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Trabulsi JC, Irving SY, Papas MA, Hollowell C, Ravishankar C, Marino BS, Medoff-Cooper B, Schall JI, Stallings VA. Total Energy Expenditure of Infants with Congenital Heart Disease Who Have Undergone Surgical Intervention. Pediatr Cardiol 2015; 36:1670-9. [PMID: 26092599 DOI: 10.1007/s00246-015-1216-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 03/02/2015] [Accepted: 06/10/2015] [Indexed: 11/29/2022]
Abstract
Growth failure is often observed in infants with congenital heart disease (CHD); it is unclear, however, whether growth failure is due to increased total energy expenditure (TEE). An observational study of infants with CHD and surgical intervention within the first 30 days of life and healthy infants of similar age was undertaken. TEE was measured using the doubly labeled water method in 3-month-old infants (n = 15 CHD, 12 healthy) and 12-month-old infants (n = 11 CHD, 12 healthy). Multiple linear regression models were fit to examine the association between health status (CHD vs. healthy) and TEE. The accuracy of equations for calculating TEE was also determined. TEE for CHD infants was not significantly different from healthy infants at 3 and 12 months; TEE in CHD infants was 36.4 kcal/day higher (95 % CI -46.3, 119.2; p = 0.37) and 31.7 kcal/day higher, (95 % CI -71.5, 134.8; p = 0.53) at 3 and 12 months, respectively, compared to healthy infants. The 2002 Dietary Reference Intake (DRI) equation and the 1989 Recommended Dietary Allowance equation over-estimated measured TEE to a lesser extent than CHD specific equations; the 2002 DRI yielded the smallest mean difference between calculated versus measured TEE (difference 79 kcal/day). During the first year of life, TEE of infants with CHD and interventional surgery within the first month of life was not different than age-matched healthy infants. When calculating TEE of ≤12-month-old infants with CHD who have undergone surgical intervention, the 2002 DRI equation may be used as a starting point for estimating initial clinical energy intake goals.
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Affiliation(s)
- Jillian C Trabulsi
- Department of Behavioral Health and Nutrition (JT, MAP, CH), University of Delaware, McDowell Hall, 25 North College Avenue, Newark, DE, 19716, USA.
| | - S Y Irving
- The University of Pennsylvania School of Nursing (SYI, BMC), Claire M. Fagan Hall, 418 Curie Boulevard, Rm. 427, Philadelphia, PA, 19104, USA.,Department of Pediatrics, The Children's Hospital of Philadelphia (VAS, JIS, CR), University of Pennsylvania Perelman School of Medicine, 34th Street and Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - M A Papas
- Department of Behavioral Health and Nutrition (JT, MAP, CH), University of Delaware, McDowell Hall, 25 North College Avenue, Newark, DE, 19716, USA
| | - C Hollowell
- Department of Behavioral Health and Nutrition (JT, MAP, CH), University of Delaware, McDowell Hall, 25 North College Avenue, Newark, DE, 19716, USA
| | - C Ravishankar
- Department of Pediatrics, The Children's Hospital of Philadelphia (VAS, JIS, CR), University of Pennsylvania Perelman School of Medicine, 34th Street and Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - B S Marino
- Divisions of Cardiology and Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago (BSM), 225 E Chicago Avenue, Chicago, IL, 60611, USA
| | - B Medoff-Cooper
- The University of Pennsylvania School of Nursing (SYI, BMC), Claire M. Fagan Hall, 418 Curie Boulevard, Rm. 427, Philadelphia, PA, 19104, USA.,Department of Pediatrics, The Children's Hospital of Philadelphia (VAS, JIS, CR), University of Pennsylvania Perelman School of Medicine, 34th Street and Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - J I Schall
- Department of Pediatrics, The Children's Hospital of Philadelphia (VAS, JIS, CR), University of Pennsylvania Perelman School of Medicine, 34th Street and Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - V A Stallings
- Department of Pediatrics, The Children's Hospital of Philadelphia (VAS, JIS, CR), University of Pennsylvania Perelman School of Medicine, 34th Street and Civic Center Blvd., Philadelphia, PA, 19104, USA
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Ross RD, Brook M, Feinstein JA, Koenig P, Lang P, Spicer R, Vincent JA, Lewis AB, Martin GR, Bartz PJ, Fischbach PS, Fulton DR, Matherne GP, Reinking B, Srivastava S, Printz B, Geva T, Shirali GS, Weinberg P, Wong PC, Armsby LB, Vincent RN, Foerster SR, Holzer RJ, Moore JW, Marshall AC, Latson L, Dubin AM, Walsh EP, Franklin W, Kanter RJ, Saul JP, Shah MJ, Van Hare GF, Feltes TF, Roth SJ, Almodovar MC, Andropoulos DB, Bohn DJ, Costello JM, Gajarski RJ, Mott AR, Stout K, Valente AM, Cook S, Gurvitz M, Saidi A, Webber SA, Hsu DT, Ivy DD, Kulik TJ, Pahl E, Rosenthal DN, Morrow R, Mahle WT, Murphy AM, Li JS, Law YM, Newburger JW, Daniels SR, Bernstein D, Marino BS. 2015 SPCTPD/ACC/AAP/AHA Training Guidelines for Pediatric Cardiology Fellowship Programs (Revision of the 2005 Training Guidelines for Pediatric Cardiology Fellowship Programs). J Am Coll Cardiol 2015; 66:S0735-1097(15)00809-8. [PMID: 25777637 DOI: 10.1016/j.jacc.2015.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gilbert JW, Wheeler GR, Mick GE, Storey BB, Herder SL, Richardson GB, Watts E, Gyarteng-Dakwa K, Marino BS, Kenney CM, Siddiqi M, Broughton PG. Urine drug testing in the treatment of chronic noncancer pain in a Kentucky private neuroscience practice: the potential effect of Medicare benefit changes in Kentucky. Pain Physician 2010; 13:187-194. [PMID: 20309384] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Because the symptoms of drug misuse are nonspecific and difficult to detect, pain physicians have relied heavily on the results of urine drug tests to diagnose and treat chronic noncancer pain in patients who are prescribed controlled substances. However, changes in Medicare local carrier determinations for Medicare Part B providers in Connecticut, Indiana, Kentucky, and New York went into effect on July 1, 2009, whereby qualitative drug screening was no longer recognized as medically reasonable and necessary in the treatment of patients with chronic noncancer pain unless the patient presents with suspected drug overdose. STUDY DESIGN A retrospective review of urine drug testing services. OBJECTIVE To determine the extent of urine drug testing in patients with chronic noncancer pain in a large, Kentucky neuroscience practice offering pain management services combined with neurologic and neurosurgical services to better understand the potential effects of recent changes to Medicare benefits. METHODS An audit of services provided during 2007 was conducted using computer software. OUTCOME MEASURES Outcome measures included the number of practice services, number of urine drug tests by payor, and the number of noncompliant patients by payor who self-released from care. RESULTS Urine drug tests represented approximately 18.2% of professional medical services rendered in 2007 to patients with a diagnosis of chronic noncancer pain. Of these, UDTs represented approximately 22.2% of services provided to Medicare patients and 24.6% of services provided to Medicaid patients. In 2007, 2,081 patients with noncompliant UDTs self released from the practice against medical advice. Of these, 23.1% were enrolled in Medicare and 47.5% were enrolled in Medicaid. Approximately 40% of patients were referred to the CARE Clinic on the basis of noncompliance as indicated by UDT and/or behavioral health issues. Of these, approximately 50% remained in treatment. Urine drug tests were also instrumental in revealing that 19.6% of patients showed signs of drug abuse or addiction. Of these patients, approximately 60% were government insured. LIMITATIONS Not a prospective, double-blinded study. We approximated the proportion of patients potentially affected by drug abuse or addiction as the percentage of patients self releasing from medical care. CONCLUSION In 2007, UDTs were used as an effective tool in adherence monitoring in a private neuroscience practice in Kentucky that offers pain management services combined with neurologic and neurosurgical services. UDTs were instrumental in referring 40% of patients for evaluation and treatment by behavioral health and addiction medicine specialists. UDTs were also instrumental in discovering signs of drug abuse or addiction in 19.6% of patients. Of these patients, approximately 60% were government insured. Should the objective and reliable sign offered by UDTs be eliminated from the physician's toolbox, the physician's ability to accurately diagnose and treat these patients could be impaired.
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Affiliation(s)
- John W Gilbert
- Spine and Brain Neurosurgical Center, Lexington, KY, USA
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Gilbert JW, Wheeler GR, Mick GE, Storey BB, Herder SL, Richardson GB, Watts E, Gyarteng-Dakwa K, Marino BS, Kenney CM, Siddiqi M, Broughton PG. Importance of urine drug testing in the treatment of chronic noncancer pain: implications of recent medicare policy changes in kentucky. Pain Physician 2010; 13:167-186. [PMID: 20309383] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Urine drug testing has become a widely used tool in American society for deterring illicit drug use. In the practice of medicine, urine drug testing is commonly used to help diagnose substance misuse, abuse, or addiction. OBJECTIVE This narrative review provides an informed perspective on the importance of urine drug testing in the medical treatment of chronic noncancer pain. The history and current uses of urine drug tests in the United States are reviewed, the prevalence and nature of prescription drug misuse is described as is related to chronic noncancer pain, and implications and considerations for practitioners are presented related to the noncancer pain diagnosis and treatment. DISCUSSION Practitioners are confronted with the ethical and legal dilemma of being called to adequately treat chronic pain in a culture with a high prevalence of prescription drug abuse. Yet the symptoms of drug abuse are nonspecific and therefore of limited value to the practitioner in determining patient compliance to drug treatment regimens. In contrast, urine drug testing has a reliable history, both in and out of medicine, as an independent sign of drug misuse. This sign can be used to aid in the diagnosis and treatment of drug misuse and underlying addictions to improve patient outcomes. CONCLUSION Regular urine drug testing should be a part of acute and chronic pain management whether or not the patient has any signs or symptoms of drug misuse.
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Affiliation(s)
- John W Gilbert
- Spine and Brain Neurosurgical Center, Lexington, KY, USA
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Brothers JA, McBride MG, Marino BS, Tomlinson RS, Seliem MA, Pampaloni MH, Gaynor JW, Spray TL, Paridon SM. Exercise performance and quality of life following surgical repair of anomalous aortic origin of a coronary artery in the pediatric population. J Thorac Cardiovasc Surg 2008; 137:380-4. [PMID: 19185157 DOI: 10.1016/j.jtcvs.2008.08.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [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] [Received: 04/28/2008] [Revised: 07/08/2008] [Accepted: 08/04/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We sought to evaluate exercise performance and quality of life in children after surgical repair of anomalous aortic origin of a coronary artery with an interarterial course. METHODS Patients who had surgery from October 2001 to January 2007 were eligible for inclusion. Exercise performance and quality of life were prospectively assessed by maximal exercise tests and age-appropriate questionnaires, respectively. We used t tests to compare pre- and postoperative exercise data and quality-of-life scores to published normative data. We performed linear regression analyses to assess associations between demographic, anatomic, and exercise variables and quality-of-life score. RESULTS Of 25/27 patients, 64% were boys, 68% had anomalous right coronary, 32% were asymptomatic. Average age at surgery was 10.8 (+/-4.1) years; median follow-up was 14.5 (2 to 48) months. Postoperative percent-predicted exercise values were: peak heart rate 97 (+/-6), working capacity 91 (+/-15), maximal oxygen consumption 82 (+/-16). In those who had preoperative exercise testing (n = 11), resting and maximal heart rates decreased significantly without significant change in exercise performance. Average child quality of life was 85/100 (+/-13) and parent-proxy 88 (+/-11) compared with normal scores of 83 (+/-15) and 88 (+/-12), respectively. CONCLUSION There is mild chronotropic impairment in children and adolescents following anomalous coronary artery repair without a decline in exercise performance. This does not appear to impair their overall quality of life. Because long-term effects on heart rate, exercise performance, and quality of life are unknown, serial exercise tests should be included as routine care of these patients.
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Affiliation(s)
- J A Brothers
- Division of Cardiology, The Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, Penn, USA
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Abstract
In critical congenital heart lesions, the ultimate outcome depends on timely and accurate diagnosis of the structural anomaly, the evaluation and resuscitation of secondary organ damage, effective lesion-specific preoperative management, and the appropriate timing and type of surgery. Crucial to this process is continuous communication among medical, surgical, and nursing disciplines.
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Affiliation(s)
- B S Marino
- Division of Cardiology, Cardiac Center, Children's Hospital of Philadelphia, Pennsylvania, USA
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Abstract
BACKGROUND The Ross procedure has been used increasingly to treat aortic valve disease in children and young adults. Benefits include the lack of anticoagulation after surgery and the potential growth and durability of the autograft. The purpose of this study was to review our institutional experience with the Ross procedure and to compare early outcome in simple aortic valve disease and complex left heart disease. METHODS AND RESULTS Between January 1995 and October 1998, 66 patients (median age, 10.8 years; range, 6 days to 34.8 years) underwent the Ross procedure. The primary indication for surgery was isolated valvular disease in 41 patients: aortic stenosis (AS; n=3), aortic insufficiency (AI; n=11), and AS/AI (n=27). The remaining 25 patients had multiple levels of left ventricular outflow tract obstruction, 12 of whom had at least moderate AI. Additional left heart disease in the complex group included subaortic stenosis (n=20), arch obstruction (n=7), mitral valve disease (n=5), apical aortic conduit stenosis or insufficiency (n=3), and supravalvar AS (n=2). There were 123 prior interventions performed in 51 patients, including aortic valvotomy/valvuloplasty (n=56), coarctation repair (n=21), subaortic stenosis resection/Konno procedure (n=10), ventricular septal defect closure (n=8), apical aortic conduit placement (n=3), aortic valve replacement (n=3), and other (n=22). An isolated Ross procedure was performed in 41 patients, 10 of whom required concurrent aortic annulus enlargement procedure to accommodate the larger pulmonary autograft. In the remaining 25 patients, 49 concurrent procedures were performed, including the Konno procedure (n=17), aortic annulus enlargement (n=2), subaortic membrane resection (n=9), arch augmentation (n=5), mitral valvuloplasty (n=5), ventricular septal defect closure (n=4), apicoaortic conduit division (n=3), and other (n=4). One patient (1.5%) died 3 days after a Ross-Konno procedure, which included arch reconstruction, from presumed arrhythmia. There were no other early deaths. One patient required ECMO (extracorporeal membrane oxygenation) for 3 days after a ventricular tachycardia (VT)-related cardiac arrest. Transient complete heart block was seen in 4 patients; the duration was <5 days. No patient had left ventricular outflow tract obstruction on discharge echocardiography. Neo-AI was graded as none (n=5), trivial-mild (n=57), or moderate (n=3). All 3 patients with moderate neo-AI at discharge had abnormal pulmonary valves before surgery. Perioperative VT was noted in 18 patients (27.2%), 2 of whom were discharged on antiarrhythmic medication. CONCLUSIONS The Ross procedure can be performed in isolation or in combination with other complex procedures with low mortality (1.5%) and acceptable short-term results, even in patients with complex left heart disease and multiple prior interventions. Postoperative VT is common. Anatomic abnormalities of the pulmonary valve preclude its use as an autograft.
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Affiliation(s)
- B S Marino
- Division of Cardiology, Children's Hospital of Philadelphia, PA 19104, USA
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