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Many clinicians have limited knowledge about the challenges of living in poverty, leading to stigma and differential treatment in healthcare settings. A poverty simulation event may help clinicians gain empathy and knowledge about the ways that poverty impacts health and well-being.This study evaluated the impact of a poverty simulation and the effect of personal characteristics on clinicians' attitudes towards poverty.Using a prospective longitudinal mixed-methods study design, a convenience sampling of clinicians from a freestanding children's hospital was recruited to participate in a poverty simulation event. The 21-item Attitudes Towards Poverty (ATP) tool was administered pre- and post-simulation and at 3 follow-up time points. Multiple linear regression analysis and linear mixed effects models were used to analyze ATP data. Qualitative data were analyzed to identify broad themes.Mean scores in the ATP domains of stigma and structural perspective increased post-simulation, but only stigma scores demonstrated sustained improvement. Scores in the personal deficiency domain remained unchanged. Being male, White, and having Liberal political views were associated with lower ATP scores in our data. Qualitative data show participants felt the simulation generated feelings of compassion and empathy.Simulation participation improved ATP scores in two domains immediately post-event, suggesting the simulation positively impacted clinicians' attitudes towards poverty. Follow-up data suggest the impact of the simulation may be temporary.Experiential learning activities, like poverty simulations, help foster awareness and empathy among clinicians but may not have long-term impact. Ongoing education is needed to create a workforce sensitized and equipped to care for families from all backgrounds.

Background Burnout is a substantial phenomenon across healthcare settings, affecting more than half of healthcare professionals and leading to negative patient and health system outcomes. Infusion center professionals (ICPs) are at increased risk of burnout attributed to high patient volume and acuity levels. Strategies to address burnout have been developed and prioritized by the American Medical Association (AMA), the World Health Organization, and other organizations. Aims This quality improvement project aimed to address perceived burnout, job-related stress, and job satisfaction among nurses, physician assistants, and medical assistants at a large pediatric hospital through integration of two infusion center (IC)-based staff engagement interventions. Methods A pre- and post-test study design was used. Existing team huddles in the IC were modified based on the AMA STEPS Forward program recommendations to incorporate appreciative inquiry and recognition into team and department events. Peer recognition was tailored toward institutional core values. The Mini-Z Burnout survey was administered before and 3 months after implementation of both interventions. Findings Pre- to post-intervention responses revealed a higher percentage of staff reporting no burnout (57.7% vs. 75%), low levels of job-related stress (58.8% vs. 65.5%), and satisfaction with current job (70.6% vs. 82.8%). Most participants agreed or strongly agreed that structured huddles (69%) and recognition events (82.8%) were beneficial and recommended continuation (65.5% and 82.8%, respectively). Open-ended responses regarding workplace stressors focused heavily on staffing and patient acuity. Linking evidence to action Project outcomes support the integration of tailored interventions to reduce burnout among pediatric ICPs. Organizational commitment to addressing burnout can provide incentive to scale up institution-wide staff engagement interventions. Further study is needed to assess the efficiency and effectiveness of such tailored interventions across diverse settings.

As patients, family members, and health care providers serving on the Family Advisory Council (FAC) of the Patient and Family-Centered I-PASS Safer Communication On Round Every Time study,1,2 we read, with interest, the scoping review by Knighton and Bass3 on the implementation of family-centered rounds (FCRs). In their review, the authors highlighted several challenges in implementing and evaluating FCRs. They note that limited high-quality research exists to reveal what constitutes a successful FCR rounding encounter. They, additionally, describe the gaps regarding the clinical effectiveness of various interventions to improve FCRs as well as if and how FCRs lead to improvements patient safety and outcomes or changes in clinical decision-making. Although we look forward to further research to better target these gaps, we wish to first share our reflections on the current evidence and make suggestions for the future of patient- and family-centered rounds (PFCRs) from the patient and family viewpoint. As family members, the majority of us did not know what rounds were before we experienced them during an admission. The learning curve is steep, pressure is immense, and fears of somehow failing our children, appearing dumb, or seeming like an incompetent parent can almost paralyze you. As a result, it may appear that we are disengaged or do not value PFCR. It would help us prepare for PFCRs if were to learn what it constitutes at the time of admission, instead of as the team is walking through the door. A brief orientation to PFCRs by the admitting team is highly valued, and, just like your trainees, it may take us several iterations of PFCR to learn how to best participate. But we quickly see that PFCRs are an essential point of communication to engage with providers, share our expertise, and understand the medical plan …

Many things that we now call ‘archaeological archives’ are actually personal collections of documentation made and amassed by archaeologists, some of which have found their way into institutions. This is indeed the case for the collections of Harald Ingholt (1896–1985), a Danish archaeologist and philologist who worked at Palmyra in the 1920s and 1930s and had a long career that was spent mostly in the USA at Yale University, studying Syrian and Gandharan sites. Ingholt's field diaries, published in the volumes under review, make up part of a collection which he donated, following his retirement, to the Ny Carlsberg Glyptotek in Copenhagen in the early 1980s; that collection also includes his personal reference material, known as ‘The Ingholt Archive’. Comprising sheets with Palmyrene images glued to them, the Archive is planned for separate publication by Brepols in the near future.

Purpose: Chemotherapy-induced nausea and vomiting (CINV) is a distressing, underrecognized effect of treatment that can occur in up to 80% of patients. The purpose of this quality improvement project was to evaluate the impact of implementation of a standardized nausea assessment tool, the Baxter Animated Retching Faces (BARF) scale, on nursing compliance with nausea assessment and the frequency and severity of patient-reported CINV for children with cancer. Method: The Plan-Do-Study-Act cycle was used to implement this practice change. With stakeholder support and hospital governance council approval, the BARF scale was introduced into the electronic medical record. Nurses were provided education about the assessment tool and were given badge buddy cards to prompt use of the tool, and workstation reminders were created. A root cause analysis was conducted to provide feedback for continuous quality improvement. Results: Retrospective, aggregate electronic medical record data from May 2018 to April 2019 were analyzed for assessment compliance, total number of admissions with vomiting episodes, and average BARF score. Over the 12-month implementation period, run charts demonstrated a shift in nursing practice with increased compliance in documented nausea assessments during the second 6-month period. There was not a significant decrease in patient-reported CINV. Conclusion: The use of standardized nausea assessments based on patient self-reporting can provide useful and consistent feedback for nurses and health care providers. This quality improvement project demonstrated increased compliance with nausea assessment documentation. Further studies are needed to demonstrate that improvements in nausea assessment may reduce the frequency and severity of CINV.

Background The evidence linking nursing care and patient outcomes has been globally demonstrated. Thus, it is time for translation and application of this evidence to robust measurement that uniquely demonstrates the value of nursing care and the characteristics of the nursing workforce that contribute to optimal patient outcomes. Objective The aim of this study was to identify and develop standardized measures representative of pediatric nursing care of the cardiovascular patient for benchmarking within freestanding children's hospitals. Methods Using a consensus-based approach, the Consortium of Congenital Cardiac Care- Measurement of Nursing Practice (C4-MNP) members developed quality measures within working groups and then individually critiqued all drafted measures. Final draft measures were then independently reviewed and critiqued by an external nursing quality measurement committee. The final quality measures were also made available to a national parent support group for feedback. Outcomes The development process used by C4-MNP resulted in 10 measures eligible for testing across freestanding children's hospitals. Employing a collaborative consensus-based method plus implementing the criteria of the National Quality Forum and external vetting period provided a strong framework for the development and evaluation of standardized measures. Next Steps The Consortium will continue with implementation and testing of each measure in 9 of our 28 collaborating centers. This activity will support initial development of benchmarks and evaluation of the association of the measures with patient outcomes.

Background Parents of children with complex, chronic conditions report a desire for continuity of care, but relatively little is known about the ways in which nursing continuity of care occurs and the extent to which it is delivered in the inpatient setting. Objectives The objective of this analysis, which arose from a study on best practices in parent/nurse interactions in the pediatric intensive care unit (PICU), was to explore the delivery of continuity of nursing care in the PICU from the perspective of both parents and nurses. Methods A qualitative, grounded theory study using situational analysis was conducted with seven parents and 12 nurse participants from a single PICU. Data sources included in-depth interviews, observation, and organizational written materials. Data were coded and analyzed using memoing and situational and positional maps to highlight emerging themes, context, and positions within the data. Results Parents repeatedly endorsed a desire for continuity of nursing care, wanting to ensure that the bedside nurse valued their child as an individual and understood the complexities of the child's care regimen. Nurses understood this need but faced both contextual and personal challenges to achieving continuity, including fluctuations in staffing needs, training demands, fear of emotional entanglement, and concern for missed learning opportunities. Discussion Continuity of nursing care is highly valued by parents of children with complex chronic condition in the PICU, but significant barriers to optimal delivery exist within the current critical care environment. Mechanisms for supporting nurses to deliver continuity of care are needed, as are alternative ways to help parents feel that all nurses caring for their child have the knowledge necessary to deliver safe and compassionate care.

In pediatric oncology, clear communication regarding symptom occurrence between clinicians and children is essential in order to provide safe and effective care. Mobile technology provides a means to enhance the standard clinician-patient interview, particularly among children, who are well versed in the use of technology. To help children identify and voice their concerns in the health care setting, researchers created Sisom, an animated computer tool for children and young people with serious and chronic illnesses. The purposes of this study of 100 dyads of patients 7-12 years of age and their parents were to: compare participants' reports of symptom occurrence using Sisom to a standard symptom checklist and determine the time requirements, ease of use, and perceived usefulness of the Sisom tool by children with cancer and their parents.Child and parent participants completed both Sisom and the Memorial Symptom Assessment Scale. Symptoms on the two tools were compared and 20 items were similar to allow for comparisons.Children reported a significantly higher number of these 20 symptoms using Sisom as compared to the MSAS (i.e., 6.8 versus 4.9 symptoms, p0.001). A similar pattern was noted for parental proxy reports (i.e., 8.7 versus 5.7 symptoms, p0.001). Sisom was completed in less than 30 min, with high ratings of ease of use and perceived usefulness from parent participants.Sisom provides a systematic and engaging method to elicit symptom reports from children for use in clinical care and research.

Patient and family-centered care (PFCC) is the foundation for pediatric healthcare. The existence of hospital rules can, however, impact the extent to which PFCC is delivered. This qualitative, grounded theory study identified the existence of explicit and implicit rules in a pediatric intensive care unit, all of which negatively affected the family's ability to receive care that was attentive to their needs. The rules also placed the registered nurse in the challenging position of serving as rule enforcer and facilitator of PFCC. Further work is needed to explore how to adapt the hospital environment to better meet families' needs.

Postural instability, falls, and fear of falling that accompany frailty with aging and disease form major impediments to physical activity. In this article we present a theoretical framework that may help researchers and practitioners in the development and delivery of intervention programs aimed at reducing falls and improving postural stability and locomotion in older individuals and in those with disability due to disease. Based on a review of the dynamical and complex systems perspectives of movement coordination and control, we show that 1) central to developing a movement-based intervention program aimed at fall reduction and prevention is the notion that variability can play a functional role and facilitate movement adaptability, 2) intervention programs aimed at fall reduction should focus more on coordination and stability boundary measures instead of traditional gait and posture outcome variables, and 3) noise-based intervention techniques using stochastic resonance may offer external aids to improve dynamic balance control.

Background Falls are the leading cause of death in adults over 65 years of age. Falls during turning are likely to result in costly and debilitating hip fractures. Two-thirds of adults who fracture a hip will never regain their previous level of independence. The purpose of this study, therefore, was to examine performance of turning in place in young and older adults. Methods Ten young (mean age = 25 years) and 10 community-dwelling older adults (mean age = 75 years) performed a standing turning task under two conditions: feet constrained and feet unconstrained. Dependent measures were rotational range of motion of the head-on-trunk, trunk-on-pelvis, pelvis and feet; trunk flexion/extension and knee flexion; and center of pressure range and center of mass range in both the anterior–posterior and medial–lateral directions. Findings In both conditions, older adults used less head-on-trunk but more trunk-on-pelvis rotation than the young adults. In the constrained condition, older adults also used more trunk extension and knee flexion than the young adults. In the unconstrained condition, more of the older adults moved their feet (60% vs. 30% of young adults). These differences in segmental motion resulted in greater center of mass movement for the older adults in the constrained but not the unconstrained foot condition. Interpretations Older adults show changes in segmental spinal range of motion associated with postural instability while turning in place. Foot movements play an essential role in compensating for these changes and maintaining postural stability.

Importance Medical errors and adverse events (AEs) are common among hospitalized children. While clinician reports are the foundation of operational hospital safety surveillance and a key component of multifaceted research surveillance, patient and family reports are not routinely gathered. We hypothesized that a novel family-reporting mechanism would improve incident detection. Objective To compare error and AE rates (1) gathered systematically with vs without family reporting, (2) reported by families vs clinicians, and (3) reported by families vs hospital incident reports. Design, Setting, and Participants We conducted a prospective cohort study including the parents/caregivers of 989 hospitalized patients 17 years and younger (total 3902 patient-days) and their clinicians from December 2014 to July 2015 in 4 US pediatric centers. Clinician abstractors identified potential errors and AEs by reviewing medical records, hospital incident reports, and clinician reports as well as weekly and discharge Family Safety Interviews (FSIs). Two physicians reviewed and independently categorized all incidents, rating severity and preventability (agreement, 68%-90%; κ, 0.50-0.68). Discordant categorizations were reconciled. Rates were generated using Poisson regression estimated via generalized estimating equations to account for repeated measures on the same patient. Main Outcomes and Measures Error and AE rates. Results Overall, 746 parents/caregivers consented for the study. Of these, 717 completed FSIs. Their median (interquartile range) age was 32.5 (26-40) years; 380 (53.0%) were nonwhite, 566 (78.9%) were female, 603 (84.1%) were English speaking, and 380 (53.0%) had attended college. Of 717 parents/caregivers completing FSIs, 185 (25.8%) reported a total of 255 incidents, which were classified as 132 safety concerns (51.8%), 102 nonsafety-related quality concerns (40.0%), and 21 other concerns (8.2%). These included 22 preventable AEs (8.6%), 17 nonharmful medical errors (6.7%), and 11 nonpreventable AEs (4.3%) on the study unit. In total, 179 errors and 113 AEs were identified from all sources. Family reports included 8 otherwise unidentified AEs, including 7 preventable AEs. Error rates with family reporting (45.9 per 1000 patient-days) were 1.2-fold (95% CI, 1.1-1.2) higher than rates without family reporting (39.7 per 1000 patient-days). Adverse event rates with family reporting (28.7 per 1000 patient-days) were 1.1-fold (95% CI, 1.0-1.2; P = .006) higher than rates without (26.1 per 1000 patient-days). Families and clinicians reported similar rates of errors (10.0 vs 12.8 per 1000 patient-days; relative rate, 0.8; 95% CI, .5-1.2) and AEs (8.5 vs 6.2 per 1000 patient-days; relative rate, 1.4; 95% CI, 0.8-2.2). Family-reported error rates were 5.0-fold (95% CI, 1.9-13.0) higher and AE rates 2.9-fold (95% CI, 1.2-6.7) higher than hospital incident report rates. Conclusions and Relevance Families provide unique information about hospital safety and should be included in hospital safety surveillance in order to facilitate better design and assessment of interventions to improve safety.

We present new high-contrast images in near-infrared wavelengths ($\lambda$ = 1.04, 1.24, 1.62, 2.18 and 3.78$\mu$m) of the young variable star CQ Tau, aiming to constrain the presence of companions in the protoplanetary disc. We reached a Ks-band contrast of 14 magnitudes with SPHERE/IRDIS at separations greater than 0."4 from the star. Our mass sensitivity curve rules out giant planets above 4 M$_{\rm Jup}$ immediately outside the spiral arms at $\sim$60 au and above 2-3 M$_{\rm Jup}$ beyond 100 au to 5$\sigma$ confidence assuming hot-start models. We do, however, detect four spiral arms, a double-arc and evidence for shadows in scattered light cast by a misaligned inner disc. Our observations may be explained by an unseen close-in companion on an inclined and eccentric orbit. Such a hypothesis would also account for the disc CO cavity and disturbed kinematics., Comment: 10 figures, 14 pages. Accepted for publication in MNRAS on 25 July 2022