Summary Objective Children undergoing congenital cardiac surgery ( CCS ) are at increased risk for acute kidney injury ( AKI ) due to a number of factors. Recent evidence suggests AKI may influence mortality beyond the immediate postoperative period and hospitalization. We sought to determine the association between renal failure and longer‐term mortality in children following CCS . Methods Our Study population included all patients that underwent cardiac surgery at our institution during a period of 3 years from 2004 through 2006. The primary definition of acute renal injury was based on pRIFLE using estimated creatinine clearance ( pRIFLE eCCL ). Results Predictors of mortality . Age, single ventricle status, and renal failure as defined by pRIFLE stage F were associated with mortality. The hazard ratio for a patient with renal failure as defined by pRIFLE stage F was 3.82 (CI 1.89–7.75). Predictors of AKI as defined by pRIFLE . Duration of cardiopulmonary bypass (CPB) and age were the only variables associated with pRIFLE by univariate analysis. However, in the ordinal or survival model, age was the only variable associated with renal failure as defined by pRIFLE . As patient age increases from 0.30 to 3.5 years, the risks of having renal injury ( pRIFLE stage I) or failure ( pRIFLE stage F) decreases (OR 0.44, CI 0.21–0.94). Conclusion Mortality risk following CCS is increased in younger patients and those experiencing postoperative renal failure as defined by pRIFLE for a period of time that extends well beyond the immediate postoperative period and the time of hospitalization.
There is no general consensus among clinicians on the superior route or duration of treatment with N-acetylcysteine (NAC) for acute acetaminophen (APAP) poisoning, and head-to-head studies comparing intravenous (IV) and oral NAC have not been done. Recent 20-hour IV NAC protocol failures in the United States prompted some to question its safety. Our objective was to determine if treatment with the 20-hour IV NAC protocol results in clinical outcomes different from the longer 36-hour oral or 72-hour oral NAC protocols in cases of acute APAP poisoning. We performed a retrospective analysis of all consecutive cases of acute APAP overdose where NAC treatment was initiated within 8 hours of ingestion between January 1, 2002, and December 31, 2007. Outcomes were survival, transplant, and death; secondary outcomes were based on King's College Criteria; interrater reliability was calculated with a kappa score. Out of 4642 cases of APAP overdose, 795 met study inclusion criteria: 213 were treated with 20-hour IV protocol, 213 with the 36-hour oral protocol, and 369 with the 72-hour oral protocol. The mean age in these groups was 25 years [95% confidence interval (CI): 22–26], 26 years (95%CI: 23–29), and 27 years (95%CI: 25–28), respectively. The mean 4-hour APAP concentration was 199 μg/mL (95%CI: 188–211), 174 μg/mL (95%CI: 164–184), and 205 μg/mL (95%CI: 195–216), respectively. No cases of transplant or death occurred, and secondary outcomes were rare. When administered within 8 hours of acute APAP poisoning, the 20-hour IV treatment protocol was as effective as the longer 36-hour oral and 72-hour oral treatment protocols. Further study is needed to determine outcome differences between IV and oral NAC when treatment is initiated >8 hours after overdose or in cases of coingestion with other drugs.
The Maslach Burnout Inventory (MBI) is considered the "gold standard" for measuring burnout, encompassing 3 scales: emotional exhaustion, depersonalization, and personal accomplishment. Other well-being instruments have shown utility in various settings, and correlations between MBI and these instruments could provide evidence of relationships among key variables to guide well-being efforts.We explored correlations between the MBI and other well-being instruments.We fielded a multicenter survey of 9 emergency medicine (EM) residencies, administering the MBI and 4 published well-being instruments: a quality-of-life assessment, a work-life balance rating, an appraisal of career satisfaction, and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire 2 question screen. Consistent with the Maslach definition, burnout was defined by high emotional exhaustion (> 26) and high depersonalization (> 12).Of 334 residents, 261 (78%) responded. Residents who reported lower quality of life had higher emotional exhaustion (ρ = -0.437, P < .0001), higher depersonalization (ρ = -0.18, P < .005), and lower personal accomplishment (ρ = 0.347, P < .001). Residents who reported a negative work-life balance had emotional exhaustion (P < .001) and depersonalization (P < .009). Positive career satisfaction was associated with lower emotional exhaustion (P < .0001), lower depersonalization (P < .005), and higher personal accomplishment (P < .05). A positive depression screen was associated with higher emotional exhaustion, higher depersonalization, and lower personal achievement (all P < .0001).Our multicenter study of EM residents demonstrated that assessments using the MBI correlate with other well-being instruments.
Abstract Background The Accreditation Council for Graduate Medical Education Common Program Requirements effective 2017 state that programs and sponsoring institutions have the same responsibility to address well‐being as they do other aspects of resident competence. Objectives The authors sought to determine if the implementation of a multifaceted wellness curriculum improved resident burnout as measured by the Maslach Burnout Inventory ( MBI ). Methods We performed a multicenter educational interventional trial at 10 emergency medicine ( EM ) residencies. In February 2017, we administered the MBI at all sites. A year‐long wellness curriculum was then introduced at five intervention sites while five control sites agreed not to introduce new wellness initiatives during the study period. The MBI was readministered in August 2017 and February 2018. Results Of 523 potential respondents, 437 (83.5%) completed at least one MBI assessment. When burnout was assessed as a continuous variable, there was a statistically significant difference in the depersonalization component favoring the control sites at the baseline and final survey administrations. There was also a higher mean personal accomplishment score at the control sites at the second survey administration. However, when assessed as a dichotomous variable, there were no differences in global burnout between the groups at any survey administration and burnout scores did not change over time for either control or intervention sites. Conclusions In this national study of EM residents, MBI scores remained stable over time and the introduction of a multifaceted wellness curriculum was not associated with changes in global burnout scores.
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