Characterizing How Pediatric Clinicians Create Choice Awareness When Performing Shared Decision-Making.

Objective: To characterize how clinicians create choice awareness when performing shared decision-making (SDM).

Methods: We conducted a secondary analysis of a cross-sectional observational study designed to characterize the decision-making processes of parents and clinicians across a range of medical decisions in different pediatric settings. For the observational study, clinicians were recruited from 6 pediatric specialties (craniofacial, hematology and oncology, hospital medicine, neonatology, pulmonary, and sports medicine) at a single US children's hospital.

Tiered Clinician Vaccine Communication Strategy to Improve Childhood Vaccine Uptake: A Cluster Randomized Clinical Trial.

Importance: No experimental studies to date have tested the effectiveness of clinician communication strategies to improve vaccine uptake among children of parents with negative vaccine attitudes.

Objective: To evaluate the effect of a tiered vaccine communication strategy on children of parents with negative vaccine attitudes.

Design, Setting, And Participants: This cluster randomized clinical trial was conducted from September 1, 2019, to March 31, 2023, at primary care pediatric clinics in Colorado (n = 12) and Washington State (n = 12).

The Delicate Situation of Childhood Vaccination: On the Dispreferredness of Soliciting Parents' Intent to Vaccinate.

In the Netherlands, parents of newborns typically participate in two-, four-, and eight-week medical consultations to monitor their children's development and discuss vaccinations, which will not be administered before eight weeks. During these visits, healthcare professionals routinely ask parents if they intend to vaccinate their children (i.e.

Limited Axial Interpretation of Coronary CT Angiography in the Emergency Department Setting.

Purpose: Incorporating coronary CT angiographic (CCTA) imaging into emergency department (ED) workflows has been limited by the need for 24/7 real-time postprocessing. The aim of this study was to determine whether interpretation of transaxial CCTA images alone (limited axial interpretation [LI]) is noninferior to interpretation of combined transaxial and multiplanar reformation images (full interpretation [FI]) in assessing patients with acute chest pain in the ED.

Methods: CCTA examinations from 74 patients were evaluated by two radiologists, one without dedicated CCTA training and one with basic CCTA experience.

Development of PIVOT with MI: A motivational Interviewing-Based vaccine communication training for pediatric clinicians.

Delay or refusal of childhood vaccines is common and may be increasing. Pediatricians are parents' most trusted source for vaccine information, yet many struggle with how to communicate with parents who resist recommended vaccines. Evidence-based communication strategies for vaccine conversations are lacking.

Validation of a Process for Shared Decision-Making in Pediatrics.

Objective: We sought to confirm, refute, or modify a 4-step process for implementing shared decision-making (SDM) in pediatrics that involves determining 1) if the decision includes >1 medically reasonable option; 2) if one option has a favorable medical benefit-burden ratio compared to other options; and 3) parents' preferences regarding the options; then 4) calibrating the SDM approach based on other relevant decision characteristics.

Methods: We videotaped a purposive sample of pediatric inpatient and outpatient encounters at a single US children's hospital. Clinicians from 7 clinical services (craniofacial, neonatology, oncology, pulmonary, pediatric intensive care, hospital medicine, and sports medicine) were eligible.

Transfer patient imaging: secondary interpretation reimbursement.

Introduction: Trauma center radiologists vary widely in the degree to which they provide secondary interpretations for transferred patients' advanced imaging. A general perception of uncertainty over reimbursement for these exams often results in reluctance to provide routine overreads. The purpose of this study is to assess the difference in reimbursement rates between primary interpretations and secondary interpretations in the emergency department (ED) setting.

Transfer Patient Imaging: Assessment of the Impact of Discrepancies Identified by Emergency Radiologists.

Purpose: Advanced imaging examinations of emergently transferred patients (ETPs) are overread to various degrees by receiving institutions. The practical clinical impact of these second opinions has not been studied in the past. The purpose of this study is to determine if emergency radiology overreads change emergency medicine decision making on ETPs in the emergency department (ED).

Fidelity evaluation of the dialogue around respiratory illness treatment (DART) program communication training.

Objective: To evaluate receipt fidelity of communication training content included in a multifaceted intervention known to reduce antibiotic over-prescribing for pediatric acute respiratory tract infections (ARTIs), by examining the degree to which clinicians implemented the intended communication behavior changes.

Methods: Parents were surveyed regarding clinician communication behaviors immediately after attending 1026 visits by children 6 months to < 11 years old diagnosed with ARTIs by 53 clinicians in 18 pediatric practices. Communication outcomes analyzed were whether clinicians: (A) provided both a combined (negative + positive) treatment recommendation and a contingency plan (full implementation); (B) provided either a combined treatment recommendation or a contingency plan (partial implementation); or (C) provided neither (no implementation).

Transfer Patient Imaging: A Novel Peer Feedback Program Beyond Institutional Boundaries.

Background: At our level 1 trauma center, we overread cross-sectional scans on all transferred patients, initially reported by community radiologists (CR). We designed a unique peer feedback learning model to address discrepancies encountered with outside overreads with the goal of practice improvement on the part of the CRs. Although there is ample literature on internal peer review and peer learning programs, no publications address errors committed by peers outside institutional boundaries.

What's in a Name? Report of the ACR Task Force on General Radiology and Multi-Subspecialization.

The ACR Council passed Resolution 47 at its 2020 annual meeting establishing a representative task force (TF) to explore the concept of the "multispecialty radiologist," previously proposed in 2012. The TF held eight virtual meetings over 8 months, considered data from a 2020 ACR Membership Tracking Survey, conducted a review of current literature, and collected anecdotal experience from TF members and ACR leadership. ACR legal counsel and a cross-section of ACR Commissions and Committees also provided input.

Transfer patient imaging: discordances between community and subspecialist emergency radiologists.

Purpose: To determine the rate and nature of significant discordances between community and subspecialist emergency radiologists' interpretations of cross-sectional exams performed on patients transferred to our trauma center.

Methods: Outside hospital CT and MRI exams performed on transfer trauma patients are routinely overread by subspecialist emergency radiologists, specifying either concordance or discordance with the interpretation by the community radiologist. We evaluated the discordant reports for clinical significance, defined as an additional finding or difference in interpretation which was likely to affect patient management.

"It's Like 1998 Again": Why Parents Still Refuse and Delay Vaccines.

We conducted a qualitative study from 2018 to 2019 to update the reasons why US parents' refuse or delay vaccines. Four focus groups and 4 semi-structured interviews involving 33 primary care pediatric providers were conducted in Washington and Colorado. A thematic analysis was conducted to identify themes related to reasons for parental refusal or delay.

Through-the-Glass Portable Radiography of Patients in Isolation Units: Experience During the COVID-19 Pandemic.

To reduce staff exposure to infection and maintain operational efficiency, we have developed a protocol to image patients using portable chest radiography through the glass of an isolation room. This technique is safe and easy to implement. Images are of comparable quality to standard portable radiographs.

'Presumptively Initiating Vaccines and Optimizing Talk with Motivational Interviewing' (PIVOT with MI) trial: a protocol for a cluster randomised controlled trial of a clinician vaccine communication intervention.

Introduction: A key contributor to underimmunisation is parental refusal or delay of vaccines due to vaccine concerns. Many clinicians lack confidence in communicating with vaccine-hesitant parents (VHP) and perceive that their discussions will do little to change parents' minds. Improving clinician communication with VHPs is critical to increasing childhood vaccine uptake.

Reducing Antibiotic Prescribing in Primary Care for Respiratory Illness.

Background: One-third of outpatient antibiotic prescriptions for pediatric acute respiratory tract infections (ARTIs) are inappropriate. We evaluated a distance learning program's effectiveness for reducing outpatient antibiotic prescribing for ARTI visits.

Methods: In this stepped-wedge clinical trial run from November 2015 to June 2018, we randomly assigned 19 pediatric practices belonging to the Pediatric Research in Office Settings Network or the NorthShore University HealthSystem to 4 wedges.

CT volumetric measurements correlate with split renal function in renal trauma.

Purpose: To evaluate whether volumetric measurements of segmental vascular injuries (SVIs) based on computed tomography (CT) imaging obtained during an initial trauma survey correlate with future nuclear medicine (NM) split renal function.

Methods: A retrospective review was performed of renal trauma patients treated at a level 1 trauma center between 2008 and 2015. Patients with unilateral SVIs on initial CT imaging with follow-up NM renal scans were evaluated.

Is it safe to inject contrast through the side arm of an introducer sheath? An in vitro study.

Purpose: Occasionally, a patient requiring computed tomography (CT) with poor venous access or in an unstable condition may have a sheath as their only form of IV access. Many institutions prohibit contrast power injection through the side ports, for concern for rupture. We hypothesize that under conditions encountered in CT scanning, the side arm of the sheath introducer is safe for power injection of contrast material.

Emergency Radiology: An Underappreciated Source of Liability Risk.

Purpose: While several studies analyze radiology malpractice lawsuits, none specifically examines the site of service. The purpose of this study is to estimate the relative likelihood of a lawsuit arising from a radiology study performed in emergency (ED), inpatient (IP) and outpatient (OP) settings.

Methods: Referrals from a malpractice review consulting company over a six year period were compared to the 2016 Medicare Part B file and stratified by site of service.