermore, Whites and Asians encompassed 87.7% (65.6% and 22.1%, respectively) of plastic surgery GMTs in 2019-2020. In the same academic year, Blacks and Hispanics together made up only 9.1% (2.5% and 6.6%, respectively) of GMTs in plastic surgery. This study portrays the importance of highlighting gender and ethnic minority disparities in the field of plastic surgery, thereby promoting initiatives for change in the coming future.This study portrays the importance of highlighting gender and ethnic minority disparities in the field of plastic surgery, thereby promoting initiatives for change in the coming future.Racial tensions continue to ignite social unrest in the United States. Structural racism is increasingly recognized as a public health issue. It is therefore necessary to continue addressing the interaction of race and medicine, including anesthesiology. While many may overlook the impact that racial discrimination has had on the development of anesthesiology, understanding pain through a racialized lens has always been entwined with this medical specialty since its origins. Considering the first public demonstration of ether anesthesia in 1846 occurred 15 years before the American Civil War (1861-1865), it is naïve to pretend that anesthesia has been insulated from racial prejudice. We increasingly recognize the effects of variables, such as housing and education, which are important as social determinants of health. Across ethnic and racial lines, statistically significant differences persist in pain assessment and analgesia delivery. To understand these irregularities without relying on unsupported theories, we must challenge our current understanding of race in medicine.
