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Several organizations including the Environmental Protection Agency, World Health Organization and American Academy of Pediatrics recommend that hospital sound levels not exceed 45 decibels. Yet, several studies across multiple age groups have observed higher than recommended levels in the intensive care setting. Elevated sound levels in hospitals have been associated with disturbances in sleep, patient discomfort, delayed recovery, and delirium.
Methods:
We measured sound levels in a pediatric cardiac intensive care unit and collected vital signs data, sedation dosing and delirium scores. During a 5-week study period, sound levels for 68 patients in 22 private and 4 semi-private rooms were monitored.
Results:
Sound levels were consistently above stated recommendations with an average daytime level of 50.6 decibels (maximum, 76.9 decibels) and an average nighttime level of 49.5 decibels (maximum, 69.6 decibels). An increase in average and maximum sound levels increased the probability of sedation administration the following hour (p-value < 0.001 and 0.01, respectively) and was predictive of an increase in heart rate and blood pressure (p-value < 0.001).
Conclusion:
Sound levels in the CICU were consistently higher than recommended. An increase in heart rate, blood pressure and sedation utilization may suggest a stress response to persistent and sudden loud sounds. Given known negative impacts of excessive noise on stress, sleep, and brain development, as well as the similar adverse effects from the related use of sedative medications, reducing excessive and sudden noise may provide an opportunity to improve short- and long-term hemodynamic and neurodevelopmental outcomes in the pediatric cardiac intensive care unit.
Malala Yousafzai won the Nobel Peace Prize when she was seventeen. In part, the world knows about her because when the Taliban prohibited girls from attending school in Afghanistan, she spoke up about it, writing articles and giving talks. As is clear by her writing, Malala has strong values that include justice and equality for women as well as a love of learning and education. She also values safety. In making her choice to speak up and criticize her government’s decision, Malala was aware that she was increasing risks to herself and her family. In response, the Taliban shot (then fifteen-year-old) Malala in the head while she was on a school bus. Thankfully, she survived and continues to advocate for a future where girls are free to learn and lead.
Malala made decisions based on trade-offs among her values, even when the priority she placed on equality and justice made her vulnerable to Taliban hostility and increased her own risk of death.
After earning a commerce degree, Will got a corporate job and wore a suit to work every day, then came home to a rental condo in the city he shared with his girlfriend. After about a year he started to wonder why he wasn’t happy. Maybe if he took more time off or got a dog? But after another year of his job, a bit of travelling with his girlfriend, and a year of going on jogs and throwing sticks for their puppy, he still felt miserable. Will realized he had been doing all the things that mattered to others without knowing what truly mattered to himself. In a flurry of decisions, Will quit his job, broke up with his girlfriend, and moved back in with his parents. That’s when he ran into an old family friend, Leah, and, in a rush of details, told her about his life since graduation.
Exploring Consequences, the fourth Decision-Maker Move, is about understanding what will happen as the result of selecting any of the various options. Or rather, what is most likely to happen. Keep in mind, both uncertainty (about what occurs) and luck (either good or bad) often play a part in how things actually turn out. Study and do well on the exam, knowing that spending the evening studying won’t be much fun. Don’t study and probably do poorly on the exam but have a good time for a few hours the night before. It’s all about the consequences. Eat the fruit salad or soup special for lunch, feel great in the afternoon and get a lot done. Choose the huge burger and a double order of fries, feel sleepy and get less done the rest of the day. Consequences follow from the choices we make.
Decisions are doors that provide people of all ages with opportunities to express who they are and to learn about who they want to become. Sometimes the young people in your life may choose the wrong door and, while that can make for a good learning experience, you probably want to help them make good decisions and avoid the bad ones. You did, after all, decide to open up this book. While we cannot program kids with the answers they need to live healthy and fulfilling lives, we can support kids in learning and using a common-sense approach to understanding and organizing their feelings and thoughts as they make their own decisions.
Creating options is an exciting and fun part of making decisions. It’s what changes “I have to do this” (reluctantly solving a problem) to “I get to do this” (enthusiastically creating an opportunity). People often excuse their decisions by saying, “I didn’t have a choice – it’s just something I had to do.” But that’s rarely true. Decision options are almost always available.
If one young person is about to make a decision, helping them construct options is relatively straightforward. Once they are clear about which values might be affected, they can generate different options likely to satisfy these qualities.
The Skidegate dialect of the Haida, an Indigenous Nation on the West Coast of Canada, has a phrase for “staying curious.” Gina gii Giixan aanagung means “to look around with curiosity and intent.” This Haida concept holds more than curiosity; it conveys the idea of staying observant with the world on purpose. It suggests an active stance. Staying curious by asking questions, paying attention, and learning new things takes energy and action.
The Stay Curious and Adjust Decision-Maker Move is about decision makers being in a learning relationship with their choices, actively seeking to uncover and learn from new information based on their own lives and experiences as well as the conversations they have with others. It’s a recognition that many choices are repeated (with minor changes), so there are ample opportunities for self-learning and making adjustments.
Meaningful conversations require skills we develop when making thoughtful decisions. More than a common-sense approach to living, the Decision-Maker Moves enable us to effectively discover and express what matters in ways that get things done. By expanding our scope to include the wellbeing of others, even if the lives of the other people are very unlike our own, we can level up from the personal to the social – from ourselves to family members, to people living in our communities, to our cities and provinces or states, and – in some cases, such as with Abhay – to our world.
At times like this, when the way forward isn’t clear, framing the choice – a quick check into what the decision is all about – can be helpful. And important. Taking control over how we picture the decisions we face is part of transforming decision problems into decision opportunities. The decision frame determines how we bring who we are and what we care about into the decision-making picture.
Written for parents, teachers, and others who live or work with teenagers, this science-based guide describes how you can become a confident 'decision mentor.' Learn to support young people in making good decisions for themselves. Treating decision making as an essential and learnable skill, the six-step 'Decision-Maker Moves' highlight the power and promise of young people as they shape their lives through the options they choose. Stories, examples, and practical tips show how decisions can transform problems into opportunities. Each chapter provides common-sense advice on when and how to talk with teenagers as they weigh up the often-conflicting values, emotions, and trade-offs affecting their choices. We cannot provide young minds with all the answers, but we can help them as they navigate both life-changing and everyday decisions.
Most students in MD-PhD programs take a leave of absence from medical school to complete PhD training, which promotes a natural loss of clinical skills and knowledge and could negatively impact a student’s long-term clinical knowledge. To address this concern, clinical refresher courses in the final year of PhD training have traditionally been used; however, effectiveness of such courses versus a longitudinal clinical course spanning all PhD training years is unclear.
Methods:
The University of Alabama at Birmingham MD-PhD Program implemented a comprehensive continuing clinical education (CCE) course spanning PhD training years that features three course components: (1) clinical skills; (2) clinical knowledge; and (3) specialty exposure activities. To evaluate course effectiveness, data from an anonymous student survey completed at the end of each semester were analyzed.
Results:
Five hundred and ninety-seven surveys were completed by MD-PhD students from fall 2014 to 2022. Survey responses indicated that the majority of students found the course helpful to: maintain clinical skills and knowledge (544/597, 91% and 559/597, 94%; respectively), gain exposure to clinical specialties (568/597, 95%), and prepare them for responsibilities during clinical clerkships. During semesters following lockdowns from the COVID-19 pandemic, there were significant drops in students’ perceived preparedness.
Conclusions:
Positive student survey feedback and improved preparedness to return to clinic after development of the course suggests the CCE course is a useful approach to maintain clinical knowledge during research training.