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  • 1
    Online Resource
    Online Resource
    Neurodevelopmental evaluation strategies for children with congenital heart disease aged birth through 5 years: recommendations from the cardiac neurodevelopmental outcome collaborative
    Cambridge University Press (CUP) ; 2020
    In:  Cardiology in the Young Vol. 30, No. 11 ( 2020-11), p. 1609-1622
    Details
    In: Cardiology in the Young, Cambridge University Press (CUP), Vol. 30, No. 11 ( 2020-11), p. 1609-1622
    Abstract: This paper provides specific guidelines for the neurodevelopmental evaluation of children aged birth through 5 years with complex congenital heart disease. There is wide recognition that children with congenital heart disease are at high risk for neurodevelopmental impairments that are first apparent in infancy and often persist as children mature. Impairments among children with complex congenital heart disease cross developmental domains and affect multiple functional abilities. The guidelines provided are derived from the substantial body of research generated over the past 30 years describing the characteristic developmental profiles and the long-term trajectories of children surviving with complex congenital heart conditions. The content and the timing of the guidelines are consistent with the 2012 American Heart Association and the American Academy of Pediatrics scientific statement documenting the need for ongoing developmental monitoring and assessment from infancy through adolescence. The specific guidelines offered in this article were developed by a multidisciplinary clinical research team affiliated with the Cardiac Neurodevelopmental Outcome Collaborative, a not-for-profit organisation established to determine and implement best neurodevelopmental practices for children with congenital heart disease. The guidelines are designed for use in clinical and research applications and offer an abbreviated core protocol and an extended version that expands the scope of the evaluation. The guidelines emphasise the value of early risk identification, use of evidence-based assessment instruments, consideration of family and cultural preferences, and the importance of providing multidimensional community-based services to remediate risk.
    Type of Medium: Online Resource
    ISSN: 1047-9511 , 1467-1107
    URL: Article
    DOI: 10.1017/S1047951120003534
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2060876-7
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  • 2
    Online Resource
    Online Resource
    The final hospital need in children discharged from a cardiology acute care unit: a single-centre survey study
    Cambridge University Press (CUP) ; 2023
    In:  Cardiology in the Young Vol. 33, No. 10 ( 2023-10), p. 1967-1974
    Details
    In: Cardiology in the Young, Cambridge University Press (CUP), Vol. 33, No. 10 ( 2023-10), p. 1967-1974
    Abstract: Children with heart disease may require inpatient care for many reasons, but ultimately have a final reason for hospitalisation prior to discharge. Factors influencing length of stay in paediatric cardiac acute care units have been described but the last reason for hospitalisation has not been studied. Our aim was to describe Final Hospital Need as a novel measure, determine Final Hospital Need in our patients, and describe factors associated with this Need. Methods: Single-centre survey design. Discharging providers selected a Final Hospital Need from the following categories: cardiovascular, respiratory, feeding/fluid, haematology/ID, pain/sedation, systems issues, and other/wound issues. Univariable and multivariable analyses were performed separately for outcomes “cardiovascular” and “feeding/fluid.” Measurements and Results: Survey response rate was 99% (624 encounters). The most frequent Final Hospital Needs were cardiovascular (36%), feeding/fluid (24%) and systems issues (13%). Probability of Final Hospital Need “cardiovascular” decreased as length of stay increased. Multivariate analysis showed Final Hospital Need “cardiovascular” was negatively associated with aortic arch repair, Norwood procedure, and Final ICU Need “respiratory” and “other.” Final Hospital Need "feeding/fluid” was negatively associated with left-sided valve procedure, but positively associated with final ICU need “respiratory,” and tube feeding at discharge. Conclusions: Final Hospital Need is a novel measure that can be predicted by clinical factors including age, Final ICU Need, and type of surgery. Final Hospital Need may be utilised to track changes in clinical care over time and as a target for improvement work.
    Type of Medium: Online Resource
    ISSN: 1047-9511 , 1467-1107
    URL: Article
    DOI: 10.1017/S1047951122003596
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2060876-7
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  • 3
    Online Resource
    Online Resource
    A Maya Palace at Holmul, Peten, Guatemala and the Teotihuacan “Entrada”: Evidence from Murals 7 and 9
    Cambridge University Press (CUP) ; 2009
    In:  Latin American Antiquity Vol. 20, No. 1 ( 2009-03), p. 228-259
    Details
    In: Latin American Antiquity, Cambridge University Press (CUP), Vol. 20, No. 1 ( 2009-03), p. 228-259
    Abstract: El reciente hallazgo de dos pinturas murales en el sitio de La Sufricaya, en la cercanía de la ciudad Maya de Holmul, Peten ofrece la oportunidad de discutir la relación entre las ciudades Maya y sus relaciones con Teotihuacan en la época Clásico Temprana. Los murales se encuentran en un complejo de edificios palaciegos menor en las cercanías del centro ceremonial de Holmul en el cual abundan los motivos iconográficos Teotihuacanos y obsidiana importada de fuentes Mexicanas. Unas de las pinturas (Mural 9) es de contenido mitológico mientras la segunda (Mural 7) es de contenido histórico y es completamente textual. Ambas son de estilo y contenido Maya. El análisis de la iconografía y epigrafía de estos monumentos permite elaborar interpretaciones sobre la función de este complejo como sede temporal de los gobernantes del sitio. A esta información se adjunta la discusión del contexto arquitectónico y de artefactos asociados a los monumentos los cuales indican fuerte s enlaces con Tikal. Estas evidencias aun si fragmentarias nos permiten una reconstrucción de las posibles modalidades en las cuales se dio el uso de dichos motivos Teotihuacanos en este caso específico y nos permiten aumentar el conocimiento sobre que papel pudo haber jugado la lejana Teotihuacan en las Tierras Bajas Maya del Clásico Temprano. Se ofrece una interpretación que enfoca en la política de intervención de Tikal sobre centros secundarios y que evita algunas posiciones extremas que se han presentado sobre este problema hasta ahora.
    Type of Medium: Online Resource
    ISSN: 1045-6635 , 2325-5080
    URL: Article
    DOI: 10.1017/S1045663500002595
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2009
    detail.hit.zdb_id: 2050681-8
    SSG: 7,36
    SSG: 6,11
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  • 4
    Online Resource
    Online Resource
    The final reason paediatric Cardiac ICU patients require care prior to discharge to the floor: a single-centre survey
    Cambridge University Press (CUP) ; 2020
    In:  Cardiology in the Young Vol. 30, No. 8 ( 2020-08), p. 1109-1117
    Details
    In: Cardiology in the Young, Cambridge University Press (CUP), Vol. 30, No. 8 ( 2020-08), p. 1109-1117
    Abstract: To determine the Final ICU Need in the 24 hours prior to ICU discharge for children with cardiac disease by utilising a single-centre survey. Methods: A cross-sectional survey was utilised to determine Final ICU Need, which was categorised as “Cardiovascular”, “Respiratory”, “Feeding”, “Sedation”, “Systems Issue”, or “Other” for each encounter. Survey responses were obtained from attending physicians who discharged children (≤18 years of age with ICU length of stay 〉 24 hours) from the Cardiac ICU between April 2016 and July 2018. Measurements and results: Survey response rate was 99% (n = 1073), with 667 encounters eligible for analysis. “Cardiovascular” (61%) and “Respiratory” (26%) were the most frequently chosen Final ICU Needs. From a multivariable mixed effects logistic regression model fitted to “Cardiovascular” and “Respiratory”, operations with significantly reduced odds of having “Cardiovascular” Final ICU Need included Glenn palliation (p = 0.003), total anomalous pulmonary venous connection repair (p = 0.024), truncus arteriosus repair (p = 0.044), and vascular ring repair (p 〈 0.001). Short lengths of stay ( 〈 7.9 days) had significantly higher odds of “Cardiovascular” Final ICU Need (p 〈 0.001). “Cardiovascular” and “Respiratory” Final ICU Needs were also associated with provider and ICU discharge season. Conclusions: Final ICU Need is a novel metric to identify variations in Cardiac ICU utilisation and clinical trajectories. Final ICU Need was significantly influenced by benchmark operation, length of stay, provider, and season. Future applications of Final ICU Need include targeting quality and research initiatives, calibrating provider and family expectations, and identifying provider-level variability in care processes and mental models.
    Type of Medium: Online Resource
    ISSN: 1047-9511 , 1467-1107
    URL: Article
    DOI: 10.1017/S104795112000164X
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2060876-7
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