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Ehrle H, Goebel J. A(nother) plea for better management of post-transplant cardiovascular morbidity. Pediatr Nephrol 2024:10.1007/s00467-024-06280-1. [PMID: 38246943 DOI: 10.1007/s00467-024-06280-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Haley Ehrle
- Departments of Pediatrics and Graduate Medical Education, Michigan State University, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - Jens Goebel
- Department of Pediatrics, Section of Pediatric Nephrology, Michigan State University, Helen DeVos Children's Hospital, 100 Michigna St. NE, Grand Rapids, MI, 49503, USA.
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Chua ME, Silangcruz JM, Kim JK, Koyle MA, Sriharan A. A Scoping Review on Learning Health Networks Available in Pediatric Surgical Specialties. J Pediatr Surg 2023; 58:2416-2428. [PMID: 37544802 DOI: 10.1016/j.jpedsurg.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Learning health networks (LHN) are consortia of institutions that collaborate and embrace the elements of the learning health system (LHS), including quality improvement, education, research, and stakeholder involvement. Their ultimate goal is rapid information dissemination in clinical care. Pediatric surgical specialties perform unique yet high-impact procedures that could benefit from LHN, thereby improving surgical outcomes and care through LHS approaches. Consequently, health system leaders should be aware of LHN and their importance in enhancing surgical care and improving outcomes. This scoping review aims to map and characterize the existing LHN applied in pediatric surgical specialties. METHODS A systematic literature search was performed on Medline, EMBASE, and Scopus up to June 2022, with an update search conducted in May 2023. Additionally, Google Scholar, ProQuest and inquiry from topic experts were used for cross-referencing relevant review articles to identify grey literature. This scoping review was conducted and reported according to the PRISMA-scoping review extension. RESULTS A total of 56 publications for 19 LHN were identified and included in this scoping review. Out of 19 identified LHN in pediatric surgical specialties, 18 were organized in North America. Eight of the networks are related to pediatric general surgery and another eight were related to pediatric transplantation. The 16 out of 19 LHN were initiated after 2001. To date, only eight of the LHNs generated reports of comparative improved outcomes. CONCLUSION This scoping review provides an overview of the available LHNs in pediatric surgical specialties. Over the past decade, several pediatric surgical specialties have embraced the principles of learning health systems, forming inter-institutional collaborations that utilize information technology to generate big data on patient-level clinical information, engage in quality improvement cycles, adopt evidence-based practices, and actively involve patients and stakeholders. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Michael E Chua
- Global Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Institute of Urology, St. Luke's Medical Center, Quezon City, NCR, Philippines.
| | | | - Jin Kyu Kim
- Department of Surgery, Faculty of Medicine and Surgery, University of Toronto, ON, Canada
| | - Martin A Koyle
- System Leadership and Innovation, Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
| | - Abi Sriharan
- System Leadership and Innovation, Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
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Ladányi Z, Bárczi A, Fábián A, Ujvári A, Cseprekál O, Kis É, Reusz GS, Kovács A, Merkely B, Lakatos BK. Get to the heart of pediatric kidney transplant recipients: Evaluation of left- and right ventricular mechanics by three-dimensional echocardiography. Front Cardiovasc Med 2023; 10:1094765. [PMID: 37008334 PMCID: PMC10063872 DOI: 10.3389/fcvm.2023.1094765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/15/2023] [Indexed: 03/19/2023] Open
Abstract
BackgroundKidney transplantation (KTX) markedly improves prognosis in pediatric patients with end-stage kidney failure. Still, these patients have an increased risk of developing cardiovascular disease due to multiple risk factors. Three-dimensional (3D) echocardiography allows detailed assessment of the heart and may unveil distinct functional and morphological changes in this patient population that would be undetectable by conventional methods. Accordingly, our aim was to examine left- (LV) and right ventricular (RV) morphology and mechanics in pediatric KTX patients using 3D echocardiography.Materials and methodsPediatric KTX recipients (n = 74) with median age 20 (14–26) years at study enrollment (43% female), were compared to 74 age and gender-matched controls. Detailed patient history was obtained. After conventional echocardiographic protocol, 3D loops were acquired and measured using commercially available software and the ReVISION Method. We measured LV and RV end-diastolic volumes indexed to body surface area (EDVi), ejection fraction (EF), and 3D LV and RV global longitudinal (GLS) and circumferential strains (GCS).ResultsBoth LVEDVi (67 ± 17 vs. 61 ± 9 ml/m2; p < 0.01) and RVEDVi (68 ± 18 vs. 61 ± 11 ml/m2; p < 0.01) were significantly higher in KTX patients. LVEF was comparable between the two groups (60 ± 6 vs. 61 ± 4%; p = NS), however, LVGLS was significantly lower (−20.5 ± 3.0 vs. −22.0 ± 1.7%; p < 0.001), while LVGCS did not differ (−29.7 ± 4.3 vs. −28.6 ± 10.0%; p = NS). RVEF (59 ± 6 vs. 61 ± 4%; p < 0.05) and RVGLS (−22.8 ± 3.7 vs. −24.1 ± 3.3%; p < 0.05) were significantly lower, however, RVGCS was comparable between the two groups (−23.7 ± 4.5 vs. −24.8 ± 4.4%; p = NS). In patients requiring dialysis prior to KTX (n = 64, 86%) RVGCS showed correlation with the length of dialysis (r = 0.32, p < 0.05).ConclusionPediatric KTX patients demonstrate changes in both LV and RV morphology and mechanics. Moreover, the length of dialysis correlated with the contraction pattern of the right ventricle.
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Affiliation(s)
- Zsuzsanna Ladányi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Correspondence: Zsuzsanna Ladányi
| | - Adrienn Bárczi
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Adrienn Ujvári
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Orsolya Cseprekál
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Éva Kis
- Department of Pediatric Cardiology, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary
| | | | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Hypertension in Pediatric Solid Organ Transplant Recipients. Curr Hypertens Rep 2023; 25:51-60. [PMID: 36862274 DOI: 10.1007/s11906-023-01237-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE OF REVIEW To review the current literature regarding hypertension (HTN) following pediatric solid organ transplant (SOTx), including definition, prevalence, risk factors, outcomes, and treatment. RECENT FINDINGS In recent years several new guidelines for the definition, monitoring, and management of pediatric HTN have been published, but with no specific recommendations regarding SOTx recipients. HTN remains highly prevalent, yet underdiagnosed and undertreated in kidney transplant (KTx) recipients, especially when ambulatory blood pressure monitoring (ABPM) is utilized. There are little data regarding its prevalence in other SOTx recipients. HTN in this population is multifactorial and is associated with HTN status prior to Tx, demographic factors (age, sex, and race), weight status, and immunosuppression protocol. HTN is associated with subclinical cardiovascular (CV) end-organ damage, including left ventricular hypertrophy (LVH) and arterial stiffness, yet there are no recent data regarding its long-term outcomes. There are also no updated recommendations regarding the optimal management of HTN in this population. Given its high prevalence and the young age of this population facing years at increased CV risk, post-Tx HTN requires more clinical attention (routine monitoring, frequent application of ABPM, better BP control). Additional research is needed for a better understanding of its long-term outcomes as well as its treatment and treatment goals. Much more research is needed regarding HTN in other pediatric SOTx populations.
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Varnell CD, Margolis P, Goebel J, Hooper DK. The learning health system for pediatric nephrology: building better systems to improve health. Pediatr Nephrol 2023; 38:35-46. [PMID: 35445971 PMCID: PMC9021363 DOI: 10.1007/s00467-022-05526-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 01/10/2023]
Abstract
Learning health systems (LHS) align science, informatics, incentives, and culture for continuous improvement and innovation. In this organizational system, best practices are seamlessly embedded in the delivery process, and new knowledge is captured as an integral byproduct of the care delivery experience aimed to transform clinical practice and improve patient outcomes. The objective of this review is to describe how building better health systems that integrate clinical care, improvement, and research as part of an LHS can improve care within pediatric nephrology. This review will provide real-world examples of how this system can be established in a single center and across multiple centers as learning health networks.
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Affiliation(s)
- Charles D Varnell
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Peter Margolis
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jens Goebel
- Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing, MI, USA
- Pediatric Nephrology, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - David K Hooper
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Improving Blood Pressure Screening in Neonatal Follow-up Clinic: A Quality Improvement Initiative. Pediatr Qual Saf 2022; 7:e559. [PMID: 35720869 PMCID: PMC9197357 DOI: 10.1097/pq9.0000000000000559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/19/2022] [Indexed: 11/26/2022] Open
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Varnell C, Harshman LA, Smith L, Liu C, Chen S, Al‐Akash S, Barletta G, Belsha C, Brakeman P, Chaudhuri A, Fadakar P, Garro R, Gluck C, Goebel J, Kershaw D, Matossian D, Nailescu C, Patel HP, Pruette C, Ranabothu S, Rodig N, Smith J, Sebestyen VanSickle J, Weng P, Danziger‐Isakov L, Hooper DK, Seifert M. COVID‐19 in pediatric kidney transplantation: The Improving Renal Outcomes Collaborative. Am J Transplant 2021. [DOI: 10.1111/ajt.16501 10.1111/ajt.16501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Charles Varnell
- Cincinnati Children’s Hospital Medical Center Cincinnati Ohio
- University of Cincinnati College of Medicine Cincinnati Ohio
| | | | - Laurie Smith
- Cincinnati Children’s Hospital Medical Center Cincinnati Ohio
| | - Chunyan Liu
- Cincinnati Children’s Hospital Medical Center Cincinnati Ohio
| | - Shiran Chen
- Cincinnati Children’s Hospital Medical Center Cincinnati Ohio
| | | | | | - Craig Belsha
- SSM Health Cardinal Glennon Children's Hospital Saint Louis Missouri
| | - Paul Brakeman
- Department of Pediatrics University of California San Francisco California
| | - Abanti Chaudhuri
- Lucile Packard Children’s HospitalStanford University Stanford California
| | - Paul Fadakar
- UPMC Children’s Hospital of Pittsburgh Pittsburgh Pennsylvania
| | - Rouba Garro
- Children’s Healthcare of AtlantaEmory School of Medicine Atlanta Georgia
| | - Caroline Gluck
- Nemours/Alfred I. duPont Hospital for Children Wilmington Delaware
| | - Jens Goebel
- Children’s Hospital Colorado Aurora Colorado
| | | | - Debora Matossian
- Ann & Robert H. Lurie Children’s Hospital of Chicago Chicago Illinois
| | - Corina Nailescu
- Riley Hospital for Children at Indiana University Health Indianapolis Indiana
| | | | - Cozumel Pruette
- Johns Hopkins University School of Medicine Baltimore Maryland
| | | | - Nancy Rodig
- Boston Children’s HospitalHarvard Medical School Boston Massachusetts
| | - Jodi Smith
- Seattle Children’s Hospital Seattle Washington
| | | | - Patricia Weng
- UCLA Mattel Children’s Hospital Los Angeles California
| | - Lara Danziger‐Isakov
- Cincinnati Children’s Hospital Medical Center Cincinnati Ohio
- University of Cincinnati College of Medicine Cincinnati Ohio
| | - David K. Hooper
- Cincinnati Children’s Hospital Medical Center Cincinnati Ohio
- University of Cincinnati College of Medicine Cincinnati Ohio
| | - Michael Seifert
- University of Alabama at BirminghamChildren’s of Alabama Birmingham Alabama
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Varnell Jr C, Harshman LA, Smith L, Liu C, Chen S, Al-Akash S, Barletta GM, Belsha C, Brakeman P, Chaudhuri A, Fadakar P, Garro R, Gluck C, Goebel J, Kershaw D, Matossian D, Nailescu C, Patel HP, Pruette C, Ranabothu S, Rodig N, Smith J, Sebestyen VanSickle J, Weng P, Danziger-Isakov L, Hooper DK, Seifert M. COVID-19 in pediatric kidney transplantation: The Improving Renal Outcomes Collaborative. Am J Transplant 2021; 21:2740-2748. [PMID: 33452854 PMCID: PMC8013281 DOI: 10.1111/ajt.16501] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/17/2020] [Accepted: 01/10/2021] [Indexed: 01/25/2023]
Abstract
There are limited data on the impact of COVID-19 in children with a kidney transplant (KT). We conducted a prospective cohort study through the Improving Renal Outcomes Collaborative (IROC) to collect clinical outcome data about COVID-19 in pediatric KT patients. Twenty-two IROC centers that care for 2732 patients submitted testing and outcomes data for 281 patients tested for SARS-CoV-2 by PCR. Testing indications included symptoms and/or potential exposures to COVID-19 (N = 134, 47.7%) and/or testing per hospital policy (N = 154, 54.8%). Overall, 24 (8.5%) patients tested positive, of which 15 (63%) were symptomatic. Of the COVID-19-positive patients, 16 were managed as outpatients, six received non-ICU inpatient care and two were admitted to the ICU. There were no episodes of respiratory failure, allograft loss, or death associated with COVID-19. To estimate incidence, subanalysis was performed for 13 centers that care for 1686 patients that submitted all negative and positive COVID-19 results. Of the 229 tested patients at these 13 centers, 10 (5 asymptomatic) patients tested positive, yielding an overall incidence of 0.6% and an incidence among tested patients of 4.4%. Pediatric KT patients in the United States had a low estimated incidence of COVID-19 disease and excellent short-term outcomes.
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Affiliation(s)
- Charles Varnell Jr
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Laurie Smith
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Chunyan Liu
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Shiran Chen
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Craig Belsha
- SSM Health Cardinal Glennon Children’s Hospital, Saint Louis, Missouri
| | - Paul Brakeman
- Department of Pediatrics, University of California, San Francisco, California
| | - Abanti Chaudhuri
- Lucile Packard Children’s Hospital, Stanford University, Stanford, California
| | - Paul Fadakar
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rouba Garro
- Children’s Healthcare of Atlanta, Emory School of Medicine, Atlanta, Georgia
| | - Caroline Gluck
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Jens Goebel
- Children’s Hospital Colorado, Aurora, Colorado
- Present address Jens Goebel, Helen DeVos Children’s Hospital, Grand Rapids, MichiganMichigan, USA
| | | | - Debora Matossian
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Corina Nailescu
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | | | - Cozumel Pruette
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Nancy Rodig
- Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jodi Smith
- Seattle Children’s Hospital, Seattle, Washington
| | | | - Patricia Weng
- UCLA Mattel Children’s Hospital, Los Angeles, California
| | - Lara Danziger-Isakov
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David K. Hooper
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michael Seifert
- University of Alabama at Birmingham, Children’s of Alabama, Birmingham, Alabama
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Hooper DK, Misurac J, Blydt-Hansen T, Chua AN. Multicenter data to improve health for pediatric renal transplant recipients in North America: Complementary approaches of NAPRTCS and IROC. Pediatr Transplant 2021; 25:e13891. [PMID: 33142362 DOI: 10.1111/petr.13891] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
Kidney transplantation increases life expectancy and improves quality of life for children with end-stage kidney disease, yet sequelae of transplantation and treatment make it difficult for transplant recipients to enjoy health and quality of life similar to their healthy peers. The NAPRTCS network was among the first to use multicenter data to inform improvements in care and outcomes for children with a kidney transplant through observational research. Now, with new technologies and unprecedented access to data, it is possible to create learning health systems as envisioned by the US National Academy of Sciences to seamlessly integrate research and continuous improvement of clinical care. In this review, we present two pre-eminent North American networks focused on using multicenter data to drive improved care and outcomes for children with a kidney transplant. Whereas, for the past 30 years NAPRTCS has focused on discovery of best practices through observational research and clinical trials, the Improving Renal Outcomes Collaborative, established in 2016, engages patients, families, clinicians, and researchers in redesigning the healthcare delivery system to enable practice change and continuous improvement of health outcomes. We discuss the history and past contributions of these networks, as well as current activities, barriers, and potential future solutions to more fully realize the vision of a true learning health system for pediatric kidney transplant recipients.
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Affiliation(s)
- David K Hooper
- Division of Nephrology (MLC-7022) and James M Anderson Center for Health Systems Excellence (MLC-7014), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jason Misurac
- Division of Pediatric Nephrology, Dialysis, and Transplantation, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Tom Blydt-Hansen
- Division of Nephrology, BC Children's Hospital, University of British Colombia, Vancouver, BC, Canada
| | - Annabelle N Chua
- Division of Pediatric Nephrology, Duke University Medical Center, Durham, NC, USA
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