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Dean A. This Is PHM: A Lesson in Mindfulness From Global Health for the Mental Health Crisis. Hosp Pediatr 2024:e2023007611. [PMID: 38646686 DOI: 10.1542/hpeds.2023-007611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 04/23/2024]
Affiliation(s)
- Andrea Dean
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Aboul-Fotouh D, Donaruma-Kwoh M, Barak G, Dean A. Severe Malnutrition in an Adolescent Girl. Pediatr Rev 2024; 45:43-46. [PMID: 38161154 DOI: 10.1542/pir.2021-005416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Doha Aboul-Fotouh
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Marcella Donaruma-Kwoh
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Gal Barak
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Andrea Dean
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
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Barak G, Dean A, Haq H, Falco C, Singhal G. The Senior Resident-Fellow Dynamic on Pediatric Hospital Medicine Teams: A Qualitative Study. Hosp Pediatr 2023; 13:912-921. [PMID: 37701970 DOI: 10.1542/hpeds.2022-006992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND AND OBJECTIVES With the Accreditation Council for Graduate Medical Education accreditation in place for pediatric hospital medicine (PHM) fellowships, fellows are playing a larger role in resident education. However, the impact of PHM fellows on pediatric residency training is not well described. We aimed to identify the factors that affect the dynamic between senior residents and fellows working together on PHM teams. METHODS In this qualitative study, we used purposive sampling and interviewed 15 senior residents and 8 PHM fellows between April and September 2020. We created a conceptual framework for the senior resident-fellow dynamic to develop the interview guide. Using verbatim transcripts uploaded into Dedoose software, 2 authors coded responses and identified themes using directed content analysis. RESULTS Twelve themes emerged as factors that impact the senior resident-fellow dynamic and fell into 6 categories: Team organization, role clarity, teaching, fellow approachability, decision-making, and attending involvement. Both senior residents and PHM fellows described an optimal dynamic in which a hierarchal approach to team structure, teaching, and decision-making is counterbalanced by fellow approachability. Role uncertainty, especially with increased attending involvement, led to conflict between residents and fellows. CONCLUSIONS This study demonstrated that a structured hierarchy surrounding supervision, decision-making, and teaching promoted level-appropriate autonomy for both senior residents and fellows. These findings can be used to design an intervention, such as a leadership curriculum for fellows and senior residents, to target behaviors that facilitate a stepwise approach to supervision and patient care.
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Affiliation(s)
- Gal Barak
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Andrea Dean
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Heather Haq
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Carla Falco
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Geeta Singhal
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
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Crowley SC, Dean A. Concern for an Antibiotic-Resistant Skin and Soft Tissue Infection after a Bee Sting. Pediatr Rev 2023; 44:e9-e12. [PMID: 37002360 DOI: 10.1542/pir.2021-005318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Affiliation(s)
| | - Andrea Dean
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX
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Ho S, McShane M, Dean A. A case of MIS-C presenting with fever and rash. Vis J Emerg Med 2023; 30:101603. [PMID: 36718415 PMCID: PMC9875750 DOI: 10.1016/j.visj.2023.101603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 11/24/2022] [Accepted: 01/12/2023] [Indexed: 01/27/2023]
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6
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Barak G, Carroll MR, Dean A. Salpingitis in an Adolescent Female With Constipation and Abdominal Pain. JPGN Rep 2022; 3:e271. [PMID: 37168476 PMCID: PMC10158367 DOI: 10.1097/pg9.0000000000000271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/10/2022] [Indexed: 05/13/2023]
Abstract
Abdominal pain is one of the most common presenting complaints in the emergency room for pediatric patients. While constipation is one of the most common causes for abdominal pain in pediatrics, serious intra-abdominal pathology must always be excluded. We report a pre-coital post-menarchal adolescent female who presented with severe abdominal pain and constipation and had radiographic findings of salpingitis. It was suspected that uterine and adnexal changes seen on imaging resulted from the fecal mass compressing the genitourinary tract leading to fluid collection manifesting as radiographic evidence of salpingitis. This mechanism is similar to bladder outlet obstruction resulting from compression by intestinal stool burden, leading to urinary stasis, bacteriuria, and ascending urinary tract infection. This case demonstrates how a common pediatric problem, constipation, can lead to a condition rarely found in the pre-coital adolescent population.
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Affiliation(s)
- Gal Barak
- From the Department of Pediatrics, Baylor College of Medicine/ Texas Children’s Hospital, Houston, TX
| | - Matthew R. Carroll
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Andrea Dean
- From the Department of Pediatrics, Baylor College of Medicine/ Texas Children’s Hospital, Houston, TX
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Barak G, Carroll MR, Dean A. The Kids Are Alright: a New Generation of Educators. Med Sci Educ 2022; 32:1189-1194. [PMID: 36276772 PMCID: PMC9583974 DOI: 10.1007/s40670-022-01618-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 06/16/2023]
Abstract
Generational theory states that as a result of experiencing the same life-altering, world-wide events at key developmental ages, individuals of a given generation share unique perspectives, values, and traits compared to other generations as reported by Johnson and Romanello (Nurse Educ. 30(5):212-216, 2005) and Howe and Strauss 2000. Thus, while individual variation still exists, generational theory can be used as a tool to predict individual behavior and capitalize on shared traits in the workplace or educational setting. The millennial generation, born between 1981 and 1996, has previously been negatively perceived; however, application of generational theory can allow for a reshaping of public perception. For example, there now exists ample research, both within and outside of medical education, on how to take advantage of typical traits of the millennial student to maximize their learning, such as Twenge (Med Educ. 43(5):398-405, 2009), Eckleberry-Hunt and Tucciarone (J Grad Med Educ. 3(4):458-461, 2011), and Nicholas (Int J Learn Annu Rev. 15(6):27-34, 2008). As the cohort ages, the focus has shifted to helping millennials reach their full potential as employees. However, due to intensive and lengthy training required, medicine is only now seeing the first cohort of millennials entering the workforce as faculty physicians. As such, academic medicine is seeing millennials move from the learner role into that of the teacher. Thus far, the influence of the shared generational characteristics on their success and challenges as clinician educators and educational leaders is novel and has not been explored in the literature. By overlaying generational theory on Srinivasan et al.'s (Acad Med. 86(10):1211-1220, 2011) proposed six competencies for medical educators, we predict the strengths and challenges of millennial medical educators and hypothesize on the impact this generation may have on academic medicine.
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Affiliation(s)
- Gal Barak
- Department of Pediatrics, Baylor College of Medicine, Houston, USA
- Texas Children’s Hospital, 1102 Bates Ave, Houston, TX FC1860 USA
| | - Matthew Ryan Carroll
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, USA
| | - Andrea Dean
- Department of Pediatrics, Baylor College of Medicine, Houston, USA
- Texas Children’s Hospital, 1102 Bates Ave, Houston, TX FC1860 USA
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Sproson L, Dean A, Keogh L, Campey J, Gandhi R, Caunt S, Selvarajah D. User involvement throughout development of technology to support diabetes foot care: a case illustration of the devices for dignity PPIE model. J Med Eng Technol 2022; 46:558-566. [PMID: 36062509 DOI: 10.1080/03091902.2022.2089259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The successful development and implementation of any healthcare technology requires input from multiple stakeholders including clinical leads, trust information technology directorates as well as project management and procurement. In this process however, a key stakeholder that is often overlooked is the patient.This paper illustrates the crucial importance of patient involvement to avoid poor design and poor uptake of technology and subsequently poor health outcomes.To highlight this, we share a case example evidencing involvement of people with lived experience of foot ulcers resulting from Diabetic foot neuropathy throughout identification of unmet technology needs, design requirements for the device and iterative device development and evaluation.
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Affiliation(s)
- L Sproson
- NIHR Devices for Dignity MedTech Co-operative, Sheffield Teaching Hospitals NHS, Foundation Trust, Sheffield, UK
| | - A Dean
- NIHR Devices for Dignity MedTech Co-operative, Sheffield Teaching Hospitals NHS, Foundation Trust, Sheffield, UK
| | - L Keogh
- Academic Directorate of Diabetes & Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J Campey
- Academic Directorate of Diabetes & Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - R Gandhi
- Academic Directorate of Diabetes & Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S Caunt
- NIHR Devices for Dignity MedTech Co-operative, Sheffield Teaching Hospitals NHS, Foundation Trust, Sheffield, UK
| | - D Selvarajah
- Academic Directorate of Diabetes & Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,University of Sheffield, Sheffield, UK
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Dean A, Fromme HB, Barak G, Zuniga L, Foradori D. GetINBurnOUT: Feedback and support for trainees experiencing burnout. Med Educ 2022; 56:562-563. [PMID: 35233798 DOI: 10.1111/medu.14774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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10
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Dean A, Foradori DM, Kumar S, Player B, Hochreiter D, Hainstock L, Kumta J, Gold J, Fromme HB. How Perceived Burnout Alters Frontline Educators' Assessments in the Clinical Learning Environment. Acad Pediatr 2022; 22:495-500. [PMID: 34929385 DOI: 10.1016/j.acap.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 08/30/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study explores frontline educators' experience with learner burnout in the clinical learning environment (CLE) and how perceived burnout may impact assessment. METHODS A survey was sent to 105 Pediatric Hospital Medicine faculty and fellows at 7 sites across the United States representing diverse CLEs. They were invited to participate in an 11-question web-based survey that was developed, edited, and revised in step-wise fashion. It consisted of 5-point Likert scale, forced-choice, and dichotomous questions. Data from the web-based survey were compiled for descriptive purposes and analyzed for trends. RESULTS The response rate was 53%. Most respondents (83%) perceive learner burnout at least once per year, but median comfort in identifying burnout was 3 (scale 1-5, 3 = neutral). Factors associated with comfort were education as primary niche (P = .01) and having wellness training (P = .045). In terms of the impact of perceived learner burnout impacts on assessment, 88% report impact on feedback sessions and 60% reported impact on summative assessment; most are more lenient. Stated belief in whether perceived burnout should or should not impact assessment had 60% sensitivity and 84% specificity in predicting whether it does. CONCLUSIONS Frontline educators routinely perceive learner burnout in the CLE and it often impacts educators' assessment of a learner. The discrepancy between the expected and actual impact may suggest amplification of known barriers to accurate assessment in the CLE. Comfort associated with wellness training suggests that interventions targeting frontline educators in the CLE may improve their ability to simultaneously support and assess learners.
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Affiliation(s)
- Andrea Dean
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital (A Dean and S Kumar), Houston, Tex.
| | - Dana M Foradori
- Department of Pediatrics, Cleveland Clinic Learner College of Medicine of Case Western Reserve University (DM Foradori), Cleveland, Ohio
| | - Shelley Kumar
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital (A Dean and S Kumar), Houston, Tex
| | - Brittany Player
- Department of Pediatrics, Medical College of Wisconsin (B Player), Milwaukee, Wis
| | - Daniela Hochreiter
- Department of Pediatrics, Yale School of Medicine (D Hochreiter), New Haven, Conn
| | - Lisa Hainstock
- Department of Pediatrics, University of Virginia Children's Hospital (L Hainstock), Charlottesville, Va
| | - Jayshree Kumta
- Department of Pediatrics, Children's Hospital of New Jersey at Newark Beth Israel Medical Center (J Kumta), Newark, NJ
| | - Jessica Gold
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford (J Gold), Stanford, Calif
| | - H Barrett Fromme
- Department of Pediatrics, University of Chicago Pritzker School of Medicine (HB Fromme), Chicago, Ill
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Maffei S, De Guzman M, Rochat R, Tran J, Risen S, Dean A, Coleman N. From Telemedicine to the ICU-Fever and Rash in a 9-Year-Old Girl. Pediatrics 2022; 149:183833. [PMID: 34972223 DOI: 10.1542/peds.2021-051501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/24/2022] Open
Abstract
A 9-year-old girl presented to her primary care pediatrician via telemedicine during the initial months of the coronavirus disease 2019 pandemic because of 4 days of warmth perceived by her mother, decreased energy, and a new rash on her upper extremities. After 10 additional days of documented fever >38°C, worsening fatigue, and 1 day of nausea, vomiting, and diarrhea, she was allowed to schedule an in-person visit with her pediatrician after testing negative for severe acute respiratory syndrome coronavirus 2. She appeared ill on arrival to clinic, and her pediatrician recommended evaluation in an emergency department. Her initial laboratory testing revealed nonspecific elevation in several inflammatory markers and leukopenia, and she responded well to intravenous hydration. Over the next 2 weeks, her fever persisted, constitutional symptoms worsened, and she developed progressively painful cervical lymphadenopathy and pancytopenia. She was evaluated in clinic by several specialists and eventually was urged to present to the emergency department again, at which time she was admitted to the PICU. After consulting additional specialists and waiting for laboratory results, the team reached a definitive diagnosis and initiated therapy; however, she experienced rapid clinical decline shortly thereafter. The specialists who assisted with identification of the underlying etiology of her symptoms were able to work together to manage the subsequent complications.
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12
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Dean A, Said A, Marri K, Chelius D. Stridor Due to Cranial Nerve X Palsy Progressing to Polyneuropathy in a Teenager With COVID-19. Pediatrics 2021; 148:183397. [PMID: 34851417 DOI: 10.1542/peds.2021-051534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/24/2022] Open
Abstract
The neurologic manifestations of coronavirus disease 2019 (COVID-19) are wide-ranging, including various cranial neuropathies, beyond anosmia and dysgeusia, the exact neuropathological mechanism of which are yet unknown. Acute cranial nerve (CN) X neuritis with vocal cord paralysis has not been reported in COVID-19 and is a rare presentation of neuropathy in general. A girl aged 14 years was admitted with stridor. She was diagnosed with symptomatic COVID-19 8 days before. By presentation, fever had resolved, but she had developed stridor; sore throat with dysphagia; chest, shoulder, and back pain; and generalized weakness. Neurologic examination and laryngoscopy were consistent with isolated left CN X palsy. Steroids were started, but neurologic disease progressed with subjective pain, right lower face numbness, and eye fatigability. Respiratory distress increased, and she was intubated for airway protection. MRI revealed abnormal enhancement of CNs III, V, XII, and X. Cerebrospinal fluid studies were normal. Nasopharyngeal severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test result was positive. She was treated with intravenous immunoglobulin, a total of 2 g/kg, and steroids were continued. She made a full neurologic recovery and was discharged after 9 days of hospitalization. This is a case of a teenager who presented with an acute, life-threatening CN X palsy and development of a progressive polyneuropathy in the setting of COVID-19. Although there was concern for Guillain-Barre syndrome, a definitive diagnosis could not be made, and the unusual features of this case, including presentation with stridor and predominate CN involvement seem to indicate a separate symptomatic COVID-19-associated polyneuritis.
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Affiliation(s)
| | | | | | - Daniel Chelius
- Otolaryngology, Baylor College of Medicine, Houston, Texas
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13
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Dean A, Arrandale L, Griffiths S, Bourke S. P.25 Improving antenatal anaesthetic assessment and dissemination of information to parturients with a high body mass index. Int J Obstet Anesth 2021. [DOI: 10.1016/j.ijoa.2021.103023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Dean A, Lloyd C, Sherwood O, Nguyen-Lu N. P.37 “To PIE (B) or not to PIE (B)?” A prospective audit of patient controlled epidural analgesia (PCEA) efficacy for labour at a large tertiary centre. Int J Obstet Anesth 2021. [DOI: 10.1016/j.ijoa.2021.103035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Lloyd C, Dean A, Nguyen-Lu N. P.103 Programmed intermittent epidural bolus protocols: an international survey of programmes currently used. Int J Obstet Anesth 2021. [DOI: 10.1016/j.ijoa.2021.103101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Affiliation(s)
| | - Andrea Dean
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX
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Abstract
Multisystem inflammatory syndrome in children (MIS-C) is an emerging disease described in children in association with infection or epidemiological link to severe acute respiratory syndrome coronavirus 2. Signs and symptoms include fever, rash, and cardiac dysfunction; US Centers for Disease Control and Prevention have put forth broad criteria for diagnosis. The illness is serious and can progress rapidly to heart failure and death. However, findings in MIS-C are nonspecific, and there is significant overlap with other systemic illnesses, including Kawasaki disease and several viral and bacterial infections. We present 5 children admitted to a teaching hospital within an 11-day period in May 2020 for MIS-C evaluation who were later diagnosed with murine typhus. Typhus is a rickettsial infection that presents with fever and rash, and, although usually self-limited, responds well to treatment with doxycycline to shorten the course of illness. Clinical and laboratory characteristics of these children are presented to illustrate similarities to MIS-C, which can also be shared with viral, bacterial, or other regional endemic infections, as well as noninfectious inflammatory diseases. This case series serves to remind pediatric hospitalists to be vigilant to avoid premature closure on MIS-C for children admitted with fever and systemic inflammation. Maintaining a wide differential diagnosis in approaching such patients is of utmost importance as community exposure to severe acute respiratory syndrome coronavirus 2 is likely and evidence of past infection becomes commonplace.
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Affiliation(s)
- Andrea Dean
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Rathi Asaithambi
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Hannah C Neubauer
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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Anderson KR, Villafranco N, Hatzenbuehler Cameron L, Schallert EK, Joshi-Patel A, Arrington A, Dean A. A 16-Year-Old Boy With Cough and Fever in the Era of COVID-19. Pediatrics 2021; 147:peds.2020-008235. [PMID: 32788269 DOI: 10.1542/peds.2020-008235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2020] [Indexed: 11/24/2022] Open
Abstract
A 16-year-old white boy with a history of chronic lung disease of prematurity, cough-variant asthma, and incidental lung nodules presented to the emergency center in spring 2020 with acute onset dry cough, shortness of breath, and fever. An initial history, gathered from his mother because of the patient's respiratory distress, revealed no recent travel. However, his mother is a health care worker at a hospital, and sick contacts included ongoing contact with a friend with cold-like symptoms. He had a variety of animals at home, including a dog, cats, fish, rodents, and reptiles. He had a history of vaping tobacco products >6 months ago. Fever and respiratory symptoms were associated with fatigue, chest tightness, abdominal pain, and myalgias. On examination, he was ill appearing and had tachycardia, tachypnea, borderline hypoxia with an oxygen saturation of 91% on room air, diminished breath sounds at the lung bases, and unremarkable abdominal examination results. A chest radiograph was consistent with the lung examination, revealing bilateral lower lobe hazy infiltrates. He showed initial improvement for 48 hours with antibiotics, intravenous fluid resuscitation, oxygen via nasal cannula, albuterol, and prednisone. Subsequently, he worsened with persistent high fever, increasing respiratory distress with pulmonary findings, and severe persistent epigastric pain, which added a layer of diagnostic complexity. As this patient's clinical course evolved and further history became available, pulmonary medicine and infectious diseases services were consulted to guide diagnostic evaluation and treatment of this patient early in the era of coronavirus disease 2019.
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Affiliation(s)
- Kelsey R Anderson
- Baylor College of Medicine, Houston, Texas; and.,Texas Children's Hospital, Houston, Texas
| | - Natalie Villafranco
- Baylor College of Medicine, Houston, Texas; and.,Texas Children's Hospital, Houston, Texas
| | | | - Erica K Schallert
- Baylor College of Medicine, Houston, Texas; and.,Texas Children's Hospital, Houston, Texas
| | - Ashley Joshi-Patel
- Baylor College of Medicine, Houston, Texas; and.,Texas Children's Hospital, Houston, Texas
| | - Amy Arrington
- Baylor College of Medicine, Houston, Texas; and.,Texas Children's Hospital, Houston, Texas
| | - Andrea Dean
- Baylor College of Medicine, Houston, Texas; and .,Texas Children's Hospital, Houston, Texas
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Masonbrink AR, Berg K, Harrison A, Rossetti A, Heller K, Darby J, Ngo ML, Dean A, Catley D. Barriers to Tobacco Cessation for Caregivers of Hospitalized Children: Perspectives of Pediatric Hospitalists. Hosp Pediatr 2020; 11:1-7. [PMID: 33262220 DOI: 10.1542/hpeds.2020-0168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Secondhand smoke exposure is associated with adverse health outcomes in children, yet tobacco cessation efforts for caregivers of hospitalized children are lacking. We sought to explore pediatric hospitalists' attitudes and barriers to providing tobacco cessation for caregivers of hospitalized children. METHODS We conducted a cross-sectional survey of pediatric hospitalists and fellows at 7 hospitals from November 1, 2018, to November 30, 2019. A 70-question anonymous survey was used to assess participants' perceptions of current practices, attitudes, and barriers to providing tobacco cessation support for caregivers of hospitalized children. We used descriptive statistics to summarize the data. RESULTS Of 207 eligible participants, 100 responded (48%). A majority (79%) agreed that offering tobacco cessation counseling for caregivers is an important part of their role in caring for hospitalized children, but 79% never received tobacco cessation training. Only half of the participants were comfortable providing brief advice and few were comfortable prescribing nicotine replacement therapy. Identified barriers included lack of time (74%), perceived lack of interest from patients' caregivers (71%), and other medical conditions of the patient taking priority (70%). The majority of participants were interested in further training in tobacco cessation support. CONCLUSIONS In this survey of 100 pediatric hospitalists, we found overall agreement that tobacco cessation support for caregivers of hospitalized children is important. However, most participants did not feel comfortable with provision of evidence-based counseling or pharmacotherapy because of identified barriers. Future work should target actionable barriers to improve provision of tobacco cessation support in this clinical setting.
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Affiliation(s)
- Abbey R Masonbrink
- Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri;
| | - Kathleen Berg
- Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Austin Harrison
- University of Mississippi Medical Center, Baton Children's Hospital, Jackson, Mississippi
| | - Allison Rossetti
- Wexner Medical Center, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
| | - Kayla Heller
- School of Medicine, Saint Louis University and Cardinal Glennon Children's Hospital, St Louis, Missouri
| | - John Darby
- School of Medicine, Wake Forest University and Brenner Children's Hospital, Winston-Salem, North Carolina
| | - My-Linh Ngo
- School of Medicine, Vanderbilt University and Monroe Carrell Jr Children's Hospital, Nashville, Tennessee; and
| | - Andrea Dean
- Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Delwyn Catley
- Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
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Dean A, Bekaii-Saab T, Boland P, Dayyani F, Mercade TM, Mody K, Belanger B, Maxwell F, Moore Y, Thiagalingam A, Wang T, Zhang B, Wainberg Z. 191P First-line liposomal irinotecan + 5 fluorouracil/leucovorin + oxaliplatin in patients with pancreatic ductal adenocarcinoma: Results from a phase I/II study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Clamp A, James E, McNeish I, Dean A, Kim JW, O'Donnell D, Hook J, Gallardo-Rincon D, Coyle C, Blagden S, Brenton J, Naik R, Perren T, Sundar S, Cook A, Badrock J, Swart A, Parmar M, Kaplan R, Ledermann J. 805O ICON8: Overall survival results in a GCIG phase III randomised controlled trial of weekly dose-dense chemotherapy in first line epithelial ovarian, fallopian tube or primary peritoneal carcinoma treatment. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Dean A, Oza A, Lorusso D, Aghajanian C, Oaknin A, Colombo N, Weberpals J, Clamp A, Scambia G, Leary A, Holloway R, Gancedo MA, Fong P, Goh J, O'Malley D, Cameron T, Maloney L, Goble S, Coleman R, Ledermann J. 821P Timing of adverse events during maintenance treatment with rucaparib for recurrent ovarian cancer in the phase III ARIEL3 study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ong Y, Dean A, Das A, Higgs D, McNulty M, Yusoff I, Johansson M, Tang C, White R. P-256 Survival rates of locally advanced and metastatic pancreatic cancer in Western Australia. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Dean A, Ong Y, Das A, Yusoff I, Johansson M, White R, Tang C. P-249 Resecting the unresectable: Superior survival of tri-modality pancreatic adenocarcinoma patients. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Wainberg Z, Bekaii-Saab T, Boland P, Dayyani F, Macarulla T, Mody K, Belanger B, Maxwell F, Moore Y, Thiagalingam A, Wang T, Zhang B, Dean A. LBA-1 First-line liposomal irinotecan + 5 fluorouracil/leucovorin + oxaliplatin in patients with pancreatic ductal adenocarcinoma: Long-term follow-up results from a phase 1/2 study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Dean A. Custom design for special needs client. Journal of Visual Impairment & Blindness 2020. [DOI: 10.1177/0145482x8908300704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- A. Dean
- Dean Tucker Shaw, Inc., Architects, 119 Beach Street, Boston, MA 02111
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Berryhill S, Morton CJ, Dean A, Berryhill A, Provencio-Dean N, Patel SI, Estep L, Combs D, Mashaqi S, Gerald LB, Krishnan J, Parthasarathy S. 1209 Effect Of Wearables On Sleep In Healthy Individuals: A Randomized Cross-over Trial And Validation Study. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
To determine whether a wearable sleep-tracker improves perceived sleep quality in healthy subjects. To test whether wearables reliably measure sleep quantity and quality compared to polysomnography.
Methods
A single-center randomized cross-over trial of community-based participants without medical conditions or sleep disorders. Wearable device (WHOOP, Inc.) that provided feedback regarding sleep information to the participant for 1-week and maintaining sleep logs versus 1-week of maintaining sleep logs alone. Self-reported daily sleep behaviors were documented in sleep logs. Polysomnography was performed on one night when wearing the wearable. PROMIS Sleep disturbance sleep scale was measured at baseline, 7, and 14 days of study participation.
Results
In 32 participants (21 women; 23.8 + 5 years), wearables improved nighttime sleep quality (PROMIS sleep disturbance; B= -1.69; 95% Confidence Interval -3.11, -0.27; P=0.021) after adjusting for age, sex, baseline, and order effect. There was a small increase in self-reported daytime naps when wearing the device (B = 3.2; SE 1.4; P=0.023) but total daily sleep remained unchanged (P=0.43). The wearable had low bias (2.5 minutes) and low precision (5.6 minutes) errors for measuring sleep duration and measured dream sleep and slow wave sleep accurately (Intra-class coefficient 0.74 + 0.28 and 0.85 + 0.15, respectively). Bias and precision error for heart rate (bias -0.17%; precision 1.5%) and respiratory rate (bias 1.8%’ precision 6.7%) were very low when compared to that measured by electrocardiogram and inductance plethysmography during polysomnography.
Conclusion
In healthy people, wearables can improve sleep quality and accurately measure sleep and cardiorespiratory variables.
Support
WHOOP Inc.
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Affiliation(s)
- S Berryhill
- UAHS Center for Sleep & Circadian Sciences; Division of Pulmonary, Allergy, Critical Care & Sleep Medicine; University of Arizona, University of Arizona, AZ
| | - C J Morton
- UAHS Center for Sleep & Circadian Sciences; Division of Pulmonary, Allergy, Critical Care & Sleep Medicine; University of Arizona, University of Arizona, AZ
| | - A Dean
- UAHS Center for Sleep & Circadian Sciences; Division of Pulmonary, Allergy, Critical Care & Sleep Medicine; University of Arizona, University of Arizona, AZ
| | - A Berryhill
- UAHS Center for Sleep & Circadian Sciences; Division of Pulmonary, Allergy, Critical Care & Sleep Medicine; University of Arizona, University of Arizona, AZ
| | - N Provencio-Dean
- UAHS Center for Sleep & Circadian Sciences; Division of Pulmonary, Allergy, Critical Care & Sleep Medicine; University of Arizona, University of Arizona, AZ
| | - S I Patel
- UAHS Center for Sleep & Circadian Sciences; Division of Pulmonary, Allergy, Critical Care & Sleep Medicine; University of Arizona, University of Arizona, AZ
| | - L Estep
- UAHS Center for Sleep & Circadian Sciences; Division of Pulmonary, Allergy, Critical Care & Sleep Medicine; University of Arizona, University of Arizona, AZ
| | - D Combs
- Department of Pediatrics, University of Arizona, Tucson, AZ
| | - S Mashaqi
- UAHS Center for Sleep & Circadian Sciences; Division of Pulmonary, Allergy, Critical Care & Sleep Medicine; University of Arizona, University of Arizona, AZ
| | - L B Gerald
- Asthma and Airways Disease Research Center, Tucson, AZ
| | - J Krishnan
- Breathe Chicago Center and Division of Pulmonary, Critical Care, Sleep, & Allergy, University of Illinois, Chicago, Illinois, Chicago, IL
| | - S Parthasarathy
- University of Arizona Health Sciences Center for Sleep and Circadian Sciences, University of Arizona, AZ
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Travers N, Dean A, Armstrong K, Peeperkorn L, Tan M, Das A. The tolerability and efficacy of FOLFIRINOX in gastro-oesophageal carcinoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz422.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Das A, Dean A, Travers N, Johansson M, Yusoff I. Durable response to second-line m-FOLFIRINOX for advanced pancreatic adenocarcinoma in patients with performance status of two or less. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz422.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dean A, Das A, McNulty M, Travers N. The emerging role of third-line gemcitabine plus nab-paclitaxel in advanced pancreatic adenocarcinoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz422.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Phadke R, Dean A, Evans M, Parker A, Maxwell D, Sewry C, Sarkozy A, Muntoni F. P.83Vacuolar myopathy with valosin containing protein (VCP)-positive intranuclear and cytoplasmic inclusions: report of two cases with early and late childhood-onset disease. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Macarulla T, Brendel K, Lieu C, Wainberg Z, Dayyani F, Zhang B, Belanger B, Moore Y, Pedret-Dunn A, Maxwell F, Dean A. Integrated population pharmacokinetic modelling of liposomal irinotecan in patients with various tumour types, including untreated metastatic pancreatic cancer (mPC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ledermann J, Oza A, Lorusso D, Aghajanian C, Oaknin A, Dean A, Colombo N, Weberpals J, Clamp A, Scambia G, Leary A, Holloway R, Gancedo MA, Fong P, Goh J, O’Malley D, Cameron T, Maloney L, Goble S, Coleman R. Effect of response to last platinum-based chemotherapy in patients (pts) with platinum-sensitive, recurrent ovarian carcinoma in the phase III study ARIEL3 of rucaparib maintenance treatment. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz250.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Min ST, Roohullah A, Tognela A, Jalali A, Lee M, Wong R, Shapiro J, Burge M, Yip D, Nott L, Zimet A, Lee B, Dean A, Steel S, Wong HL, Gibbs P, Lim SHS. Patient demographics and management landscape of metastatic colorectal cancer in the third-line setting: Real-world data in an Australian population. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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35
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Wainberg Z, Boland P, Lieu C, Dayyani F, Macarulla T, Zhang B, Belanger B, Moore Y, Wang T, Maxwell F, Dean A. A phase 1/2, open-label, dose-expansion study of liposomal irinotecan (nal-IRI) plus 5-fluorouracil/leucovorin (5-FU/LV) and oxaliplatin (OX) in patients with previously untreated metastatic pancreatic cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz157.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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36
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Das A, Dean A. Modified FOLFIRINOX as a second-line treatment in pancreatic adenocarcinoma following gemcitabine plus nab-paclitaxel failure in patients with performance status two or less. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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37
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Dean A, Peeperkorn L, Armstrong K, De Marie A, Watanabe Y, Tan M, Travers N. Prospective evaluation of FOLFIRINOX in Neo-adjuvant treatment of gastro-oesophageal junction carcinomas. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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38
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Das A, Dean A, McNulty M. Third-line re-treatment of advanced pancreatic adenocarcinoma with gemcitabine and nab-paclitaxel. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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39
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Coleman R, Oza A, Lorusso D, Aghajanian C, Oaknin A, Dean A, Colombo N, Weberpals J, Clamp A, Scambia G, Leary A, Holloway R, Gancedo MA, Fong P, Goh J, O'Malley D, Banerjee S, Goble S, Cameron T, Ledermann J. Post hoc exploratory analysis of rucaparib in patients with platinum-sensitive recurrent ovarian carcinoma from the randomized, placebo-controlled phase III study ARIEL3: Effect of a deleterious germline or no germline mutation on efficacy. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ledermann J, Oza A, Lorusso D, Aghajanian C, Oaknin A, Dean A, Colombo N, Weberpals J, Clamp A, Scambia G, Leary A, Holloway R, Gancedo MA, Fong P, Goh J, Backes F, Banerjee S, Goble S, Cameron T, Coleman R. The effect of age on efficacy and safety outcomes with rucaparib: A post hoc exploratory analysis of ARIEL3, a phase III, randomized, placebo-controlled maintenance study in patients with recurrent ovarian carcinoma. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Johnson J, Wilson KM, Zhou C, Johnson DP, Kenyon CC, Tieder JS, Dean A, Mangione-Smith R, Williams DJ. Home Smoke Exposure and Health-Related Quality of Life in Children with Acute Respiratory Illness. J Hosp Med 2019; 14:212-217. [PMID: 30933671 PMCID: PMC6948779 DOI: 10.12788/jhm.3164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/06/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study aims to assess whether secondhand smoke (SHS) exposure has an impact on health-related quality of life (HRQOL) in children with acute respiratory illness (ARI). METHODS This study was nested within a multicenter, prospective cohort study of children (two weeks to 16 years) with ARI (emergency department visits for croup and hospitalizations for croup, asthma, bronchiolitis, and pneumonia) between July 1, 2014 and June 30, 2016. Subjects were surveyed upon enrollment for sociodemographics, healthcare utilization, home SHS exposure (0 or ≥1 smoker in the home), and child HRQOL (Pediatric Quality of Life Physical Functioning Scale) for both baseline health (preceding illness) and acute illness (on admission). Data on insurance status and medical complexity were collected from the Pediatric Hospital Information System database. Multivariable linear mixed regression models examined associations between SHS exposure and HRQOL. RESULTS Home SHS exposure was reported in 728 (32%) of the 2,309 included children. Compared with nonexposed children, SHS-exposed children had significantly lower HRQOL scores for baseline health (mean difference -3.04 [95% CI -4.34, -1.74]) and acute illness (-2.16 [-4.22, -0.10]). Associations were strongest among children living with two or more smokers. HRQOL scores were lower among SHS-exposed children for all four conditions but only significant at baseline for bronchiolitis (-2.94 [-5.0, -0.89]) and pneumonia (-4.13 [-6.82, -1.44]) and on admission for croup (-5.71 [-10.67, -0.75]). CONCLUSIONS Our study demonstrates an association between regular SHS exposure and decreased HRQOL with a dose-dependent response for children with ARI, providing further evidence of the negative impact of SHS.
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Affiliation(s)
- Jakobi Johnson
- Division of Hospital Medicine, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Karen M Wilson
- Division of General Pediatrics, Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Chuan Zhou
- Department of Pediatrics, University of Washington and the Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
| | - David P Johnson
- Division of Hospital Medicine, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Chén C Kenyon
- Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia and the Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Joel S Tieder
- Division of General Pediatrics and Hospital Medicine, Department of Pediatrics, University of Washington and Seattle Children’s Hospital, Seattle, Washington
| | - Andrea Dean
- Section of Pediatric Hospital Medicine, Texas Children’s Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Rita Mangione-Smith
- Department of Pediatrics, University of Washington and the Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
| | - Derek J Williams
- Division of Hospital Medicine, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
- Corresponding Author: Derek J Williams, MD, MPH; E-mail: ; Telephone: 615-322-2744; Twitter: @dwillmd
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Pavlenko E, Barbova A, Hovhannesyan A, Tsenilova Z, Slavuckij A, Shcherbak-Verlan B, Zhurilo A, Vitek E, Skenders G, Sela I, Cabibbe AM, Cirillo DM, de Colombani P, Dara M, Dean A, Zignol M, Dadu A. Alarming levels of multidrug-resistant tuberculosis in Ukraine: results from the first national survey. Int J Tuberc Lung Dis 2019; 22:197-205. [PMID: 29506617 DOI: 10.5588/ijtld.17.0254] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING The true prevalence of multidrug-resistant tuberculosis (MDR-TB) in Ukraine is not known. Available data are a decade old and limited to only one province. OBJECTIVE To determine the prevalence of MDR-TB among new and previously treated TB cases in Ukraine and explore the risk factors associated with drug resistance. METHODS A total of 1550 sputum smear-positive pulmonary TB patients were recruited from 40 clusters throughout Ukraine. Sputum specimens were examined using culture, drug susceptibility testing and pncA gene sequencing. RESULTS The proportion of MDR-TB among new and previously treated TB cases was respectively 24.1% (95%CI 20.7-27.6) and 58.1% (95%CI 52.1-64.1). More than one third (38.0%) of MDR-TB or rifampicin (RMP) resistant cases showed resistance to either a fluoroquinolone (FQ) or a second-line injectable agent or both. Resistance to pyrazinamide and FQs was low in patients with RMP-susceptible TB. Among new TB cases, the odds of MDR-TB were higher among patients who were younger, female and living in south-eastern provinces, as well as among human immunodeficiency virus-positive patients who belonged to a low socio-economic group. CONCLUSIONS Our study showed that the burden of MDR-TB in Ukraine was much greater than previously assumed. Urgent actions are needed to prevent further spread of drug-resistant TB in Ukraine.
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Affiliation(s)
- E Pavlenko
- Ministry of Health of Ukraine, Kiev, Ukraine
| | - A Barbova
- Central Reference Laboratory on TB Microbiological Diagnostics of the Ministry of Health, Kiev, Ukraine
| | | | | | | | | | - A Zhurilo
- Microbiology Laboratory, Yanovskii's National Institute of Phthisiology and Pulmonology, National Academy of Medical Science of Ukraine, Kiev, Ukraine
| | - E Vitek
- US Agency for International Development Regional Mission for Ukraine, Belarus and Republic of Moldova; Office of Health and Social Transition, Kiev, Ukraine
| | - G Skenders
- TB Supranational Reference Laboratory, Riga, Latvia
| | - I Sela
- TB Supranational Reference Laboratory, Riga, Latvia
| | - A M Cabibbe
- TB Supranational Reference laboratory San Raffaele Scientific Institute, Milan, Italy
| | - D M Cirillo
- TB Supranational Reference laboratory San Raffaele Scientific Institute, Milan, Italy
| | | | - M Dara
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - A Dean
- Global TB Programme, WHO, Geneva, Switzerland
| | - M Zignol
- Global TB Programme, WHO, Geneva, Switzerland
| | - A Dadu
- WHO Regional Office for Europe, Copenhagen, Denmark
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Lorusso D, Coleman R, Oza A, Aghajanian C, Oaknin A, Dean A, Colombo N, Weberpals J, Clamp A, Scambia G, Leary A, Holloway R, Amenedo Gancedo M, Fong P, Goh J, O’Malley D, Banerjee S, Goble S, Cameron T, Ledermann J. Subgroup analysis of rucaparib in platinum-sensitive recurrent ovarian carcinoma: Effect of prior chemotherapy regimens in ARIEL3. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy285.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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44
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Clamp A, McNeish I, Dean A, Gallardo-Rincon D, Kim JW, O’Donnell D, Hook J, Blagden S, Brenton J, Naik R, Perren T, Sundar S, Cook A, James E, Gabra H, Lord R, Hall M, Dark G, Kaplan R, Ledermann J. Response to neoadjuvant chemotherapy in ICON8: A GCIG phase III randomised trial evaluating weekly dose-dense chemotherapy integration in first-line epithelial ovarian/ fallopian tube/ primary peritoneal carcinoma (EOC) treatment. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy285.151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Macarulla Mercade T, Bodoky G, Siveke J, Lee KH, Chen J, Mirakhur B, Dean A, Chen LT, de Jong F. NAPOLI-1 phase III trial outcomes by prior surgery, and disease stage, in patients with metastatic pancreatic ductal adenocarcinoma (mPDAC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bingham E, Squillante B, Seiple S, Carney L, Weston S, Dean A, Bailer J, Boyden S, Meyers R, Smith B. Process to Improve the Consistency and Accuracy of Diagnosing Malnutrition in a Large Pediatric Academic Hospital. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.06.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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47
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Lakatos G, Lee K, Siveke J, Blanc J, Mercadé TM, Dean A, Bodoky G, Mirakhur B, Chen J, Wang-Gillam A, Chen L, de Jong F. Prognostic value of baseline biliary stents on outcomes in patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) in the NAPOLI-1 trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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McNulty M, Dean A, Das A, Gordon M. Use of gemcitabine and nab-paclitaxel as a third-line treatment following failure of first line gemcitabine for advanced pancreatic adenocarcinoma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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49
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Mercadé TM, Wang-Gillam A, Chen L, Blanc J, Lee K, Bodoky G, Dean A, Chen J, Mirakhur B, Siveke J, de Jong F. The effect of best response to prior anticancer therapy on efficacy outcomes in the NAPOLI-1 trial of patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) previously treated with gemcitabine-based therapy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mercadé TM, Wang-Gillam A, Chen L, Blanc J, Lee K, Bodoky G, Dean A, Siveke J, Mirakhur B, Chen J, de Jong F. Prognostic effect of primary tumor location in the NAPOLI-1 phase 3 study in metastatic pancreatic ductal adenocarcinoma (mPDAC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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