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OBJECTIVE: Extremely low birth weight (ELBW; < or =1000 g) infants with necrotizing enterocolitis (NEC) or isolated intestinal perforation (IP) are treated surgically with either initial laparotomy or peritoneal drain placement. The only published data comparing these therapies are from small, retrospective, single-center studies that do not address outcomes beyond nursery discharge. The objective of this study was to conduct a prospective, multicenter, observational study to (1) develop a hypothesis about the relative effect of these 2 therapies on risk-adjusted outcomes through 18 to 22 months in ELBW infants and (2) to obtain data that would be useful in designing and conducting a successful trial of this hypothesis. METHODS: A prospective, cohort study was conducted at 16 clinical centers within the National Institute of Child Health and Human Development Neonatal Research Network. To assist in risk adjustment, the attending pediatric surgeon recorded the preoperative diagnosis and intraoperative diagnosis and identified infants who were considered to be too ill for laparotomy. Predefined measures of short- and longer-term outcome included (1) either predischarge death or prolonged parenteral nutrition (>85 days) after enrollment and (2) either death or neurodevelopmental impairment on a standardized examination at 18 to 22 months' adjusted age. RESULTS: Severe NEC or IP occurred in 156 (5.2%) of 2987 ELBW infants; 80 were treated with initial drainage, and 76 were treated with initial laparotomy. By 18 to 22 months, 78 (50%) had died; 112 (72%) had died or were shown to be impaired. Outcome was worse in the subgroup with NEC. Laparotomy was never performed in 76% (28 of 36) of drain-treated survivors. CONCLUSIONS: Drainage was commonly used, and outcome was poor. Our findings, particularly the risk-adjusted odds ratio favoring laparotomy for death or impairment, indicate the need for a large, multicenter clinical trial to assess the effect of the initial surgical therapy on outcome at > or =18 months. [ABSTRACT FROM AUTHOR]

Background: The older adult population is rapidly expanding in the United States (US), with a high prevalence of high blood pressure, high cholesterol, and diabetes. Medication nonadherence is prevalent in this population, with less evidence on the influence of social determinants of health (SDoH). Thus, the objective of this study was to identify and prioritize SDoH associated with medication adherence among US older adults with these comorbidities., Method: Using the World Health Organization Commission on Social Determinants of Health and Pharmacy Quality Alliance Medication Access Conceptual Frameworks, publicly available National Health and Nutrition Examination Survey datasets (2009-2018) were cross-sectionally analyzed among respondents aged 65 and older who were diagnosed with study diseases. Data analyses included descriptive statistics, and logistic regression using an alpha level of 0.05., Result: Analyses included 5513 respondents' data. Bivariate analysis revealed significant differences in medication adherence based on several structural (e.g., ethnicity) and intermediary (e.g., disability status) determinants of health. Multivariable analysis revealed significant differences in medication adherence for alcohol consumption ( p = 0.034) and usual healthcare place ( p = 0.001)., Conclusions: The study findings underscore pertinent implications for public health and policy, with specific SDoH being the most likely to affect medication adherence in common chronic conditions among older adults in the US.

The multicenter Necrotizing Enterocolitis Surgery Trial compared initial peritoneal drainage with laparotomy among infants with extremely low birth weight and surgical necrotizing enterocolitis or intestinal perforation. In this post hoc analysis of trial data, initial drainage was associated with adverse respiratory outcomes, both in hospital and through 2 years corrected age., Competing Interests: Declaration of Competing Interest The National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (U10 HD27871, U10 HD53119, UG1 HD21364, UG1 HD21373, UG1 HD21385, UG1 HD27851, UG1 HD27853, UG1 HD27856, UG1 HD27880,UG1 HD27904, UG1 HD34216, UG1 HD36790, UG1 HD40492, UG1 HD40689, UG1 HD53089, UG1 HD53109, UG1 HD68244, UG1 HD68270, UG1 HD68278, UG1 HD68263, UG1 HD68284, UG1 HD87226, UG1 HD87229) and the National Center for Advancing Translational Sciences (NCATS) (UL1 TR6, UL1 TR41, UL1 TR42, UL1 TR77, UL1 TR93, UL1 TR442, UL1 TR454, UL1 TR1117) provided grant support through cooperative agreements for the Neonatal Research Network’s Necrotizing Enterocolitis Surgery Trial (NEST). While NICHD staff had input into the trial design, conduct, analysis, and manuscript drafting, the comments and views of the authors do not necessarily represent the views of NICHD, the National Institutes of Health, the Department of Health and Human Services, or the U.S. Government. The authors have no conflicts of interest to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To develop a severity-adjusted, hospital-level benchmarking comparative performance report for postoperative organ space infection (OSI) and antibiotic utilization in children with complicated appendicitis., Background: No benchmarking data exist to aid hospitals in identifying and prioritizing opportunities for infection prevention or antimicrobial stewardship in children with complicated appendicitis., Methods: This was a multicenter cohort study using National Surgical Quality Improvement Program-Pediatric data from 16 hospitals participating in a regional research consortium, augmented with antibiotic utilization data obtained through supplemental chart review. Children with complicated appendicitis who underwent appendectomy from July 1, 2015 to June 30, 2020 were included. Thirty-day postoperative OSI rates and cumulative antibiotic utilization were compared between hospitals using observed-to-expected (O/E) ratios after adjusting for disease severity using mixed-effect models. Hospitals were considered outliers if the 95% CI for O/E ratios did not include 1.0., Results: A total of 1790 patients were included. Overall, the OSI rate was 15.6% (hospital range: 2.6% to 39.4%) and median cumulative antibiotic utilization was 9.0 days (range: 3.0 to 13.0). Across hospitals, adjusted O/E ratios ranged 5.7-fold for OSI (0.49 to 2.80, P = 0.03) and 2.4-fold for antibiotic utilization (0.59 to 1.45, P < 0.01). Three (19%) hospitals were outliers for OSI (1 high and 2 low performers), and 8 (50%) were outliers for antibiotic utilization (5 high and 3 low utilizers). Ten (63%) hospitals were identified as outliers in one or both measures., Conclusions: A comparative performance benchmarking report may help hospitals identify and prioritize quality improvement opportunities for infection prevention and antimicrobial stewardship, as well as identify exemplar performers for dissemination of best practices., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To evaluate the impact of prophylactic antibiotics on early infectious complications after central venous access device (VAD) placement in children with cancer., Background: Despite the frequency of VAD procedures in children, the effectiveness of prophylactic antibiotics for reducing infectious complications is unknown., Methods: This was a retrospective cohort study of children with cancer undergoing central VAD placement identified in the Pediatric Health Information System database between 2017 and 2021. The primary outcome was the rate of early infectious complications (composite surgical site infections, central line-associated bloodstream infections, and bacteremia). Multivariable logistic regression was used to evaluate factors associated with early infection, and heterogeneity of treatment effect of prophylactic antibiotics was compared across subgroups., Results: A total of 9216 patients were included (6058 ports and 3158 tunneled lines). Prophylactic antibiotics were associated with lower early infectious complications overall [1.3% vs 2.4%; odds ratio (OR): 0.55 (95% CI: 0.39-0.79), P < 0.001], an effect demonstrated for tunneled lines (OR: 0.59, 95% CI: 0.41-0.84) but not ports (OR: 3.01, 95% CI: 0.66-13.78). On multivariate analysis, prophylactic antibiotics (OR: 0.67, 95% CI: 0.45-0.97) and solid tumors (OR: 0.38, 95% CI: 0.22-0.64) were associated with reduced odds of early infections, whereas tunneled lines (OR: 20.78, 95% CI: 9.83-43.93) and acute myelogenous leukemia (OR: 2.37, 95% CI: 1.58-3.57) had increased odds., Conclusions: Prophylactic antibiotics are associated with reduced early infectious complications after central VAD placement overall. Despite recommendations from multiple national organizations against prophylactic antibiotics, these findings suggest a benefit in children with malignancy undergoing tunneled line placement., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: The American Association of Colleges of Pharmacy's Social and Administrative Sciences Section and the American Pharmacists Association-Academy of Pharmaceutical Research and Science's Economic, Social and Administrative Sciences Section formed a Gender Equity Task Force to determine if there is evidence to suggest that there is gender disparity in pay; responsibilities; treatment by peers/colleagues, students, and administration; leadership opportunities; and rank, tenure status, and career advancement for Section members; and to develop recommendations to address existing disparities., Methods: A Qualtrics survey was emailed in December 2020 to all American Association of Colleges of Pharmacy's Social and Administrative Sciences and American Pharmacists Association-Academy of Pharmaceutical Research and Science's Economic, Social and Administrative Sciences Section members. The questionnaire included items regarding favorability toward men or women in various academic domains (research, teaching, service, recruitment, mentoring, and advancement). Participants were asked if they had experienced gender inequity, and if so, at what type of institution and academic rank. The χ 2 tests of independence and post hoc comparisons were used to assess item responses according to gender., Results: Of the respondents, 72% indicated that they had experienced gender inequity. Women and persons of color were more likely to do so. Women commonly reported that men received more favorable treatment in nearly all academic domains, whereas men reported that women and men were treated equally., Conclusion: Pharmacy faculty specializing in social and administrative sciences reported experiences of gender inequity and perceptions of gender inequity. Perception gaps existed between male and female faculty in numerous academic domains. Colleges and schools of pharmacy should increase awareness of, and strive to self-assess, gender inequity in their institutions., Competing Interests: Declaration of Competing Interest T.S.M. is the American Association of Colleges of Pharmacy Vice President and Chief Strategy and Diversity Officer. L.P. reports nonfinancial support provided by American Pharmacists Association. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 American Association of Colleges of Pharmacy. Published by Elsevier Inc. All rights reserved.)

Objective: We aimed to determine the incidence of growth failure in infants with necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP) and whether initial laparotomy versus peritoneal drainage (PD) impacted the likelihood of growth failure., Summary Background Data: Infants with surgical NEC and SIP have high mortality, and most have neurodevelopmental impairment and poor growth. Existing literature on growth outcomes for these infants is limited., Methods: This is a preplanned secondary study of the Necrotizing Enterocolitis Surgery Trial dataset. The primary outcome was growth failure (Z-score for weight <-2.0) at 18 to 22 months. We used logistic regression, including diagnosis and treatment, as covariates. Secondary outcomes were analyzed using the Fisher exact or Pearson χ2 test for categorical variables and the Wilcoxon rank sum test or one-way ANOVA for continuous variables., Results: Among 217 survivors, 207 infants (95%) had primary outcome data. Growth failure at 18 to 22 months occurred in 24/50 (48%) of NEC infants versus 65/157 (42%) SIP (P=0.4). The mean weight-for-age Z-score at 18 to 22 months in NEC infants was -2.05±0.99 versus -1.84±1.09 SIP (P=0.2), and the predicted mean weight-for-age Z-score SIP (Beta -0.27; 95% CI: -0.53, -0.01; P=0.041). Median declines in weight-for-age Z-score between birth and 18 to 22 months were significant in all infants but most severe (>2) in NEC infants (P=0.2)., Conclusions: This first ever prospective study of growth outcomes in infants with surgical NEC or SIP demonstrates that growth failure is very common, especially in infants with NEC, and persists at 18-22 months., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To describe the literature on the connections between empathy and professional identity formation (PIF) in pharmacy and other health professions education. A PRISMA-Scoping Review methodology was used for this study. Searches were conducted in PubMed and CINAHL from 2010 to January 12, 2023, with English added as a limiter. Articles had to address empathy and PIF, whether implicitly or explicitly. "Theory talk" was modified and utilized with 6 levels of connectedness to assess article quality., Findings: A total of 419 articles were reviewed for inclusion into the study with a total of 45 articles being included. Seventeen (37.8 %) and 12 articles (26.7 %) included a definition for empathy and PIF, respectively. Thirty-eight articles (84.4 %) implicitly discussed a connection between PIF and empathy. Educational initiatives that fostered connections between empathy and PIF focused on classroom activities, clinical rotation activities, and assessments. Key elements to enhance empathy and PIF development across articles focused on mentorship, role models, and reflective practice, alongside intentional curricular integration. Similarly, barriers to empathy and PIF are multifaceted., Summary: Despite educational initiatives in the literature that attempt to foster connections between empathy and PIF in classroom activities, clinical rotation activities, and assessments, most connections are implicit, as opposed to explicit. This may be due to the multiple barriers, such as the hidden curriculum, which make the connection between empathy and PIF difficult. This area needs further research and development given the importance of empathy in all health care provider interactions., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: Reliance on International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes may misclassify perforated appendicitis with resultant research, fiscal, and public health implications. We aimed to improve the accuracy of administrative data for perforated appendicitis classification relying on ICD-10-CM codes from 2015 to 2018., Methods: We conducted a retrospective study of randomly sampled patients aged ≤18 years diagnosed with acute appendicitis from eight children's hospitals. Patients were identified using the Pediatric Health Information System, and true perforation status was determined by medical record review. We developed two algorithms by leveraging Pediatric Health Information System data elements and data mining (DM) approaches. The two developed algorithm performance was compared against algorithms that exclusively relied on ICD-10-CM codes using area under the curve and other measures., Results: Of 1051 clinically validated encounters that were included, 383 (36.4%) patients were identified to have perforated appendicitis. The two algorithms developed using DM approaches primarily leveraged ICD-10-CM codes and length of stay. DM-developed algorithms had a significantly higher accuracy than algorithms relying exclusively on ICD-10-CM (P value < 0.01): sensitivity and specificity for DM-developed algorithms were 0.86-0.88 and 0.95-0.97, respectively, which were overall higher than algorithms that relied on only ICD-10-CM., Conclusions: This study provides an algorithm that can improve the accuracy of perforated appendicitis classification using commonly available elements in administrative data. We recommend that this algorithm is used in future appendicitis classification to ensure valid reporting, hospital-level benchmarking, and fiscal or public health assessments., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To compare rates of postoperative drainage and culture profiles in children with complicated appendicitis treated with the 2 most common antibiotic regimens with and without antipseudomonal activity [piperacillin-tazobactam (PT) and ceftriaxone with metronidazole (CM)]., Background: Variation in the use of antipseudomonal antibiotics has been driven by a paucity of multicenter data reporting clinically relevant, culture-based outcomes., Methods: A retrospective cohort study of patients with complicated appendicitis (7/2015-6/2020) using NSQIP-Pediatric data from 15 hospitals participating in a regional research consortium. Operative report details, antibiotic utilization, and culture data were obtained through supplemental chart review. Rates of 30-day postoperative drainage and organism-specific culture positivity were compared between groups using mixed-effects regression to adjust for clustering after propensity matching on measures of disease severity., Results: In all, 1002 children met the criteria for matching (58.9% received CM and 41.1% received PT). In the matched sample of 778 patients, children treated with PT had similar rates of drainage overall [PT: 11.8%, CM: 12.1%; odds ratio (OR): 1.44 (OR: 0.71-2.94)] and higher rates of drainage associated with the growth of any organism [PT: 7.7%, CM: 4.6%; OR: 2.41 (95% CI: 1.08-5.39)] and Escherichia coli [PT: 4.6%, CM: 1.8%; OR: 3.42 (95% CI: 1.07-10.92)] compared to treatment with CM. Rates were similar between groups for drainage associated with multiple organisms [PT: 2.6%, CM: 1.5%; OR: 3.81 (95% CI: 0.96-15.08)] and Pseudomonas [PT: 1.0%, CM: 1.3%; OR: 3.42 (95% CI: 0.55-21.28)]., Conclusions and Relevance: The use of antipseudomonal antibiotics is not associated with lower rates of postoperative drainage procedures or more favorable culture profiles in children with complicated appendicitis., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Importance: Gangrenous, suppurative, and exudative (GSE) findings have been associated with increased surgical site infection (SSI) risk and resource use in children with nonperforated appendicitis. Establishing the role for postoperative antibiotics may have important implications for infection prevention and antimicrobial stewardship., Objective: To compare SSI rates in children with nonperforated appendicitis with GSE findings who did and did not receive postoperative antibiotics., Design, Setting, and Participants: This was a retrospective cohort study using American College of Surgeons' National Surgical Quality Improvement Program (NSQIP)-Pediatric Appendectomy Targeted data from 16 hospitals participating in a regional research consortium. NSQIP data were augmented with operative report and antibiotic use data obtained through supplemental medical record review. Children with nonperforated appendicitis with GSE findings who underwent appendectomy between July 1, 2015, and June 30, 2020, were identified using previously validated intraoperative criteria. Data were analyzed from October 2022 to July 2023., Exposure: Continuation of antibiotics after appendectomy., Main Outcomes and Measures: Rate of 30-day postoperative SSI including both incisional and organ space infections. Complementary hospital and patient-level analyses were conducted to explore the association between postoperative antibiotic use and severity-adjusted outcomes. The hospital-level analysis explored the correlation between postoperative antibiotic use and observed to expected (O/E) SSI rate ratios after adjusting for differences in disease severity (presence of gangrene and postoperative length of stay) among hospital populations. In the patient-level analysis, propensity score matching was used to balance groups on disease severity, and outcomes were compared using mixed-effects logistic regression to adjust for hospital-level clustering., Results: A total of 958 children (mean [SD] age, 10.7 [3.7] years; 567 male [59.2%]) were included in the hospital-level analysis, of which 573 (59.8%) received postoperative antibiotics. No correlation was found between hospital-level SSI O/E ratios and postoperative antibiotic use when analyzed by either overall rate of use (hospital median, 53.6%; range, 31.6%-100%; Spearman ρ = -0.10; P = .71) or by postoperative antibiotic duration (hospital median, 1 day; range, 0-7 days; Spearman ρ = -0.07; P = .79). In the propensity-matched patient-level analysis including 404 patients, children who received postoperative antibiotics had similar rates of SSI compared with children who did not receive postoperative antibiotics (3 of 202 [1.5%] vs 4 of 202 [2.0%]; odds ratio, 0.75; 95% CI, 0.16-3.39; P = .70)., Conclusions and Relevance: Use of postoperative antibiotics did not improve outcomes in children with nonperforated appendicitis with gangrenous, suppurative, or exudative findings.

Importance: Inguinal hernia repair in preterm infants is common and is associated with considerable morbidity. Whether the inguinal hernia should be repaired prior to or after discharge from the neonatal intensive care unit is controversial., Objective: To evaluate the safety of early vs late surgical repair for preterm infants with an inguinal hernia., Design, Setting, and Participants: A multicenter randomized clinical trial including preterm infants with inguinal hernia diagnosed during initial hospitalization was conducted between September 2013 and April 2021 at 39 US hospitals. Follow-up was completed on January 3, 2023., Interventions: In the early repair strategy, infants underwent inguinal hernia repair before neonatal intensive care unit discharge. In the late repair strategy, hernia repair was planned after discharge from the neonatal intensive care unit and when the infants were older than 55 weeks' postmenstrual age., Main Outcomes and Measures: The primary outcome was occurrence of any prespecified serious adverse event during the 10-month observation period (determined by a blinded adjudication committee). The secondary outcomes included the total number of days in the hospital during the 10-month observation period., Results: Among the 338 randomized infants (172 in the early repair group and 166 in the late repair group), 320 underwent operative repair (86% were male; 2% were Asian, 30% were Black, 16% were Hispanic, 59% were White, and race and ethnicity were unknown in 9% and 4%, respectively; the mean gestational age at birth was 26.6 weeks [SD, 2.8 weeks]; the mean postnatal age at enrollment was 12 weeks [SD, 5 weeks]). Among 308 infants (91%) with complete data (159 in the early repair group and 149 in the late repair group), 44 (28%) in the early repair group vs 27 (18%) in the late repair group had at least 1 serious adverse event (risk difference, -7.9% [95% credible interval, -16.9% to 0%]; 97% bayesian posterior probability of benefit with late repair). The median number of days in the hospital during the 10-month observation period was 19.0 days (IQR, 9.8 to 35.0 days) in the early repair group vs 16.0 days (IQR, 7.0 to 38.0 days) in the late repair group (82% posterior probability of benefit with late repair). In the prespecified subgroup analyses, the probability that late repair reduced the number of infants with at least 1 serious adverse event was higher in infants with a gestational age younger than 28 weeks and in those with bronchopulmonary dysplasia (99% probability of benefit in each subgroup)., Conclusions and Relevance: Among preterm infants with inguinal hernia, the late repair strategy resulted in fewer infants having at least 1 serious adverse event. These findings support delaying inguinal hernia repair until after initial discharge from the neonatal intensive care unit., Trial Registration: ClinicalTrials.gov Identifier: NCT01678638.

Background: Diabetes is the fifth leading cause of death in the United States (US), affecting approximately 27%, or 15.9 million adults 65 years of age and older. Diabetes is the most expensive chronic condition in the US and accounts for the second largest avoidable healthcare cost. Adherence to long-term medication treatment plans is crucial among patients with diabetes because it decreases risk of developing comorbid conditions and improves quality of life. Greater exposure to adverse social determinants of health (SDOH) over an individual's lifespan can result in worse health outcomes. Hence, it is important to obtain a better understanding of how social determinants of health (SDOH) influence patients' behaviors and affect medication adherence among older adults with diabetes., Objectives: Identify and prioritize SDOH associated with medication adherence among a nationally representative sample of older adults with diabetes. Secondary objectives were to characterize SDOH, estimate medication adherence, and explain implications for health disparity populations among older adults in the US who have been diagnosed with diabetes., Methods: This study used a cross-sectional secondary data analysis to examine the National Health and Nutrition Examination Survey database, identifying associations between SDOH and medication adherence among older adults with diabetes in the US., Results: A total of 1807 respondents' data were included in the analyses. Nearly three-quarters (73.9%) of patients were considered adherent to their oral diabetes medications. Multivariable analysis revealed significant differences in medication adherence based on disability status ( p  = 0.016), household balanced meals ( p  = 0.033), and interview language ( p  = 0.008)., Conclusions: Results revealed those with a disability, those who could not afford a balanced meal, and/or those who spoke English were associated with a higher likelihood of being nonadherent to their diabetes medications in comparison to individuals not in these groups. These findings can assist in developing SDOH-centered medication adherence strategies for pharmacists to implement with older patients with diabetes., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors. Published by Elsevier Inc.)

Objective: The objective of this study was to evaluate whether infants randomized in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network Necrotizing Enterocolitis Surgery Trial differed from eligible infants and whether differences affected the generalizability of trial results., Study Design: Secondary analysis of infants enrolled in Necrotizing Enterocolitis Surgery Trial (born 2010-2017, with follow-up through 2019) at 20 US academic medical centers and an observational data set of eligible infants through 2013. Infants born ≤1000 g and diagnosed with necrotizing enterocolitis or spontaneous intestinal perforation requiring surgical intervention at ≤8 weeks were eligible. The target population included trial-eligible infants (randomized and nonrandomized) born during the first half of the study with available detailed preoperative data. Using model-based weighting methods, we estimated the effect of initial laparotomy vs peritoneal drain had the target population been randomized., Results: The trial included 308 randomized infants. The target population included 382 (156 randomized and 226 eligible, non-randomized) infants. Compared with the target population, fewer randomized infants had necrotizing enterocolitis (31% vs 47%) or died before discharge (27% vs 41%). However, incidence of the primary composite outcome, death or neurodevelopmental impairment, was similar (69% vs 72%). Effect estimates for initial laparotomy vs drain weighted to the target population were largely unchanged from the original trial after accounting for preoperative diagnosis of necrotizing enterocolitis (adjusted relative risk [95% CI]: 0.85 [0.71-1.03] in target population vs 0.81 [0.64-1.04] in trial) or spontaneous intestinal perforation (1.02 [0.79-1.30] vs 1.11 [0.95-1.31])., Conclusion: Despite differences between randomized and eligible infants, estimated treatment effects in the trial and target population were similar, supporting the generalizability of trial results., Trial Registration: ClinicalTrials.gov ID: NCT01029353., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interests., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: To evaluate whether redosing antibiotics within an hour of incision is associated with a reduction in incisional surgical site infection (iSSI) in children with appendicitis., Background: Existing data remain conflicting as to whether children with appendicitis receiving antibiotics at diagnosis benefit from antibiotic redosing before incision., Methods: This was a multicenter retrospective cohort study using data from the Pediatric National Surgical Quality Improvement Program augmented with antibiotic utilization and operative report data obtained though supplemental chart review. Children undergoing appendectomy at 14 hospitals participating in the Eastern Pediatric Surgery Network from July 2016 to June 2020 who received antibiotics upon diagnosis of appendicitis between 1 and 6 hours before incision were included. Multivariable logistic regression was used to compare odds of iSSI in those who were and were not redosed with antibiotics within 1 hour of incision, adjusting for patient demographics, disease severity, antibiotic agents, and hospital-level clustering of events., Results: A total of 3533 children from 14 hospitals were included. Overall, 46.5% were redosed (hospital range: 1.8%-94.4%, P <0.001) and iSSI rates were similar between groups [redosed: 1.2% vs non-redosed: 1.3%; odds ratio (OR) 0.84, (95%,CI, 0.39-1.83)]. In subgroup analyses, redosing was associated with lower iSSI rates when cefoxitin was used as the initial antibiotic (redosed: 1.0% vs nonredosed: 2.5%; OR: 0.38, (95% CI, 0.17-0.84)], but no benefit was found with other antibiotic regimens, longer periods between initial antibiotic administration and incision, or with increased disease severity., Conclusions: Redosing of antibiotics within 1 hour of incision in children who received their initial dose within 6 hours of incision was not associated with reduction in risk of incisional site infection unless cefoxitin was used as the initial antibiotic., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: The 2020-2021 American Association of Colleges of Pharmacy Faculty Affairs Standing Committee (FASC) was charged with identifying how faculty can self-advocate and promote themselves in a social influence context., Findings: The FASC identified social influence and persuasion theories and strategies that can be used by faculty to initiate self-advocacy discussions and collaborations. Social influence and persuasion theories can provide a framework for research and scholarship or for beginning discussions regarding self-advocacy., Summary: This FASC report describes the Committee charge, background information, and an overview of social influence theories and how these theories can be applied in academic pharmacy. The report concludes with a summary of issues for follow-up to the Committee's work., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2023 American Association of Colleges of Pharmacy. Published by Elsevier Inc. All rights reserved.)

The goal of this Best Practice Review is to support researchers in successfully preparing and publishing qualitative research in pharmacy education. Standard practice from the literature and journals' guidance from related fields were reviewed, and recommendations and resources applicable to qualitative research in pharmacy education were compiled for researchers planning to conduct and publish qualitative research. This review provides recommendations, not requirements, for publication in the Journal and is intended to be a guide, especially for authors and reviewers relatively new to the field of qualitative research. Additionally, researchers planning to publish their qualitative research are advised to review available best practices and standards, such as the Consolidated Criteria for Reporting Qualitative Research checklist and the Standards for Reporting Qualitative Research. Given the diverse methodology of qualitative research, it is important for authors to provide sufficient details and justifications of selected methods for transparency and to report collected results in a manner that allows reviewers and readers to adequately assess the validity of their study and the applicability of the findings., Competing Interests: Declaration of Competing Interests None declared., (Copyright © 2023 American Association of Colleges of Pharmacy. Published by Elsevier Inc. All rights reserved.)

Background: The objective of this study was to evaluate the clinical utility of a routine predischarge WBC count (RPD-WBC) for predicting postdischarge organ space infection (OSI) in children with complicated appendicitis., Study Design: This was a multicenter study using NSQIP-Pediatric data from 14 hospitals augmented with RPD-WBC data obtained through supplemental chart review. Children with fever or surgical site infection diagnosed during the index admission were excluded. The positive predictive value (PPV) for postdischarge OSI was calculated for RPD-WBC values of persistent leukocytosis (≥9.0 × 10 3 cells/μL), increasing leukocytosis (RPD-WBC > preoperative WBC), quartiles of absolute RPD-WBC, and quartiles of relative proportional change from preoperative WBC. Logistic regression was used to calculate predictive values adjusted for patient age, appendicitis severity, and use of postdischarge antibiotics., Results: A total of 1,264 children were included, of which 348 (27.5%) had a RPD-WBC obtained (hospital range: 0.8 to 100%, p < 0.01). The median RPD-WBC was similar between children who did and did not develop a postdischarge OSI (9.0 vs 8.9; p = 0.57), and leukocytosis was absent in 50% of children who developed a postdischarge OSI. The PPV of RPD-WBC was poor for both persistent and increasing leukocytosis (3.9% and 9.8%, respectively) and for thresholds based on the quartiles of highest RPD-WBC values (>11.1, PPV: 6.4%) and greatest proportional change (<32% decrease from preoperative WBC; PPV: 7.8%)., Conclusions: Routine predischarge WBC data have poor predictive value for identifying children at risk for postdischarge OSI after appendectomy for complicated appendicitis., (Copyright © 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: The objective was to explore the hospital-level relationship between routine pre-discharge WBC utilization (RPD-WBC) and outcomes in children with complicated appendicitis., Methods: Multicenter analysis of NSQIP-Pediatric data from 14 consortium hospitals augmented with RPD-WBC data. WBC were considered routine if obtained within one day of discharge in children who did not develop an organ space infection (OSI) or fever during the index admission. Hospital-level observed-to-expected ratios (O/E) for 30-day outcomes (antibiotic days, imaging utilization, healthcare days, and OSI) were calculated after adjusting for appendicitis severity and patient characteristics. Spearman correlation was used to explore the relationship between hospital-level RPD-WBC utilization and O/E's for each outcome., Results: 1528 children were included. Significant variation was found across hospitals in RPD-WBC use (range: 0.7-100%; p < 0.01) and all outcomes (mean antibiotic days: 9.9 [O/E range: 0.56-1.44, p < 0.01]; imaging: 21.9% [O/E range: 0.40-2.75, p < 0.01]; mean healthcare visit days: 5.7 [O/E 0.74-1.27, p < 0.01]); OSI: 14.1% [O/E range: 0.43-3.64, p < 0.01]). No correlation was found between RPD-WBC use and antibiotic days (r = +0.14, p = 0.64), imaging (r = -0.07, p = 0.82), healthcare days (r = +0.35, p = 0.23) or OSI (r = -0.13, p = 0.65)., Conclusions: Increased RPD-WBC utilization in pediatric complicated appendicitis did not correlate with improved outcomes or resource utilization at the hospital level., Level of Evidence: III., Type of Study: Clinical Research., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective. The majority of practicing pharmacists and student pharmacists are women. However, instruments to assess perceptions of gender equity within pharmacy academia are not available. The objective of this research was to describe the psychometric analysis of a questionnaire developed to assess gender equity by a Gender Equity Task Force and to report reliability and validity evidence. Methods. A questionnaire with 21 items addressing the teaching, research, service, advancement, mentoring, recruitment, and gender of college leaders was created. The survey was distributed via email in December 2020 to all social and administrative science section members of two professional associations. Rasch analysis was performed to evaluate the reliability and validity evidence for the questionnaire. Results. After reverse coding, all items met parameters for unidimensionality necessary for Rasch analysis. Once adjacent categories were merged to create a 3-point scale, the scale and items met parameters for appropriate functionality. Items were ordered hierarchically in order of difficulty. The modified instrument and scale can be treated as interval level data for future use. Conclusion. This analysis provides reliability and validity evidence supporting use of the gender equity questionnaire in the social and administrative academic pharmacy population if recommended edits such as the 3-point scale are used. Future research on gender equity can benefit from use of a psychometrically sound questionnaire for data collection., (© 2023 American Association of Colleges of Pharmacy.)

Objective. To determine, by survey, the inclusion of systemic racism education in US Doctor of Pharmacy (PharmD) curricula and identify barriers and facilitators to addressing this content. Methods. A survey was developed and distributed to curricular representatives at US colleges and schools of pharmacy. The survey assessed inclusion of systemic racism education in curricula, faculty involvement in teaching systemic racism content, barriers to adding systemic racism content in curricula, and future curricular plans. Data were analyzed using descriptive statistics for institutional background information, curricular content, and barriers to inclusion. Relationships between the inclusion of systemic racism content at public versus private programs were examined, and associations between traditional and accelerated programs were assessed. Results. Fifty-eight colleges and schools of pharmacy provided usable responses. Of the respondents, 84% indicated that teaching systemic racism content and its impact on health and health care was a low priority. For 24% of respondents, systemic racism content was not currently included in their curriculum, while 34% indicated that systemic racism content was included in one or more courses or modules but was not a focus. Despite systemic racism content being offered in any didactic year, it was rarely included in experiential curricula. Top barriers to inclusion were lack of faculty knowledge and comfort with content and limited curricular space. No significant differences were found between program types. Conclusion. Based on the current level of systemic racism education and barriers to inclusion, faculty need training and resources to teach systemic racism concepts within pharmacy curricula. The inclusion of systemic racism concepts and guidance in the Accreditation Council for Pharmacy Education's Accreditation Standards could help to drive meaningful change and promote health equity., (© 2023 American Association of Colleges of Pharmacy.)

Background: Gabapentinoids (gabapentin and pregabalin) are widely used in clinical practice, but recent evidence indicates that they carry an increased risk of misuse. As healthcare professionals (HCPs) and policymakers plan different strategies to promote harm reduction, it is important to understand different interested party viewpoints., Objective: To explore prescriber, pharmacist, and drug policy expert (DPE) awareness, opinions, and experiences regarding gabapentinoid misuse., Methods: A qualitative description study using individual semi-structured virtual interviews was conducted between February and April 2021. Participants included prescribers (physicians, physician assistants [PA], or nurse practitioners [NP]) and pharmacists practicing in outpatient, ambulatory, or community-based healthcare settings; individuals with relevant drug policy expertise were also included. Qualtrics (Provo, Utah) and Zoom (San Jose, California) were used to facilitate quantitative (for initial screening and participant characteristics) and qualitative (interview) data collection. Data were coded and organized into themes in NVivo (QSR International; Burlington, Massachusetts) using thematic analysis steps., Results: A total of 43 individuals participated in this study, including 16 (37.2%) pharmacists, 13 (30.2%) physicians, seven (16.3%) NPs, four (9.3%) DPEs, two (4.7%) pharmacist/DPEs, and one (2.3%) PA. Results were organized along four themes: (1) challenges/opportunities in gabapentinoid use; (2) gabapentinoid misuse awareness; (3) solutions to gabapentinoid misuse and (4) contributing barriers in pain management. Participants invoked different opinions in their consideration of gabapentinoid misuse, including the desire for harm reduction, the limitations of the current healthcare and insurance system, the lack of options for pain and substance use disorder treatment, and the influence of patient expectations., Conclusions: Gabapentinoid misuse was commonly framed in comparative fashion to ongoing concerns with opioids, and proposed solutions often focused less on regulatory control and more toward patient and HCP education and an overhaul of the health system approach to substance use and healthcare overall., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Anecdotal evidence suggests that gender inequity persists in academic pharmacy. To date, there are limited published data about the perception of gender inequity in academic pharmacy., Objective: The objective of this project was to determine themes associated with gender inequity perceptions in social and administrative science faculty from 2 national pharmacy organizations., Methods: A gender equity task force comprising 13 members from Social and Administrative Sciences (SAS) sections of the American Pharmacists Association and the American Association of Colleges of Pharmacy was formed. The task force designed a semistructured interview guide comprising questions about demographics and core areas where inequities likely exist. When the survey invitation was sent to faculty members of the SAS sections via Qualtrics, faculty indicated whether they were willing to be interviewed. Interviews were conducted by 2 members of the task force via video conferencing application. The interviews were transcribed. Topic coding involving general categorization by theme followed by refinement to delineate subcategories was used. Coding was conducted independently by 3 coders followed by consensus when discrepancies were identified., Results: A total of 21 faculty participated in the interviews. Respondents were primarily female (71%), were white (90%), had Doctor of Philosophy as their terminal degree (71%), and were in nontenure track positions (57%). Most respondents (90%) experienced gender inequity. A total of 52% reported experiencing gender inequity at all ranks from graduate student to full professor. Four major themes were identified: microaggression (57%), workload (86%), respect (76%), and opportunities (38%). Workload, respect, and opportunities included multiple subthemes., Conclusion: Faculty respondents perceive gender inequities in multiple areas of their work. Greater inequity perceptions were present in areas of workload and respect. The task force offers multiple recommendations to address these inequities., (Published by Elsevier Inc.)

The Necrotizing Enterocolitis Surgery Trial (NEST) highlights the importance of distinguishing necrotizing enterocolitis (NEC) from spontaneous intestinal perforation (SIP) when developing surgical treatment plans. Further research is needed to increase the accuracy of this distinction, but even with our current abilities to do this initial laparotomy appears to be optimal for infants with presumed NEC. The preferred initial operation for those with SIP is more equivocal. Rates of NEC are likely decreasing slowly, whereas those with SIP are not. New imaging modalities, especially ultrasound, are becoming more useful but require more detailed investigation. Understanding the mechanisms causing these two conditions remains of paramount importance., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective. Student pharmacists must cultivate self-awareness to ensure that they can assess their skill development and abilities, including affective domain skills such as empathy. External feedback can augment development, but validated assessments are needed for accuracy. Thus, the objectives of this study were to establish validity evidence for the revised version of the Kiersma-Chen Empathy Scale (KCES-R), compare student self-perceptions and simulated patient perceptions of student empathy using a parallel patient scale (KCES-PV), and evaluate student reflections on the encounter. Methods. Student pharmacists completed an assessment of their self-perceptions of empathy (KCES-R) before and after the patient encounter. Simulated patients completed the KCES-PV regarding the student pharmacists' empathy immediately after the encounter. Student pharmacists also watched their encounter videos and completed a self-reflection on their use of empathy. Responses were analyzed using statistical tests, whereas students' reflections were examined using thematic analysis. Results. Results showed that the KCES-R contains two factors with high internal consistency and can detect changes in empathy. Student pharmacists' self-perceptions of their empathy abilities appeared higher than when their empathy abilities were evaluated by simulated patients. Student pharmacists had a strong belief in the importance of expressing empathy during patient encounters and indicated a need for further development. Conclusion. This study provides validity evidence for the use of the KCES-R and presents a parallel scale that may be used by simulated patients. Validated parallel scales along with reflective practice could be a potential avenue to grow self-awareness and empathy by allowing students to receive feedback and then reflect on their perceived versus actual demonstration of the skill., (© 2022 American Association of Colleges of Pharmacy.)

Randomized controlled trials (RCTs) are challenging, but are the studies most likely to change practice and benefit patients. RCTs investigating neonatal surgical therapies are rare. The Necrotizing Enterocolitis Surgery Trial (NEST) was the first surgical RCT conducted by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network (NRN), and multiple lessons were learned. NEST was conducted over a 7.25-year enrollment period and the primary outcome was death or neurodevelopmental impairment (NDI) at 18-22 months corrected age. Surgical investigators designing clinical trials involving neonatal surgical treatments have many considerations to include, including how to study eligible but non-randomized patients, heterogeneity of treatment effect, use of frequentist and Bayesian analyses, assessment of generalizability, and anticipating criticisms during peer review. Surgeons are encouraged to embrace these challenges and seek innovative methods to acquire evidence that will be used to improve patient outcomes., Competing Interests: Disclosures The authors have no conflicts to disclose. While NICHD staff had input into the study design, conduct, analysis, and manuscript drafting, the comments and views of the authors do not necessarily represent the views of NICHD, the National Institutes of Health, the Department of Health and Human Services, or the U.S. Government., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The curricula of US schools and colleges of pharmacy provide students with only a cursory introduction to patients with disabilities, and this is usually achieved through didactic content. These brief introductions are considered helpful; however, pedagogical approaches do not provide comprehensive content for mastery of skills and strategies for delivering accessible healthcare services to patients with disabilities. Student pharmacists' need to obtain the requisite education, knowledge, and skills to provide effective healthcare to patients with disabilities. Accordingly, it is essential that schools and colleges of pharmacy prepare student pharmacists to be competent and confident in providing effective and accessible care to this underserved patient population., (© 2022 American Association of Colleges of Pharmacy.)

Importance: The clinical significance of gangrenous, suppurative, or exudative (GSE) findings is poorly characterized in children with nonperforated appendicitis., Objective: To evaluate whether GSE findings in children with nonperforated appendicitis are associated with increased risk of surgical site infections and resource utilization., Design, Setting, and Participants: This multicenter cohort study used data from the Appendectomy Targeted Database of the American College of Surgeons Pediatric National Surgical Quality Improvement Program, which were augmented with operative report data obtained by supplemental medical record review. Data were obtained from 15 hospitals participating in the Eastern Pediatric Surgery Network (EPSN) research consortium. The study cohort comprised children (aged ≤18 years) with nonperforated appendicitis who underwent appendectomy from July 1, 2015, to June 30, 2020., Exposures: The presence of GSE findings was established through standardized, keyword-based audits of operative reports by EPSN surgeons. Interrater agreement for the presence or absence of GSE findings was evaluated in a random sample of 900 operative reports., Main Outcomes and Measures: The primary outcome was 30-day postoperative surgical site infections (incisional and organ space infections). Secondary outcomes included rates of hospital revisits, postoperative abdominal imaging, and postoperative length of stay. Multivariable mixed-effects regression was used to adjust measures of association for patient characteristics and clustering within hospitals., Results: Among 6133 children with nonperforated appendicitis, 867 (14.1%) had GSE findings identified from operative report review (hospital range, 4.2%-30.2%; P < .001). Reviewers agreed on presence or absence of GSE findings in 93.3% of cases (weighted κ, 0.89; 95% CI, 0.86-0.92). In multivariable analysis, GSE findings were associated with increased odds of any surgical site infection (4.3% vs 2.2%; odds ratio [OR], 1.91; 95% CI, 1.35-2.71; P < .001), organ space infection (2.8% vs 1.1%; OR, 2.18; 95% CI, 1.30-3.67; P = .003), postoperative imaging (5.8% vs 3.7%; OR, 1.70; 95% CI, 1.23-2.36; P = .002), and prolonged mean postoperative length of stay (1.6 vs 0.9 days; rate ratio, 1.43; 95% CI, 1.32-1.54; P < .001)., Conclusions and Relevance: In children with nonperforated appendicitis, findings of gangrene, suppuration, or exudate are associated with increased surgical site infections and resource utilization. Further investigation is needed to establish the role and duration of postoperative antibiotics and inpatient management to optimize outcomes in this cohort of children.

Background: Non-routine events (NRE) are defined as any suboptimal occurrences in a process being measured in the opinion of the reporter and comes from the field of human factors engineering. These typically occur well up-stream of an adverse event and NRE measurement has not been applied to the complex context of neonatal surgery. We sought to apply this novel safety event measurement methodology to neonates in the NICU undergoing gastrostomy tube placement., Methods: A prospective pilot study was conducted between November 2016 and August 2020 in the Level IV NICU and the pediatric operating rooms of an urban academic children's hospital to determine the incidence, severity, impact, and contributory factors of clinician-reported non-routine events (NREs, i.e., deviations from optimal care) and 30-day NSQIP occurrences in neonates receiving a G-tube., Results: Clinicians reported at least one NRE in 32 of 36 (89%) G-tube cases, averaging 3.0 (Standard deviation: 2.5) NRE reports per case. NSQIP-P review identified 7 cases (19%) with NSQIP-P occurrences and each of these cases had multiple reported NREs. One case in which NREs were not reported was without NSQIP-P occurrences. The odds ratio of having a NSQIP-P occurrence with the presence of an NRE was 0.695 (95% CI 0.06-17.04)., Conclusion: Despite being considered a "simple" operation, >80% of neonatal G-tube placement operations had at least one reported NRE by an operative team member. In this pilot study, NRE occurrence was not significantly associated with the subsequent reporting of an NSQIP-P occurrence. Understanding contributory factors of NREs that occur in neonatal surgery may promote surgical safety efforts and should be evaluated in larger and more diverse populations., Level of Evidence: IV., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2021. Published by Elsevier Inc.)

Objective. This study aimed to provide further validity evidence for the Kiersma-Chen Empathy Scale (KCES) by analyzing data collected from multiple administrations of the scale and conducting cognitive interviews of students in pharmacy and nursing programs to identify needed revisions. Methods. De-identified data from previous administrations of the KCES were used to evaluate the scale. Evidence of response process was enhanced through cognitive interviews with 20 pre-pharmacy and pharmacy students at Cedarville University. After survey revisions, the cognitive interview process was repeated with 10 University of Wyoming nursing students. Results. Based on psychometric data and cognitive interviews, the KCES was revised as follows: key components of cognitive and affective empathy were retained, scaling was changed to reflect necessity and empathy ability, negatively worded items were removed, and the single scale was converted into two parallel subscales. Conclusion. This study used data from thousands of geographically and professionally diverse samples. Based on potential problems identified in quantitative analyses, cognitive interviews with nursing and pharmacy students were conducted, and modifications to the KCES were made. Further psychometric validation is needed regarding the KCES-R., (© 2022 American Association of Colleges of Pharmacy.)

Background: Pediatric trauma patients sustaining blunt abdominal trauma (BAT) with intra-abdominal injury (IAI) are frequently admitted to the intensive care unit (ICU). This study was performed to identify predictors for ICU admission following BAT., Methods: Prospective study of children (< 16 years) who presented to 14 Level-One Pediatric Trauma Centers following BAT over a 1-year period. Patients were categorized as ICU or non-ICU patients. Data collected included vitals, physical exam findings, laboratory results, imaging, and traumatic injuries. A multivariable hierarchical logistic regression model was used to identify predictors of ICU admission. Predictive ability of the model was assessed via tenfold cross-validated area under the receiver operating characteristic curves (cvAUC)., Results: Included were 2,182 children with 21% (n = 463) admitted to the ICU. On univariate analysis, ICU patients were associated with abnormal age-adjusted shock index, increased injury severity scores (ISS), lower Glasgow coma scores (GCS), traumatic brain injury (TBI), and severe solid organ injury (SOI). With multivariable logistic regression, factors associated with ICU admission were severe trauma (ISS > 15), anemia (hematocrit < 30), severe TBI (GCS < 8), cervical spine injury, skull fracture, and severe solid organ injury. The cvAUC for the multivariable model was 0.91 (95% CI 0.88-0.92)., Conclusion: Severe solid organ injury and traumatic brain injury, in association with multisystem trauma, appear to drive ICU admission in pediatric patients with BAT. These results may inform the design of a trauma bay prediction rule to assist in optimizing ICU resource utilization after BAT., Study Design: Prognosis study., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The aim of the study was to determine the incidence, type, severity, preventability, and contributing factors of nonroutine events (NREs)-events perceived by care providers or skilled observers as a deviations from optimal care based on the clinical situation-in the perioperative (i.e., preoperative, operative, and postoperative) care of surgical neonates in the neonatal intensive care unit and operating room., Methods: A prospective observational study of noncardiac surgical neonates, who received preoperative and postoperative neonatal intensive care unit care, was conducted at an urban academic children's hospital between November 1, 2016, and March 31, 2018. One hundred twenty-nine surgical cases in 109 neonates were observed. The incidence and description of NREs were collected via structured researcher-administered survey tool of involved clinicians. Primary measurements included clinicians' ratings of NRE severity and contributory factors and trained research assistants' ratings of preventability., Results: One or more NREs were reported in 101 (78%) of 129 observed cases for 247 total NREs. Clinicians reported 2 (2) (median, interquartile range) NREs per NRE case with a maximum severity of 3 (1) (possible range = 1-5). Trained research assistants rated 47% of NREs as preventable and 11% as severe and preventable. The relative risks for National Surgical Quality Improvement Program - pediatric major morbidity and 30-day mortality were 1.17 (95% confidence interval = 0.92-1.48) and 1.04 (95% confidence interval = 1.00-1.08) in NRE cases versus non-NRE cases., Conclusions: The incidence of NREs in neonatal perioperative care at an academic children's hospital was high and of variable severity with a myriad of contributory factors., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: The aim of this study was to determine which initial surgical treatment results in the lowest rate of death or neurodevelopmental impairment (NDI) in premature infants with necrotizing enterocolitis (NEC) or isolated intestinal perforation (IP)., Summary Background Data: The impact of initial laparotomy versus peritoneal drainage for NEC or IP on the rate of death or NDI in extremely low birth weight infants is unknown., Methods: We conducted the largest feasible randomized trial in 20 US centers, comparing initial laparotomy versus peritoneal drainage. The primary outcome was a composite of death or NDI at 18 to 22 months corrected age, analyzed using prespecified frequentist and Bayesian approaches., Results: Of 992 eligible infants, 310 were randomized and 96% had primary outcome assessed. Death or NDI occurred in 69% of infants in the laparotomy group versus 70% with drainage [adjusted relative risk (aRR) 1.0; 95% confidence interval (CI): 0.87-1.14]. A preplanned analysis identified an interaction between preoperative diagnosis and treatment group (P = 0.03). With a preoperative diagnosis of NEC, death or NDI occurred in 69% after laparotomy versus 85% with drainage (aRR 0.81; 95% CI: 0.64-1.04). The Bayesian posterior probability that laparotomy was beneficial (risk difference <0) for a preoperative diagnosis of NEC was 97%. For preoperative diagnosis of IP, death or NDI occurred in 69% after laparotomy versus 63% with drainage (aRR, 1.11; 95% CI: 0.95-1.31); Bayesian probability of benefit with laparotomy = 18%., Conclusions: There was no overall difference in death or NDI rates at 18 to 22 months corrected age between initial laparotomy versus drainage. However, the preoperative diagnosis of NEC or IP modified the impact of initial treatment., Competing Interests: The authors report no conflict of interests., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Interprofessional education (IPE) provides unique opportunities for students to better understand their roles, roles of other healthcare professionals, and prepare for teamwork for patient benefit. Interprofessional team education is recognized as a key element in the 2016 ACPE standards., Objective: Assess student self-perceived competence in four IPEC domains after an inpatient simulation activity., Methods: Pre/post-test design used the Interprofessional Education Collaborative Competency Survey. The activity included medical, nursing, social work, and pharmacy students working in healthcare teams to develop collaborative treatment plans for simulated patients with altered mental status., Results: Ninety-seven health profession students completed the activity, while 49 second-year (P2) student pharmacists participated in the study. All completed a pre-test and 47/49 (96%) completed a post-test. At pre-test, students ranked themselves highest in abilities to respect patient privacy (100% strongly agree) and acting with honesty and integrity in relationships (100% strongly agree). They reported lower ability in describing team development process. At post-test, significant increases were seen in managing ethical dilemmas ( p < .002) and respect ( p = .49), though decreases were seen in using appropriate or respectful language ( p < .02)., Conclusion: Significant differences in student perceptions of ethics and communication were observed after participation in a transition of care inpatient IPE simulation., Competing Interests: The authors have no conflicts of interest to report., (© 2021 The Authors.)

Introduction: Previous research has shown that pharmacists can have an essential role in improving patient care transitions. However, the extent of student pharmacists' training, readiness, and confidence in ability to provide transitions of care (TOC) remains unclear. Our goal was to examine student pharmacist preparation, readiness, and confidence for engaging in TOC., Methods: Second-year student pharmacists at two schools/colleges of pharmacy in the United States were asked questions about their training, readiness, and confidence for providing TOC services. Descriptive statistics were used to analyze data., Results: In all, 113 (59 Western New England University [WNE] and 54 University of Wyoming [UWYO]) second-year pharmacy students received the survey request and 78 (50 WNE and 28 UWYO) completed the survey, resulting in an overall response rate of 69%. Participants reported that pharmacy coursework provided the highest level of preparedness to offer TOC services (37%), followed by introductory pharmacy practice experiences (31%). Most participants reported having the highest level of confidence for activities related to gathering patient medication histories during TOC (46.1%), and similarly, this category of activity showed the highest population of participants who indicated a positive level of readiness (41.3%)., Conclusions: Applicable training and experiences with TOC increase the likelihood of greater confidence and readiness for student pharmacists to provide TOC at their future practice sites. These results provide a framework for additional quantitative research in TOC engagement among student pharmacists., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: To evaluate the usefulness of assistive technology in health care interactions between student pharmacists and simulated patients who are deaf/hard of hearing and to assess changes in confidence and comfort levels (among both groups) when using assistive technology., Methods: Forty-nine second-year student pharmacists were enrolled in a pharmacy communication laboratory course and 8 undergraduate students were recruited during Fall 2019. The first communication laboratory interaction consisted of student pharmacists using their normal mode of communication with role-played patients who are deaf/hard of hearing to establish baseline measures; a pretest survey was administered to each participant at the conclusion of this 10-minute laboratory interaction. In the second laboratory interaction, student pharmacists used the app to assist in communicating with the simulated patients who are deaf/hard of hearing. Posttests were administered at the conclusion of this laboratory interaction., Results: Most student pharmacists and simulated patients who are deaf/hard of hearing reported feeling able to effectively communicate their needs to the other individual in their dyad (pharmacist or patient) during their health care interactions. Using an iPad (Apple Inc) app to communicate significantly increased student pharmacist and simulated patient comfort with health care communication from preintervention to postintervention., Conclusion: The use of assistive technology in simulated communication laboratory interactions can enhance student pharmacist comfort in health care interactions with patients who are deaf/hard of hearing., (Copyright © 2020 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Purpose: To describe the practice pattern for routine laboratory and imaging assessment of children following blunt abdominal trauma (BAT)., Methods: Children (age < 16 years) presenting to 14 pediatric trauma centers following BAT over a 1-year period were prospectively identified. Injury, demographic, routine laboratory and imaging utilization data were collected. Descriptive, comparative, and correlation analysis was performed., Results: 2188 children with a median age of 8 (4,12) years were included and the median injury severity score was 5 (1,10). There were significant differences in activation status, injury severity, and mechanism across centers; however, there was no correlation of level of activation, injury severity, or severe mechanism with test utilization. Routine laboratory and imaging utilization for hematocrit, hepatic enzymes, pancreatic enzymes, base deficit urine microscopy, chest and pelvis X-ray, and abdominal computed tomography (CT) varied significantly among centers. Only obtaining a hematocrit had a moderate correlation with CT use. There was no correlation between centers that were high or low frequency laboratory utilizers with CT use., Conclusions: Wide variability exists in the routine initial laboratory and imaging assessment in children following BAT. This represents an opportunity for quality improvement in pediatric trauma., Level of Evidence: Level II.

Objective: To compare the incidence, severity, preventability, and contributing factors of non-routine events-deviations from optimal care based on the clinical situation-associated with team-based, nurse-to-nurse, and mixed handovers in a large cohort of surgical neonates., Study Design: A prospective observational study and one-time cross-sectional provider survey were conducted at one urban academic children's hospital. 130 non-cardiac surgical cases in 109 neonates who received pre- and post-operative NICU care., Results: The incidence of clinician-reported NREs was high (101/130 cases, 78%) but did not differ significantly across acuity-tailored neonatal handover practices. National Surgical Quality Improvement-Pediatric occurrences of major morbidity were significantly higher (p < 0.001) in direct team handovers than indirect nursing or mixed handovers., Conclusions: NREs occur at a high rate and are of variable severity in neonatal perioperative care. NRE rates and contributory factors were homogenous across handover types. Surveyed clinicians recommend structured handovers for all patients at every transfer point regardless of acuity.

Objective: To determine rates of gastrostomy (GT) in very low birth weight (VLBW) infants., Study Design: Retrospective, cross-sectional analysis of the Kids' Inpatient Database for the years 2000, 2003, 2006, 2009 and 2012. We identified VLBW births and infants undergoing a GT, with and without fundoplication, using ICD-9-CM codes., Result: National rates (per 1000 VLBW births) of GT increased from 11.5 GT (95% CI 10-13) in 2000 to 22.9 (95% CI 20-25) in 2012 (p < 0.001). Gastrostomy with and without fundoplication increased during the study period (p < 0.001 in both groups). VLBW survival also increased from 78.5% in 2000 to 81.1% in 2012 (p < 0.001). In all study years, the Northeast census region had the lowest GT rates, while the West had the highest rates in 4 of the 5 study years., Conclusion: Between 2000 and 2012, the incidence of GT in VLBW infants doubled, associated with improvements in survival in this population.