Journal of Pediatric Surgery Open最新文献

{"title":"Vacuum assisted closure therapy in children with complicated abdominal wounds, with or without viscero-cutaneous fistulae","authors":"","doi":"10.1016/j.yjpso.2024.100153","DOIUrl":"10.1016/j.yjpso.2024.100153","url":null,"abstract":"<div><h3>Background</h3><p>Management of complicated abdominal wounds is challenging in children. Vacuum-assisted closure proved to be beneficial. We aimed to report the outcome of VAC over 5 years’ practice in complicated abdominal wounds with or without viscero-cutaneous fistulae.</p></div><div><h3>Methods</h3><p>Retrospective review of children managed by VAC over 5 years, from January 2017 to December 2022. Included patients had complicated abdominal wounds. Customized VAC devices with continuous negative pressure were used for all patients. The applied pressure was tailored according to the patient's age and the wound condition.</p></div><div><h3>Results</h3><p>Nineteen patients were included, their ages ranged from 3 months to 15 years. Peritonitis was the main pathology in 12 patients, abdominal wall infection in 4, and a combination of both in 3. VAC was applied over closed wounds in 10 patients and over open wounds in 9; 6 of them had cutaneous fistulae. The median duration of VAC application over closed wounds was 7.5 days, while it was 10 days in open wounds. VAC promoted healing in closed and narrow-gapped wounds, while it was successfully used as a bridging therapy in 4 patients with wide-gapped wounds. Patients with viscero-cutaneous fistulae were successfully managed without further surgical intervention. VAC was complicated by fascial dehiscence with evisceration and incisional hernia in two patients.</p></div><div><h3>Conclusion</h3><p>VAC could be beneficial to complicated abdominal wounds in pediatric age. It was helpful in managing small viscero-cutaneous fistulae.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100153"},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000388/pdfft?md5=00eb53d8a7f51a71ae6910fd05bd3d26&pid=1-s2.0-S2949711624000388-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141407159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attending physicians and trainees' perspective of patient safety culture in operating room: A mixed methods study","authors":"Nutan B. Hebballi ,&nbsp;Molly P. Kilcullen ,&nbsp;Maryam Broussard ,&nbsp;Madelene J. Ottosen ,&nbsp;Eric J. Thomas ,&nbsp;Eduardo Salas ,&nbsp;KuoJen Tsao","doi":"10.1016/j.yjpso.2024.100152","DOIUrl":"https://doi.org/10.1016/j.yjpso.2024.100152","url":null,"abstract":"<div><h3>Background</h3><p>Regulatory quantitative assessments are routinely undertaken to understand the patient safety culture within an organization. However, adjunctive qualitative approaches to explore low-scoring areas of safety culture in the operating room (OR) are lacking and may provide additional insight. Thus, we explored OR patient safety culture perceptions of pediatric surgical providers, specifically among attending physicians and trainees.</p></div><div><h3>Methods</h3><p>A cross-sectional survey was pilot-tested by pediatric surgical attending physicians and surgical trainees from one academic hospital OR. The “Safer Culture” survey was developed using validated survey measures of concepts from the Safer Culture framework and modified by cognitive interviews with subject-matter experts. The survey was electronically administered, and the results were analyzed descriptively, and percent positive scores were computed. Semi-structured interviews with a purposive sample of participants were then conducted and thematically analyzed.</p></div><div><h3>Results</h3><p>Of the 144 participants, 67 completed the survey (response rate: 46.5 %). <em>Safety competence</em> (&gt;95 %) and <em>individual commitment &amp; prioritization of safety</em> (&gt;90 %) were rated highest by attending physicians and trainees. Trainees rated <em>policies &amp; resources for safety</em> and <em>cohesion</em> the lowest (&lt;60 %). Attending physicians and trainees rated <em>just culture</em> the lowest (&lt;56 %). Interview data revealed three overarching themes explain the lowest ratings: 1) feedback and fear influence incident reporting, 2) lack of accountability and learning affect just culture, and 3) individual and group preparedness impact safe surgical care.</p></div><div><h3>Conclusions</h3><p>Safer Culture survey identified low-performing issues affecting OR safety culture by pediatric surgical providers. Their perceptions specified areas to focus initiatives to improve OR safety culture.</p></div><div><h3>Levels of evidence</h3><p>Level III.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100152"},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000376/pdfft?md5=ecbe8f4567cbbdf6cbc5c319c2deabde&pid=1-s2.0-S2949711624000376-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141315023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Wilms renal tumors: Twenty years experience in a referral center","authors":"Cristina Garcés-Visier ,&nbsp;Przemyslaw Maruszewski ,&nbsp;Ana Lourdes Luis-Huertas ,&nbsp;Pedro Borrrego-Jimenez ,&nbsp;Daniel Azorín ,&nbsp;Alberto Martín-Vega ,&nbsp;Manuel Espinoza-Vega ,&nbsp;Blanca Herrero-Velasco ,&nbsp;Jose Lorenzo Alonso-Calderón","doi":"10.1016/j.yjpso.2024.100151","DOIUrl":"10.1016/j.yjpso.2024.100151","url":null,"abstract":"<div><h3>Background</h3><p>Non-Wilms Renal Tumors (NWRT) constitute less than 10% of all renal tumors diagnosed in childhood. We studied our experience in the diagnosis and management of these tumors to compare our results with the current literature.</p></div><div><h3>Study design</h3><p>This is a retrospective observational study which includes all patients aged 0-18 years with histopathological diagnosis of NWRT treated in our center during the period 2000-2022.</p></div><div><h3>Results</h3><p>We identified 10 patients with diagnosis of: cystic nephroma(3), congenital mesoblastic nephroma(1), renal cell carcinoma(2), clear cell sarcoma of the kidney (2), renal Ewing's sarcoma(1) and malignant rhabdoid tumor of the kidney(1). Sixty percent (60%) were female. The median age at diagnosis was 3.25 years (IQR 1.5-10). Median age at diagnosis excluding CN was 6 years old (IQR 2.62-10.75). Molecular alterations were detected in 60% of the cases. Hematuria (40%) and palpable abdominal mass (40%) were the most frequent presenting symptoms. In total, 62.5% patients were misdiagnosed during the preoperative period as Wilms' tumor (WT), based on imaging data. <del>A</del> Radical nephroureterectomy was performed in all cases and staging lymphadenectomy in 70%. We recorded a major complication in one patient, who suffered a contralateral lower renal pole infarction due to section of a polar vessel during surgery. This patient had no preoperative vascular study. The recurrence-free survival rate was 90% with a median follow-up of 6.4 years (IQR 2-13.9).</p></div><div><h3>Discussion</h3><p>Radiological imaging has fundamental importance in the diagnosis of renal tumors, especially to identify children who might benefit from initial surgical treatment or the indication of biopsy for preoperative histopathological confirmation before initiating cytotoxic treatment. However, there are no pathognomonic imaging findings that clearly differentiate between WT and other renal tumors, nor among the heterogeneous group of NWRT[<span><span>3</span></span>]. In our series, 62.5% of patients were misdiagnosed as WT based on imaging features.</p><p>We found different molecular alterations in 60% of our patients (Table 1). None of them predispose to the development of bilateral tumors nor correlates with predisposing syndromes of metachronous tumors.</p><p>Apart from its retrospective design, this study is limited by small number of cases and a long study period.</p></div><div><h3>Conclusions</h3><p>Correct differential diagnosis of NWRT is necessary for an adequate therapeutic approach. The molecular-genetic profile is an important step in the diagnosis of NWRT that allows for the use of targeted therapies in refractory patients. Detailed anatomical study by vascular mapping minimizes the risk of iatrogenic damage during tumor resection.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100151"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000364/pdfft?md5=83215d0377f5c8331eba5eab9dcffb06&pid=1-s2.0-S2949711624000364-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141959401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The surgical management of peripheral IV extravasation injuries in infants and children","authors":"Genevieve Kierulf ,&nbsp;Nicole Becher ,&nbsp;Adam Goldsmith ,&nbsp;Young Mee Choi ,&nbsp;Steven Moulton","doi":"10.1016/j.yjpso.2024.100150","DOIUrl":"https://doi.org/10.1016/j.yjpso.2024.100150","url":null,"abstract":"<div><h3>Introduction</h3><p>Peripheral IV extravasation (PIVE) injuries are a common cause of skin injury in infants and children. Although most PIVE injuries are minor and self-limited, severe PIVE injuries associated with calcium deposition and/or full-thickness skin injury will require surgical management.</p></div><div><h3>Methods</h3><p>This is a retrospective review of children with PIVE injures who required surgical management at our institution from 2012 to 2022. Data collected included demographics, substance infiltrated, immediate management, surgical history, and long-term outcomes. Immediate management for those at imminent risk for skin loss or circulation impairment involved treatment with hyaluronidase to minimize tissue damage, followed by removal of the IV catheter. PIVEs involving calcium containing infiltrates were observed for 2–4 weeks to allow the calcium to precipitate, before undertaking surgical debridement of calcium deposits.</p></div><div><h3>Results</h3><p>There were 11 PIVE injuries requiring surgery during the 10-year study period, of which 7 (63.6 %) were infants (&lt; 30 days old). Surgery was delayed 2–4 weeks for those whose infiltrate contained calcium, to allow for precipitation and coalescence of the calcium in the soft tissue. Nine patients required debridement with skin grafting. One patient underwent debridement with wound closure, and one underwent needle decompression alone. Eight patients (72.7 %) received follow-up from OT/PT services, and most (75 %) achieved optimal functional outcomes including full range of motion and age-appropriate motor skills.</p></div><div><h3>Conclusions</h3><p>Most IV infiltrate injuries self-resolve with no sequelae. Those injuries caused by calcium containing fluids or caustic medications can result in significant tissue destruction requiring operative intervention.</p></div><div><h3>Level of Evidence</h3><p>Treatment Study, Level IV</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100150"},"PeriodicalIF":0.0,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000352/pdfft?md5=6ed25579ffdc74b160a2487300f865e0&pid=1-s2.0-S2949711624000352-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141244505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rebooting the anal sphincter: A retrospective cohort of children with intractable constipation receiving intrasphincteric botox injections","authors":"Luke Uden ,&nbsp;Mansha Jiwane ,&nbsp;Jyoti R Sharma ,&nbsp;Ajay Sharma ,&nbsp;Daisy Evans ,&nbsp;Britta S von Ungern-Sternberg ,&nbsp;Parshotam Gera","doi":"10.1016/j.yjpso.2024.100147","DOIUrl":"10.1016/j.yjpso.2024.100147","url":null,"abstract":"<div><h3>Background</h3><p>Chronic childhood constipation is a common problem that severely impacts quality of life. Recently, the efficacy of intrasphincteric botulinum toxin (botox) injection in breaking the cycle of constipation has been demonstrated. The current study aims to investigate response rate to treatment, symptom and examination finding associations, and identify associations between patient characteristics and outcome.</p></div><div><h3>Methods</h3><p>Parental consent was given for the review of medical records. This retrospective cohort included paediatric patients, under 16 years old, presenting to Perth Paediatrics, in Western Australia, from August 2017 to June 2022, who received botox injections (10 IU/kg, at 3, 6, and 9 o'clock) for intractable constipation. Patients required a negative diagnosis of Hirschsprung's disease for inclusion. A successful outcome was defined by a reduction in related symptoms and dosage of aperients at a post-operative consultation at least two weeks following injection, compared to those prior.</p></div><div><h3>Results</h3><p>Of 81 patients, 83 % experienced an overall improvement in symptoms following their first injection. 47 % noted a reduced laxative requirement, with no patients reporting any adverse effects. Twelve patients received a second injection, of which 58 % reported a successful outcome afterward. Across all variables, the majority of patients experienced a positive response. In this retrospective cohort, there were no associations demonstrated between comorbidities, age, sex, symptomatology, or examination findings, and positive response.</p></div><div><h3>Conclusions</h3><p>These results suggest that, in managing intractable constipation in children, intrasphincteric botox injection may be beneficial in reducing symptoms, with no reported adverse events in this cohort.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100147"},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000327/pdfft?md5=440447d85d6ed24c8bbd2002b557a537&pid=1-s2.0-S2949711624000327-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141037147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a tool to assess patient and caregiver satisfaction for minor pediatric surgical procedures","authors":"Karan Gandhi ,&nbsp;Jacob Davidson ,&nbsp;Camille Duggal ,&nbsp;Vanessa Fantillo ,&nbsp;Julie E. Strychowsky","doi":"10.1016/j.yjpso.2024.100145","DOIUrl":"10.1016/j.yjpso.2024.100145","url":null,"abstract":"<div><h3>Introduction</h3><p>Patient satisfaction questionnaires offer valuable perspectives on patient experiences and the quality of healthcare received. Despite their importance, a gold standard for measuring patient satisfaction in pediatric surgery remains elusive. This study introduces a patient satisfaction questionnaire designed to fill the gap in evaluating patient experiences specifically in pediatric surgical settings, aiming to create a standardized measure for assessing patient satisfaction.</p></div><div><h3>Methods</h3><p>The think-aloud method was used with patient advisors and an expert panel of hospital stakeholders to refine a novel patient and caregiver satisfaction tool. Through an iterative process, data was gathered, analyzed and the survey progressively revised. The final survey was then pilot tested.</p></div><div><h3>Results</h3><p>Three patient advisors and seven hospital stakeholders participated in the study. The think-aloud method was used to establish cognitive, content, and face validity. There were five distinct satisfaction domains established. Pilot testing included 30 participants and was used to establish construct validity and test-retest reliability.</p></div><div><h3>Conclusions</h3><p>This study addresses the existing gap in measuring patient satisfaction in pediatric surgery settings. The think-aloud method was used to ensure cognitive, content, and face validity ensuring multiple domains are addressed. Pilot testing of the tool showed feasibility in both the operating room and minor procedure room setting while also demonstrating test re-test validity. These results indicate that this questionnaire holds promise for use in a variety of pediatric surgical settings. Further research is necessary to confirm these findings in larger, more diverse populations and to assess its impact on improving patient care and experiences.</p></div><div><h3>Type of Study</h3><p>Survey Development and Validation Study.</p></div><div><h3>Level of Evidence</h3><p>III</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100145"},"PeriodicalIF":0.0,"publicationDate":"2024-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000303/pdfft?md5=7eaa504cc593bfe3d07aed1f41c7b11e&pid=1-s2.0-S2949711624000303-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141031138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can ERAS help reduce health disparities and overcome barriers to equitable surgical care in marginalized communities?","authors":"Chirag Ram ,&nbsp;Ruoying Li ,&nbsp;Andrew D. Franklin ,&nbsp;Kurt Heiss ,&nbsp;Carmelle Romain ,&nbsp;Irving J. Zamora","doi":"10.1016/j.yjpso.2024.100141","DOIUrl":"10.1016/j.yjpso.2024.100141","url":null,"abstract":"<div><p>Health inequities persist in surgical outcomes between different races and ethnicities. Enhanced Recovery after Surgery (ERAS) protocols are innovative perioperative management strategies that have improved outcomes and reduced costs of delivering care. Quality improvement tools embedded in the protocols allow for sequential improvements in compliance and outcomes. Standardization of perioperative care may reduce healthcare inequities and improve outcomes in marginalized communities. In this review, we describe the benefits of ERAS in surgical outcomes, discuss how implementation of ERAS could potentially reduce health disparities in pediatric surgical patients, demonstrate the barriers present in ERAS implementation, propose solutions to these implementation barriers (Table 1).</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100141"},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000261/pdfft?md5=b0c2ec020de44043076229908693f717&pid=1-s2.0-S2949711624000261-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140757178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The learning curve of single-incision pediatric endosurgery","authors":"Noémie Wildschutz ,&nbsp;Nathalie Brewer ,&nbsp;Oliver J. Muensterer","doi":"10.1016/j.yjpso.2024.100144","DOIUrl":"https://doi.org/10.1016/j.yjpso.2024.100144","url":null,"abstract":"<div><h3>Background</h3><p>Single incision pediatric endosurgery (SIPES) has been established in some pediatric surgery centers for certain operations. A concern in implementing these technically challenging procedures is the associated learning curve. This study describes the learning curve associated with the 3 most common procedures appendectomy, cholecystectomy, and pyloromyotomy.</p></div><div><h3>Methods</h3><p>All SIPES appendectomies, cholecystectomies, and pyloromyotomies performed by an academic pediatric surgeon in the first 14 months of performing SIPES were chronologically divided into thirds of equal number, groups A (first), B (middle), and C (last). The learning curve for each operation was assessed by comparing operating times, conversion rates (defined as adding additional trocars) and complication rates among these groups.</p></div><div><h3>Results</h3><p>During the study period, 183 appendectomies, 51 cholecystectomies, and 49 pyloromyotomies using SIPES technique were performed. With increasing experience, operating times (mean±standard deviation) decreased significantly for all 3 operations (42±14 to 36±13 min for appendectomies, <em>p</em> = 0.015; 78±20 to 59±18 for cholecystectomies, <em>p</em> = 0.004; 26±7.7 to 20±5.5 min for pyloromyotomies, <em>p</em> = 0.015). The number of additional trocars placed during appendectomies declined steadily from 21 % in group A to 0 % in group C (<em>p</em> &lt; 0.001). There were more complications during appendectomy in groups A versus B (8 % versus 0 %, <em>p</em> = 0.03), but no other differences in complication rates were found.</p></div><div><h3>Conclusion</h3><p>Operating times for all SIPES operations declined throughout the study period. With experience, the need for additional trocars and the complication rate during appendectomy approaches zero. We have shown that it is feasible to safely and effectively transition to the new surgical technique.</p></div><div><h3>Level of evidence</h3><p>II - prospective cohort study</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100144"},"PeriodicalIF":0.0,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000297/pdfft?md5=72a970b8bf6dd10663ec7ad1e15e6914&pid=1-s2.0-S2949711624000297-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140644961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Approaches to starting and growing ERAS at a Children's Hospital","authors":"Kyle O. Rove ,&nbsp;Megan A. Brockel","doi":"10.1016/j.yjpso.2024.100140","DOIUrl":"https://doi.org/10.1016/j.yjpso.2024.100140","url":null,"abstract":"<div><p>Enhanced Recovery After Surgery is a multi-disciplinary, multi-modal, evidence-based approach to perioperative care that is known to improve outcomes for adult patients and has more recently been shown to lead to similar improvements for children. Its success in adult patients has led to growing interest in the adoption of ERAS in the pediatric population. Successful ERAS implementation hinges on strong leadership, provider and patient education and engagement, and continuous audit with the use of quality improvement methodology. The electronic health record is an invaluable tool that can be leveraged to not only aid in delivering standardized care through order sets for medications, fluids, and daily cares, but also to document and audit process measures and outcomes. In this paper, the authors describe our 10-year journey at a free-standing children's hospital from initial “baby steps” implementing individual elements for a single surgery to 11 active, comprehensive protocols spanning eight specialties and growing.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"7 ","pages":"Article 100140"},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294971162400025X/pdfft?md5=9326a87b8b4f1da49bbdeea1a5141786&pid=1-s2.0-S294971162400025X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140638643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Board Page","authors":"","doi":"10.1016/S2949-7116(24)00027-3","DOIUrl":"https://doi.org/10.1016/S2949-7116(24)00027-3","url":null,"abstract":"","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"6 ","pages":"Article 100142"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000273/pdfft?md5=a567b760e22d1a6a33d7b1caf00d0577&pid=1-s2.0-S2949711624000273-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140638609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}