Background Children often experience respiratory illnesses requiring bedside nurses skilled in recognizing respiratory decompensation. Historically, recognizing respiratory distress has relied on teaching during direct patient care. Virtual reality simulation may accelerate such recognition among novice nurses. Objective To determine whether a virtual reality curriculum improved new nurses' recognition of respiratory distress and impending respiratory failure in pediatric patients based on assessment of physical examination findings and appropriate escalation of care. Methods New nurses (n = 168) were randomly assigned to complete either an immersive virtual reality curriculum on recognition of respiratory distress (intervention) or the usual orientation curriculum (control). Group differences and changes from 3 months to 6 months after the intervention were examined. Results Nurses in the intervention group were significantly more likely to correctly recognize impending respiratory failure at both 3 months (23.4% vs 3.0%, P< .001) and 6 months (31.9% vs 2.6%, P < .001), identify respiratory distress without impending respiratory failure at 3 months (57.8% vs 29.6%, P = .002) and 6 months (57.9% vs 17.8%, P < .001), and recognize patients' altered mental status at 3 months (51.4% vs 18.2%, P < .001) and 6 months (46.8% vs 18.4%, P= .006). Conclusions Implementation of a virtual reality-based training curriculum was associated with improved recognition of pediatric respiratory distress, impending respiratory failure, and altered mental status at 3 and 6 months compared with standard training approaches. Virtual reality may offer a new approach to nurse orientation to enhance training in pediatrics -specific assessment skills.

BACKGROUND Pediatric patients with behavioral needs are frequently admitted to the hospital for medical care; when behavioral crises occur, patients and staff are at risk for injury. Our aim was to implement a behavior response team (BRT) to increase the days between employee injury due to aggressive patient interactions on the inpatient medical units from 99 to 150 over 1 year.METHODS A multidisciplinary team used quality improvement methods to design and implement the BRT system that includes 2 options: huddle to proactively plan for patients exhibiting early signs of escalation and STAT for immediate help for patients with imminent risk of harm to self or others. Using run and statistical process control charts, we tracked events per month, days between Occupational Safety & Health Administration-recordable events, and violent restraint use over time for 1 year after implementation. Staff pre and postimplementation surveys were compared to assess staff perception of safety and support provided by the BRT intervention.RESULTS The BRT was implemented across the inpatient system in July 2020, with an average number of 13 events per month. Days between Occupational Safety & Health Administration-recordable events remained stable with a maximum of 134 days. Restraint use remained stable at 0.74 per 1000 patient days. The perception of behavioral support available to staff increased significantly pre to postsurvey.CONCLUSIONS The implementation of a BRT can improve staff perception of support and confidence in safely caring for patients with behavior needs on the inpatient medical unit, although additional provider- and system-level improvements are needed to prevent employee injuries.

Background: Nurse residency programs continually identify needs to enhance educational experiences for new nurses to build clinical competence when transitioning to practice. Virtual reality (VR) based education may play an important role in this experience.Methods: In this prospective cohort educational study nurses (n = 83) participated in a VR experience on the assessment of pediatric respiratory distress and failure, followed by a survey assessing demographics, retrospective pre/post self-assessment of competence, immersion, and attitudes toward VR.Results: The VR curriculum significantly improved nurses' self-assessed competence in the recognition and management of respiratory distress and failure. Participants endorsed that the VR experience mimicked real-life patient experiences, was more effective than traditional education modalities, accurately depicted, reinforced, and would influence future care of patients with respiratory distress and failure.Conclusions: Findings suggest the VR curriculum improved nurse perception of their ability to care for patients with respiratory distress and failure. VR may represent a new modality for training new nurses on the clinical assessment of respiratory distress and failure.Cite this article: Raab, D.L., Ely, K., Donnellan, A., Israel, K., Lin, L., & Zackoff, M.W. (2023, Month). New Nurse Self-assessed Clinical Competence, Immersion, and Attitudes Following Virtual Reality Training on the Assessment of Pediatric Respiratory Distress. Clinical Simulation in Nursing , 84, 101461. https: //doi.org/10.1016/j.ecns.2023.101461 .(c) 2023 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.

Abstract Introduction This pilot, randomized controlled trial aimed to evaluate the usability, among adolescents and young adults (AYAs) with ulcerative colitis (UC), of a web‐based tool (‘iBDecide’) designed to facilitate shared decision making (SDM). Methods AYAs with UC (n = 35) were randomized to intervention (iBDecide, n = 14) and control (n = 12) arms before a scheduled clinic visit. We measured the usability of iBDecide, SDM, preferred decision‐making style, decision conflict and intervention use. Results Participants in the intervention group found iBDecide easy to use and agreed that it made them feel ready to participate in decision making and that they would use it to prepare for appointments. There were 130 visits to iBDecide, lasting on average 3 min, 41 s. The medication and nutrition trackers were among the most‐viewed pages. Pages specifically designed to facilitate SDM were viewed only four times. Across groups, too few participants reported making decisions during clinic visits for decision‐related measures to be reported. Conclusions This pilot trial provides evidence for the usability of iBDecide and guidance for developing a larger‐scale trial of a combined web‐based and in‐clinic SDM intervention. Overall, iBDecide shows promise in engaging AYAs with UC in SDM and condition management. Patient or Public Contribution Patients, specifically AYAs with UC, and healthcare providers were involved in the design of this study's intervention, iBDecide. Additionally, the research team, from study conception to manuscript writing, included a young adult with inflammatory bowel disease. Clinical Trial Registration: This study was registered at clinicaltrials.gov (NCT04207008).

Introduction: Human trafficking (HT) is a global problem that may affect children's health. In the United States, victims and children are at risk in most communities. History of abuse is a risk factor for HT. This study explored associations between pediatric patients with positive universal abuse screens and indicators from the commercial sexual exploitation of children/child sex trafficking (CSEC/CST) screening tool. Method: A retrospective chart review was conducted on random patients, aged 11-17 years, with positive universal abuse screens at emergency/urgent care departments in a large Midwest pediatric medical center in 2018. Documentation identifying at least two CSEC/CST screening tool indicators was abstracted from these records. Data analysis included descriptive statistics, univariate analyses, and correlations. Results: Two or more indicators from the CSEC/CST screening tool were identified in 43% (n = 121). Age and history of running away were significant predictors for a patient having two or more CSEC/CST positive indicators. Discussion: Targeted screening and interventions are needed to identify and help these vulnerable youth.

An immersive virtual reality curriculum was piloted with new nurse graduates that focused on improving clinical reasoning and situational awareness for pediatric respiratory distress and impending respiratory failure. Learnings from this pilot could inform strategies for development of standardized, efficient, and safe onboarding curricula to increase the likelihood of successful transition to practice.

为探究山地城镇教育设施网络结构及其空间格局的演变特征,以重庆市万州区为例,运用复杂网络分析方法,构建多时段教育设施协作网络模型,计算其强度分布、网络密度、节点强度、网络腹地等指标,反映网络整体性、层级性、核心设施职能结构.结果 表明:1)网络整体空间格局由“一核多翼”向“多核多翼”演变;2)不同层级教育设施呈现出“整体破碎-局部集聚”的空间分布格局;3)核心设施职能分为“结对帮扶型”和“集团核心型”,“结对帮扶型”设施网络腹地受空间距离制约较小,而“集团核心型”设施网络腹地受空间距离制约显著.基于此,结合区位、政策、设施功能等空间格局的影响因素,提炼设施空间格局演变模式,并对规划取向进行探讨.

An immersive virtual reality curriculum was piloted with new nurse graduates that focused on improving clinical reasoning and situational awareness for pediatric respiratory distress and impending respiratory failure. Learnings from this pilot could inform strategies for development of standardized, efficient, and safe onboarding curricula to increase the likelihood of successful transition to practice.

文章从农村小学生流动就学行为视角出发,构建汉源县农村小学教育服务协同网络模型,计算模块度、入度强度和网络腹地等指标所反映的网络组团结构、层级结构特征.研究结果表明:①农村小学教育服务协同网络可划分为6个组团,且组团内部的农村小学服务范围呈现连续性特征;②依据网络腹地范围的不同,农村小学可划分为区域级中心小学、镇乡级中心小学和一般小学三个层级.在此基础上,提出了支持农村小学教育服务协同发展的农村小学服务范围划定和服务层级的优化策略以及教育服务制度建设的建议.

Background: Cystic Fibrosis (CF) is an autosomal recessive disorder of exocrine glands characterized by abnormal production of thick mucus, primar-ily in bronchi of the lungs. Individuals experience recurrent respiratory infections, increased work of breathing, cough and musculoskeletal changes with pain. Previous research found that massage therapy (MT) decreased pain, muscle tightness, and anxiety in individuals with CF, but did not use valid/reliable measurements of quality of life (QOL).Purpose: To evaluate the effects of MT on QOL and clinical outcomes in individuals 8 to 21 years old with CF. Setting: A 622-bed nonprofit pediatric hospital in Ohio in the United States.Participants: Convenience sample of 24 patients with CF; 12 randomly assigned to treatment and control groups, respectively. Research Design and Intervention: Prospective two-group controlled pre/post pilot study using deep tissue myofascial trigger point massage over 10 to 12 weeks.Measurements: Pediatric Quality of Life Inven-tory (Peds QL 4.0); Cystic Fibrosis Questionnaire-Revised (CFQ-R); numeric rating scales (NRS) for pain, muscle tightness, ease of breathing, relax-ation; pulmonary function (PFT); single breath count; thoracic excursion (TE).Results: All participants were Caucasian; mean age 15.7 (SD = 3.5) years; 16 (66.6%) female. No significant differences were found in terms of age, gender, baseline pain between MT and control groups. At the final visit, compared to the control group, the children in MT group showed statistically significantly reduced muscle tight-ness (p = .048) with a large effect size (?²=0.163) and marginally statistically significantly higher levels of relaxation (p = .052), less pain (p = .076), and improved upper TE (p = .078) and lower TE (p = .056) scores with large and moderate effect sizes (?² = 0.156, ?² = 0.095, ?² = 0.083, and ?² = 0.073). No statistically significant differences in children’s and caregivers’ QOL scores between the two groups were found.Conclusions: Massage therapy was found to significantly reduce muscle tightness, marginally significantly help pain, relaxation, and thoracic excursion in participants with CF

OBJECTIVES:The purpose of this pilot study was three-fold: 1) to evaluate the safety and feasibility of instituting massage therapy in the immediate postoperative period after congenital heart surgery, 2) to examine the preliminary results on effects of massage therapy versus standard of care plus three reading visits on postoperative pain and anxiety, and 3) to evaluate preliminary effects of opioid and benzodiazepine exposure in patients receiving massage therapy compared with reading controls. DESIGN:Prospective, randomized controlled trial. SETTING:An academic children's hospital. SUBJECTS:Sixty pediatric heart surgery patients between ages 6 and 18 years. INTERVENTIONS:Massage therapy and reading. MEASUREMENT AND MAIN RESULTS:There were no adverse events related to massage or reading interventions in either group. Our investigation found no statistically significant difference in Pain or State-Trait Anxiety scores in the initial 24 hours after heart surgery (T1) and within 48 hours of transfer to the acute care unit (T2) after controlling for age, gender, and Risk Adjustment for Congenital Heart Surgery 1 score. However, children receiving massage therapy had significantly lower State-Trait Anxiety scores after receiving massage therapy at time of discharge (T3; p = 0.0075) than children receiving standard of care plus three reading visits. We found no difference in total opioid exposure during the first 3 postoperative days between groups (median [interquartile range], 0.80 mg/kg morphine equivalents [0.29-10.60] vs 1.13 mg/kg morphine equivalents [0.72-6.14]). In contrast, children receiving massage therapy had significantly lower total benzodiazepine exposure in the immediate 3 days following heart surgery (median [interquartile range], 0.002 mg/kg lorazepam equivalents [0-0.03] vs 0.03 mg/kg lorazepam equivalents [0.02-0.09], p = 0.0253, Wilcoxon rank-sum) and number of benzodiazepine PRN doses (0.5 [0-2.5] PRN vs 2 PRNs (1-4); p = 0.00346, Wilcoxon rank-sum). CONCLUSIONS:Our pilot study demonstrated the safety and feasibility of implementing massage therapy in the immediate postoperative period in pediatric heart surgery patients. We found decreased State-Trait Anxiety scores at discharge and lower total exposure to benzodiazepines. Preventing postoperative complications such as delirium through nonpharmacologic interventions warrants further evaluation.

PURPOSE:Hospitalized patients with a developmental or intellectual disability and a psychiatric disorder (dual-diagnosis) often pose a risk to themselves or others leading to high injury rates for their providers. Therefore, evidence-based strategies to reduce employee injuries resulting from interactions are necessary.METHODS:To reduce injuries resulting from interactions with dual-diagnosis patients, the Initial Behavioural Assessment (IBA) and Protective Equipment Decision Key (PEDK) were used in inpatient neuropsychiatry. The IBA-PEDK identify patients' aggressive behaviors to provide employees with personal protective equipment (PPE). Inter-rater reliability, validity, and adherence were examined.RESULTS:Injuries significantly decreased after implementing the IBA-PEDK. The average kappa coefficient was 0.64 with a 90.6% agreement. Ninety-three percent of respondents reported wearing PPE at the time of injury.CONCLUSIONS:A quick, user-friendly tool that provides a standardized method for determining PPE based on patient-specific behavior can significantly reduce aggression-related injuries.

随着网络空间安全问题的日益突出,对网络安全人才建设不断提出新的要求,尽快培养出高水平高素质的专业人才成为当务之急.结合北京交通大学信息安全专业建设情况,通过人才培养模式、课程体系、实习实训体系3个方面的探索与实践,构建适应社会发展需求的信息安全专业的创新型人才培养体系.

Parents/caregivers of hospitalized patients are at risk of sleep disruption. We performed a cross-sectional quantitative and qualitative evaluation of sleep in parents/caregivers of children undergoing hematopoietic stem cell transplant (HSCT; n=17). Additionally, we explored the frequency of room entries for hospitalized patients undergoing HSCT (n=189 nights). Twelve caregivers (71%) demonstrated significant sleep disturbance, 12 (71%) described sleep quality as poor, 15 (88%) averaged<6hours of sleep per night, 14 (82%) awakened at least four times per night. Patient rooms were entered a median of 12 times per night (interquartile range 10-15). Intervention studies to improve caregiver sleep during hospitalization are needed.

OBJECTIVES:The purpose of this study was to describe how pediatric cardiac intensive care clinicians assess and manage delirium in patients following cardiac surgery.DESIGN:Descriptive self-report survey.SETTING:A web-based survey of pediatric cardiac intensive care clinicians who are members of the Pediatric Cardiac Intensive Care Society.PATIENT OR SUBJECTS:Pediatric cardiac intensive care clinicians (physicians and nurses).INTERVENTIONS:None.MEASUREMENT AND MAIN RESULTS:One-hundred seventy-three clinicians practicing in 71 different institutions located in 13 countries completed the survey. Respondents described their clinical impression of the occurrence of delirium to be approximately 25%. Most respondents (75%) reported that their ICU does not routinely screen for delirium. Over half of the respondents (61%) have never attended a lecture on delirium. The majority of respondents (86%) were not satisfied with current delirium screening, diagnosis, and management practices. Promotion of day/night cycle, exposure to natural light, deintensification of care, sleep hygiene, and reorientation to prevent or manage delirium were among nonpharmacologic interventions reported along with the use of anxiolytic, antipsychotic, and medications for insomnia.CONCLUSIONS:Clinicians responding to the survey reported a range of delirium assessment and management practices in postoperative pediatric cardiac surgery patients. Study results highlight the need for improvement in delirium education for pediatric cardiac intensive care clinicians as well as the need for systematic evaluation of current delirium assessment and management practices.

Purpose: Early-phase clinical trials (EPTs) have led to new, more effective treatment options for children with cancer. Despite the extensive use of EPTs in pediatric oncology, little is known about parent and child experiences during EPT participation. The purposes of this pilot study were to assess the feasibility and preliminary results of having children with cancer and their parents complete measures of treatment burden and quality of life (QOL) concurrent with EPT participation. Methods: In this descriptive, longitudinal, pilot study, parents and children were followed for the first 60 days of an EPT. Feasibility was assessed by participant enrollment and retention and completion of measures. Measures completed included the following: demographic form (completed at baseline); Diary of Trial Experiences to capture treatment burden (completed ongoing); and PedsQL™ Quality of Life Inventories, Cancer Modules, and Family Impact Module (completed at baseline, post–first disease evaluation, and off-study). Data were analyzed using descriptive statistics. Results: Feasibility goals of enrollment, retention, and measure completion were partially met. Preliminary treatment burden and QOL results are provided. Conclusions: While QOL assessments may provide insight into EPT experiences, future studies need to be conducted at multiple sites and enrollment goals must account for participant attrition.

The American Academy of Pediatrics recommends that shared reading commence as soon as possible after birth and screen-based media be discouraged for those less than 18 months old. Early routines can predict long-term use and health outcomes. This longitudinal study involved low-socioeconomic status mothers (n = 282) enrolled in home visiting. Surveys were administered prenatally and at 2 months old regarding shared reading and infant television viewing, and health literacy was screened prenatally. Planned age to initiate reading decreased from 2.8 to 1.8 months old, 80% reading by 2 months old, averaging 1 to 3 days per week, with “too busy” being the major barrier. Planned age for infant TV decreased from 13.2 to 4.3 months old, 68% viewing by 2 months old and more than half daily. TV was observed in 70% of infant sleep environments. Health literacy was correlated with perceived developmental benefits of shared reading (positively) and TV viewing (negatively), 43% of mothers scoring at risk for inadequate levels. A majority cited the prenatal period as opportune to discuss reading and TV.

为研究钢筋混凝土梁在爆炸波作用下的毁伤判据,对两种尺寸的钢筋混凝土梁在缩比条件下进行了不同爆炸距离作用和装药量下的试验研究。试验中以高层和框架结构中最常见的两种梁为研究对象,通过11次独立的爆炸试验,观测了钢筋混凝土梁在不同装药量下的破坏模式和破坏特征。研究结果表明:钢筋混凝土梁在近区爆炸荷载作用下,在同一爆高下,随着装药量的增加,梁的破坏程度逐渐增加,破坏模式由迎爆面中心两侧少量混凝土脱落和背爆面少量断裂裂纹逐渐增加为迎爆面倒三角锥形式混凝土压碎弯曲破坏,背爆面出现三角锥裂纹和背爆面少量混凝土脱落破坏,最终迎爆面和背爆面三角锥破坏区域贯通形成中心区域压碎崩塌弯曲破坏;崩塌区域的尺寸随着装药量增加而逐渐增加。近区爆炸(以爆距0.5 m为例)作用下,试验钢筋混凝土梁的毁伤判据为:当比例爆高Z>0.4 m/kg1/3时,梁遭受到轻微破坏;当比例爆高0.3 m/kg1/3<Z<0.4 m/kg1/3时,梁遭受到中等破坏;当比例爆高0.28 m/kg1/3<Z<0.3 m/kg1/3时,混凝土梁遭受重度破坏;当比例爆高Z<0.28 m/kg1/3,梁遭受严重破坏。在近区爆炸作用下,钢筋混凝土梁的破坏不仅依赖于爆炸比例距离,还与爆高有关,同一比例距离下爆高越大,梁试件的破坏越严重。研究结果可为工程应用及毁伤评估提供参考。

BACKGROUND: Noise is a problem placing registered nurses (RNs) at risk for safety events, decreased job performance, fatigue, irritability, and hearing loss. OBJECTIVE: The purpose of this study is to measure noise levels and sources on pediatric inpatient units as well as to explore the health impact of noise on RNs. METHODS: This was a descriptive nonexperimental study with 65 pediatric RNs from 14 units. Noise (levels, source, location, and activity), heart rate (HR), and stress were measured. Correlations between sound pressure levels (SPLs), HR, and stress were examined. RESULTS: Mean (SD) SPLs were 75.8 (8.9) dBA and were significantly higher than SPLs for patients. Noise was significantly associated with HR but not with time in tachycardia or stress. Primary sources of noise were employee conversations in patient rooms. CONCLUSIONS: On all units, SPLs exceeded protection agency guidelines. Cost-prohibitive structural changes underscore the importance of using behavioral and culture modification to reduce noise.

OBJECTIVE: The purpose of this study was to develop a valid and reliable patient classification system (PCS) for a neonatal ICU (NICU). BACKGROUND: PCSs have been widely used to determine required care hours, budgeting, and staffing. There is a lack of and a vital need for a valid and reliable pediatric PCS because of differences in needs and treatment from adults. METHODS: Data were collected in a NICU using work sampling, chart reviews, and expert opinion. The resulting PCS was assessed for validity and reliability, ease of use, effectiveness, and satisfaction. RESULTS: The PCS showed significantly high reliability and validity. Survey scores revealed nurses perceived the tool to be easy to use and effective. CONCLUSIONS: Using subjective and objective methods, a NICU PCS was shown to be a valid and reliable measure to determine the hours per patient day required to provide care.