Robert Dudas - Academia.edu (original) (raw)

Papers by Robert Dudas

Western Journal of Emergency Medicine, 2017

BMC Medical Education, Feb 11, 2015

BMC Medical Education, Dec 1, 2021

Hospital Pediatrics, 2018

Drug and Alcohol Dependence, Jul 1, 2005

RTI International is one of the world's leading research institutes, dedicated to improving the h... more RTI International is one of the world's leading research institutes, dedicated to improving the human condition by turning knowledge into practice. Our staff of more than 2,800 provides research and technical expertise to governments and businesses in more than 40 countries in the areas of health and pharmaceuticals, education and training, surveys and statistics, advanced technology, international development, economic and social policy, energy and the environment, and laboratory and chemistry services. For more information, visit www.rti.org. RTI International is a trade name of Research Triangle Institute.

The Journal of Pediatrics, 2021

Objective To describe the impact of a national interventional collaborative on pediatric readines... more Objective To describe the impact of a national interventional collaborative on pediatric readiness within general emergency departments (EDs). Study design A prospective, multicenter, interventional study measured pediatric readiness in general EDs before and after participation in a pediatric readiness improvement intervention. Pediatric readiness was assessed using the weighted pediatric readiness score (WPRS) on a 100-point scale. The study protocol extended over 6 months and involved 3 phases: (1) a baseline on-site assessment of pediatric readiness and simulated quality of care; (2) pediatric readiness interventions; and (3) a follow-up on-site assessment of WPRS. The intervention phase included a benchmarking performance report, resources toolkits, and ongoing interactions between general EDs and academic medical centers. Results Thirty-six general EDs were enrolled, and 34 (94%) completed the study. Four EDs (11%) were located in Canada, and the rest were in the US. The mean improvement in WPRS was 16.3 (P < .001) from a baseline of 62.4 (SEM = 2.2) to 78.7 (SEM = 2.1), with significant improvement in the domains of administration/coordination of care; policies, protocol, and procedures; and quality improvement. Six EDs (17%) were fully adherent to the protocol timeline. Conclusions Implementing a collaborative intervention model including simulation and quality improvement initiatives is associated with improvement in WPRS when disseminated to a diverse group of general EDs partnering with their regional pediatric academic medical centers. This work provides evidence that innovative collaboration facilitated by academic medical centers can serve as an effective strategy to improve pediatric readiness and processes of care. (J Pediatr 2020;-:1-8). E ach year in the US, over 30 million acutely ill and injured children are evaluated in an emergency department (ED). The majority (90%) of these children receive care in general EDs that concurrently care for children and adults, 1,2 and the minority of these visits occur in pediatric EDs designed and operated primarily to care for children. 1 The gap in pediatric care between

Psychotherapy and Psychosomatics, 2012

Verlangsamung der Emphysemprogredienz wird am besten bei einer mittelgradigen Funktionseinschränk... more Verlangsamung der Emphysemprogredienz wird am besten bei einer mittelgradigen Funktionseinschränkung (FEV 1) der Lunge erreicht. Anwendung: Soweit nicht anders verordnet, reicht eine wöchentliche Dosis von 60 mg Alpha-1-Proteinaseninhibitor/kg Körpergewicht als Kurzinfusion aus, um den Alpha-1-Proteinaseninhibitorspiegel im Serum ständig über 80 mg/dl zu halten. Dieser Wert gilt als Mindestwert zum Schutz gegen eine weitere Verschlechterung des Lungenemphysems. Die gebrauchsfertige Lösung ist langsam intravenös mit einem geeigneten Infusionsbesteck zu infundieren. Die Infusionsgeschwindigkeit sollte 0,08 ml/kg Körpergewicht pro Minute nicht überschreiten. Kontraindikationen: IgA-Mangel mit Antikörpern gegen IgA, dekompensiertes Cor pulmonale. Vorsichtsmassnahmen: Im Falle einer schweren Überempfindlichkeitsreaktion (mit Blutdruckabfall <90 mm Hg, Atemnot bis hin zum anaphylaktischen Schock) ist Prolastin sofort abzusetzen und eine entsprechende Behandlung, gegebenenfalls eine Schocktherapie, einzuleiten. Da Prolastin zu einer kurzfristigen Erhöhung des Blutvolumens führen kann, ist bei Patienten mit schwerer Herzinsuffizienz besondere Vorsicht geboten. Schwangerschaft/Stillzeit: Es liegen keine Untersuchungen vor. Bei der Anwendung während der Schwangerschaft oder der Stillperiode ist Vorsicht geboten. Unerwünschte Wirkungen: Selten (0,01-0,1%) wurden die folgenden Ereignisse beobachtet: vorübergehende Blutdruckerhöhung, Überempfindlichkeitsreaktionen gegen menschliche Plasmaproteine. Interaktionen: keine bekannt. Pharmazeutische Angaben: Trockensubstanz nicht über 25°C lagern. Nicht einfrieren. Die gebrauchsfertige Lösung darf nur innerhalb von 3 Stunden nach der Herstellung verwendet werden. Abgabekategorie B. Zulassungsinhaberin: Crucell Switzerland AG, Rehhagstrasse 79, CH-3018 Bern. Die vollständigen Informationen finden sich in der Fachinformation (Arzneimittelkompendium, www.kompendium.ch). Stand April 2010 PRO170EU0312 F12012

Academic Medicine, 2009

Purpose The infrequency of severe childhood illness limits opportunities for emergency medicine (... more Purpose The infrequency of severe childhood illness limits opportunities for emergency medicine (EM) providers to learn from real-world experience. Simulation offers an evidence-based educational approach to develop and practice clinical skills. Method This was a two-phase, randomized trial with a wait-list control condition. The development phase (2005–2006) involved systematic curriculum and rating checklist creation, producing a six-case, simulation-based curriculum linked to three evaluation cases. In the validation phase (2006–2007), the authors randomized 69 residents from two EM residencies to either an intervention group that received the curriculum one month before the first assessment of all participants or a wait-list control group that received the identical curriculum three months later. A final assessment of all residents followed one month after that. Two raters evaluated all residents. Primary outcome measures are percentages of items completed correctly. The authors assessed rater agreement using intraclass correlation (ICC) and compared group performance using mixed-model analysis of variance. Results ICCs surpassed 0.78. The instructional intervention produced a statistically significant effect for two of three evaluation cases for the validation phase of the study, a case × occasion interaction. Training year was significantly associated with better performance. In a multivariate analysis, training year and session correlated with score, but study group did not. Conclusions A one-day, simulation-based pediatric EM curriculum produced limited results. The evaluation approach is reasonable and reproducible for the population studied. Instructional dose strength and factors may have limited curriculum effectiveness. Focused, frequent, and effortful instructional interventions are necessary to achieve substantial performance improvements.

MedEdPORTAL, 2020

Introduction: The Johns Hopkins Pediatrics Clerkship developed the PRECEDE (preclerkship educatio... more Introduction: The Johns Hopkins Pediatrics Clerkship developed the PRECEDE (preclerkship educational exercises) curriculum with the primary goal of offering students formative instruction in essential pediatric clinical skills to prepare them for their clerkship. PRECEDE sessions occur at the beginning of each basic clerkship for new clinical clerkship students. The otitis media module is one in a series of modules presented in the curriculum and consists of a lecture and four short skills-development stations, each with a faculty facilitator. Methods: This 2-hour module began with a 1-hour didactic overview of otitis media. Medical students were divided into three groups. One group learned about writing prescriptions via two otitis media clinical vignettes. Another group explored visualization and diagnosis of otitis media via video. The last student group was subdivided and learned proper techniques for positioning and restraining pediatric patients during otoscopic exams and the psychomotor skills for performing otoscopic examinations, including pneumatic otoscopy. Student groups rotated through all four activity stations. Students were guided through discussion to develop interpretation, diagnostic, and treatment skills for acute otitis media. Results: Between 2010 and 2012, 254 third-and fourth-year medical students participated in this module. When asked to evaluate overall quality, 86% of learners rated the module as excellent, and 14% rated it as good. Discussion: By establishing these important skills, students may be better equipped to develop appropriate otitis media assessments, diagnoses, and care plans for patients and to use otitis media as a platform for broad education in other essential pediatric skills.

Pediatrics, 2019

In this article, we offer a framework for coaching students to understand clinical relevance and ... more In this article, we offer a framework for coaching students to understand clinical relevance and increase efficiency in patient care.

The Pediatric Infectious Disease Journal, 1998

Drug and Alcohol Dependence, 2005

My co-authors and I are pleased about the provisional acceptance of our manuscript entitled. "Imp... more My co-authors and I are pleased about the provisional acceptance of our manuscript entitled. "Improving teaching on an inpatient pediatrics service: a retrospective analysis of a program change." We greatly appreciate the thoughtful peer reviews of the referees. We are submitting this letter as well as a revised manuscript to respond to the suggestions and clarify any comments. Referee #1 did not seem to have any specific concerns to which we were expected to respond. He stated, "This is a very sound helpful article on a topic with which many paediatricians struggle. Well-designed with appropriate statistics. Findings are of relevance to paediatricians internationally." Referee #3 suggested no minor or major revisions. The comments of Referee #2 were more detailed and we respond to the comments below. Minor Essential Revisions: Reviewer Comment: In the results section the authors describe an "average" of 26 faculty members per year from 2006-2008. The authors then list faculty members from several departments but then combine all the evaluations into one score. Was there a difference between generalists and subspecialists in either the ward attending evaluations and/or the teaching attendings evaluations. This would be of extreme importance for those interested in medical education research and programmatic development. Authors' response: We appreciate the reviewer's insight on the potential implication of differential teaching ratings of generalists vs. specialists. We had considered this analysis. Some of our reasoning for not pursuing it included the following: Of the 46 necessary ward and teaching attending blocks, 20 are available for medical student teaching attending. Of these, on average 17/20 are covered by generalists, making comparisons difficult due to the small number of comparisons for "specialists." Of the 26 available ward attending blocks, an average of 8 are fulfilled by "specialists." Of these 8, one-half (n=4) have general practices, including Emergency Medicine, and Adolescent Medicine, Infectious Diseases. Again, the small number of rotating physicians who are strict subspecialists (cardiology, genetics, hematology, endocrinology),

This study was a cross-sectional survey of primary female caregivers during their childs 4-month ... more This study was a cross-sectional survey of primary female caregivers during their childs 4-month well-child visit. Our objectives were to document current caregiver awareness of infant feeding guidelines, and calculate the frequency of and reasons for early introduction of solid foods. Questionnaires were completed for 102 children. Forty-five respondents (44%) introduced solids at less than 4 months of age. Hispanic caregivers, OR 0.2 (0.07-0.9), and those who breastfed (partial or exclusive), OR 0.4 (0.2-0.9), were less likely to introduce cereal at less than 4 months of age. Among caregivers who introduced solids at less than 4 months, 36 (80%) stated that the child was not satisfied with formula or breast milk alone and 24 (53%) stated that solids helped the child sleep better at night. Thirty-four caregivers (76%) who started solids at less than 4 months were aware of guidelines regarding proper infant feeding practices. Despite knowledge of infant feeding guidelines, female ca...

SAGE Open Medical Case Reports

In children under the age of 5 who have abnormalities in history, physical examination, and labor... more In children under the age of 5 who have abnormalities in history, physical examination, and laboratory studies indicating multi-system disease, uncovering the correct diagnosis is challenging. Here, we report the course of a 4-year-old girl who presented with a change in behavior, fever, arthralgia, arthritis, and hematuria following three recent hospitalizations for pneumonia and impetigo. Serologic findings were suggestive of a rheumatologic etiology and a renal biopsy was consistent with Membranous Lupus Nephritis Class V which helped secure the diagnosis of pediatric systemic lupus erythematosus. We review the clinical features and diagnostic criteria of early-onset systemic lupus erythematosus and discuss diagnostic considerations and prognosis.

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, Jan 8, 2018

Pediatric out-of-hospital cardiac arrest survival outcomes are dismal (<10%). Care that is pro... more Pediatric out-of-hospital cardiac arrest survival outcomes are dismal (<10%). Care that is provided in adherence to established guidelines has been associated with improved survival. Lower mortality rates have been reported in higher-volume hospitals, teaching hospitals, and trauma centers. The primary objective of this article was to explore the relationship of hospital characteristics, such as annual pediatric patient volume, to adherence to pediatric cardiac arrest guidelines during an in situ simulation. Secondary objectives included comparing adherence to other team, provider, and system factors. This prospective, multicenter, observational study evaluated interprofessional teams in their native emergency department (ED) resuscitation bays caring for a simulated 5-year-old child presenting in cardiac arrest. The primary outcome, adherence to the American Heart Association pediatric guidelines, was assessed using a 14-item tool including three component domains: basic life su...

Medical teacher, Jun 14, 2018

In 2011, Johns Hopkins Medicine integrated with All Children's Hospital in St. Petersburg Flo... more In 2011, Johns Hopkins Medicine integrated with All Children's Hospital in St. Petersburg Florida to create an academic campus nearly 1000 miles from Baltimore. In 2014, the newly named Johns Hopkins All Children's Hospital established a new pediatric residency program. At that time, the Association for Graduate Medical Education had not accredited a new pediatric program in the USA in over 10 years. A unique set of circumstances provided an opportunity for program developers to build the residency under newly identified core tenets to create a number of innovative features targeted to address the many calls for change in graduate medical education. This paper focuses on three of those innovations and demonstrates how they address the many challenges introduced by the changing landscape of graduate medical education. Although a full evaluation of our program is only possible after many years, this article presents the core tenets which guided curricular development and discu...