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Hollenbach J, Simoneau T, Sun Y, Becene I, Almeida S, Langton C, Flores G. Design, methods, and baseline characteristics of a pilot, randomized, controlled trial of the effects of an electronic monitoring device on medication adherence in children with asthma. Contemp Clin Trials Commun 2021; 21:100706. [PMID: 33644492 PMCID: PMC7887642 DOI: 10.1016/j.conctc.2021.100706] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/11/2020] [Accepted: 01/01/2021] [Indexed: 11/18/2022] Open
Abstract
Non-adherence to medication is common Current methods of assessing adherence are inaccurate. Electronic monitoring devices (EMDs) may more accurately assess adherence, but are not currently used in practice. The design, methods, and participant baseline characteristics are described for a pilot trial of the effects of an EMD on asthma medication adherence in a pediatric population. This was a pilot, randomized, controlled trial of children with persistent asthma managed with daily inhaled corticosteroids (ICS). Seventy-five children were randomized 2:1 to receive either two EMDs (one for ICS and one for rescue) linked via Bluetooth to a mobile application (app) or standard of care (controls). EMDs recorded dates and times of inhaler actuations and the app sent daily medication reminders to participants. Controls were provided standard care. Medication adherence was measured using pharmacy refill records and self-report, whereas EMD data were used to measure adherence in the intervention group. Secondary outcomes included asthma control, pulmonary function, and quality of life. Results One hundred sixty children were screened for eligibility, with 123 individuals excluded. Seventy-five children were enrolled, with 25 allocated to the control group and 50 to the intervention. The mean age of participants is 12 years old (±2.9), with equal proportions of male and female children; 45% are Latinx and 19% African-American; 77% report Medicaid or CHIP coverage. Half of participants have moderate persistent asthma and 48% had marginally controlled asthma at time of enrollment. There were no significant inter-group differences in baseline sociodemographic characteristics. Conclusion This pilot successfully reached target populations and met recruitment and enrollment goals. It is addressing an important knowledge gap by evaluating the effects of an EMD with a mobile app on adherence rates, findings which could prove useful in determining whether routine use of EMDs in clinical practice help children achieve better asthma control and outcomes. Clinical Trials.gov NCT03734861.
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Affiliation(s)
- JessicaP. Hollenbach
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA
- Department of Pediatrics, Uconn Health School of Medicine, Farmington, CT, 06030, USA
- Corresponding author. Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA.
| | - Tregony Simoneau
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Ye Sun
- Children's Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY, 10467, USA
| | - Iris Becene
- Tufts University, 419 Boston Ave, Medford, MA, 02155, USA
| | - Sigrid Almeida
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA
| | - Christine Langton
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA
| | - Glenn Flores
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA
- Department of Pediatrics, Uconn Health School of Medicine, Farmington, CT, 06030, USA
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Cicutto L, Gleason M, Haas-Howard C, White M, Hollenbach JP, Williams S, McGinn M, Villarreal M, Mitchell H, Cloutier MM, Vinick C, Langton C, Shocks DJ, Stempel DA, Szefler SJ. Building Bridges for Asthma Care Program: A School-Centered Program Connecting Schools, Families, and Community Health-Care Providers. J Sch Nurs 2020; 36:168-180. [PMID: 30336726 PMCID: PMC7222283 DOI: 10.1177/1059840518805824] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Asthma imposes tremendous burden on children, families, and society. Successful management requires coordinated care among children, families, health providers, and schools. Building Bridges for Asthma Care Program, a school-centered program to coordinate care for successful asthma management, was developed, implemented, and evaluated. The program consists of five steps: (1) identify students with asthma; (2) assess asthma risk/control; (3) engage the family and student at risk; (4) provide case management and care coordination, including engagement of health-care providers; and (5) prepare for next school year. Implementation occurred in 28 schools from two large urban school districts in Colorado and Connecticut. Significant improvements were noted in the proportions of students with completed School Asthma Care Plans, a quick-relief inhaler at school, Home Asthma Action/Treatment Plans and inhaler technique (p < .01 for all variables). Building Bridges for Asthma Care was successfully implemented extending asthma care to at-risk children with asthma through engagement of schools, health providers, and families.
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Affiliation(s)
- Lisa Cicutto
- Community Outreach and Research, National Jewish Health, Denver, CO, USA
- Clinical Science Program, College of Nursing, Anschutz Medical Campus, University of Colorado, Denver, CO, USA
| | - Melanie Gleason
- Building Bridges Asthma Program, Children's Hospital of Colorado, Aurora, CO, USA
- Department of Pediatrics, Section of Pediatric Pulmonary Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Christy Haas-Howard
- Nursing and Student Health Services, Denver Public Schools, Denver, CO, USA
- Asthma Grant Program, Colorado Department of Education, Denver, CO, USA
| | - Marty White
- Children's Hospital Colorado/Denver Public Schools, Denver, CO, USA
| | - Jessica P. Hollenbach
- Department of Pediatrics, School of Medicine, University of Connecticut, Hartford, CT, USA
- Asthma Center, Connecticut Children's Medical Center, Hartford, CT, USA
| | | | | | | | | | - Michelle M. Cloutier
- Asthma Center, Connecticut Children's Medical Center, Hartford, CT, USA
- Department of Pediatrics, UConn Health, Farmington, CT, USA
| | - Carol Vinick
- Asthma Center, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Christine Langton
- Asthma Center, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Donna J. Shocks
- Nursing and Student Health Services, Denver Public Schools, Denver, CO, USA
| | - David A. Stempel
- Propeller Health, San Francisco, CA, USA
- GlaxoSmithKline, Sacramento, CA, USA
| | - Stanley J. Szefler
- Pediatric Asthma Research Program, Breathing Institute, Section of Pediatric Pulmonary Medicine, Aurora, CO, USA
- Denver School of Medicine, University of Colorado, Aurora, CO, USA
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Hollenbach J, Villarreal M, Simoneau T, Langton C, Mitchell H, Flores G, M Cloutier M, Szefler S. Inaccuracy of asthma-related self-reported health-care utilization data compared to Medicaid claims. J Asthma 2018; 56:947-950. [PMID: 30091938 DOI: 10.1080/02770903.2018.1502302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jessica Hollenbach
- a Department of Pediatrics, Connecticut Children's Medical Center , Hartford , Connecticut , USA.,b Department of Pediatrics, University of Connecticut School of Medicine , Farmington , Connecticut , USA
| | | | - Tregony Simoneau
- b Department of Pediatrics, University of Connecticut School of Medicine , Farmington , Connecticut , USA.,d Asthma Center, Connecticut Children's Medical Center , Hartford , Connecticut , USA
| | - Christine Langton
- d Asthma Center, Connecticut Children's Medical Center , Hartford , Connecticut , USA
| | | | - Glenn Flores
- a Department of Pediatrics, Connecticut Children's Medical Center , Hartford , Connecticut , USA
| | - Michelle M Cloutier
- f Pediatric Pulmonology, University of Connecticut Health Center , Farmington , Connecticut , USA
| | - Stanley Szefler
- g Pediatric Pulmonary Medicine, University of Colorado Denver School of Medicine , Aurora , Colorado , USA
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Szefler SJ, Cloutier MM, Villarreal M, Hollenbach JP, Gleason M, Haas-Howard C, Vinick C, Calatroni A, Cicutto L, White M, Williams S, McGinn M, Langton C, Shocks D, Mitchell H, Stempel DA. Building Bridges for Asthma Care: Reducing school absence for inner-city children with health disparities. J Allergy Clin Immunol 2018; 143:746-754.e2. [PMID: 30055181 DOI: 10.1016/j.jaci.2018.05.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/16/2018] [Accepted: 05/25/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children with asthma are at increased risk for experiencing health and educational disparities because of increased school absence. School nurses are well positioned to support asthma management and improve school attendance. OBJECTIVE We sought to implement and assess the effect of the Building Bridges for Asthma Care Program on improving school attendance and measures of asthma control. METHODS Children with asthma (age, 5-14 years) in the Denver Public School System (n = 240) and the Hartford Public School System (n = 223) were enrolled in the Building Bridges Program during the 2013-2014 and 2014-2015 school years and followed until the end of the second school year. The primary outcome was school absence, with secondary outcomes, including asthma control, measured based on Childhood Asthma Control Test or the Asthma Control Test scores and rescue inhaler use. RESULTS Participants experienced a 22% absolute decrease in school absenteeism, the number of children with an Asthma Control Test/Childhood Asthma Control Test score of less than the control threshold of 20 decreased from 42.7% to 28.8%, and bronchodilator use greater than 2 times per week decreased from 35.8% to 22.9% (all changes were significant, P < .01). CONCLUSIONS Children enrolled in the Building Bridges for Asthma Care Program experienced reduced school absence and improved asthma control.
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Affiliation(s)
- Stanley J Szefler
- Pediatric Asthma Research Program and the Breathing Institute, Children's Hospital Colorado, and the Section of Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colo.
| | - Michelle M Cloutier
- Pediatrics and Medicine, UCONN Health, and the Asthma Center, Connecticut Children's Medical Center, Hartford, Conn
| | | | - Jessica P Hollenbach
- Department of Pediatrics, University of Connecticut School of Medicine, and the Asthma Center, Connecticut Children's Medical Center, Hartford, Conn
| | - Melanie Gleason
- Building Bridges Asthma Program, Children's Hospital Colorado, and the Department of Pediatrics, Section of Pediatric Pulmonary Medicine, University of Colorado School of Medicine, Aurora, Colo
| | - Christy Haas-Howard
- Denver Public Schools, Nursing and Student Health Services, and the Colorado Department of Education, Asthma Grant Program, Denver, Colo
| | - Carol Vinick
- Building Bridges Coordinator, Asthma Center, and the Connecticut Children's Medical Center, Hartford, Conn
| | | | - Lisa Cicutto
- Community Outreach and Research, National Jewish Health, and the Clinical Science Program, University of Colorado Denver AMC, Denver, Colo
| | - Marty White
- Children's Hospital Colorado/Denver Public Schools, Denver, Colo
| | | | | | - Christine Langton
- Building Bridges Coordinator, Asthma Center, and the Connecticut Children's Medical Center, Hartford, Conn
| | - Donna Shocks
- Denver Public Schools, Nursing and Student Health Services, Denver, Colo
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Rocca C, Freedman L, Langton C, Ly E, Landy U. Abortion opposition and interprofessional conflict: a national survey of obstetrics–gynecology teaching hospitals. Contraception 2017. [DOI: 10.1016/j.contraception.2017.07.018] [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: 10/18/2022]
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6
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Freedman L, Langton C, Landy U, Ly E, Rocca C. Abortion care policies and enforcement in U.S. obstetrics–gynecology teaching hospitals: a national survey. Contraception 2017. [DOI: 10.1016/j.contraception.2017.07.017] [Citation(s) in RCA: 3] [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: 10/18/2022]
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Turner D, Hyams J, Markowitz J, Lerer T, Mack DR, Evans J, Pfefferkorn M, Rosh J, Kay M, Crandall W, Keljo D, Otley AR, Kugathasan S, Carvalho R, Oliva-Hemker M, Langton C, Mamula P, Bousvaros A, LeLeiko N, Griffiths AM. Appraisal of the pediatric ulcerative colitis activity index (PUCAI). Inflamm Bowel Dis 2009; 15:1218-23. [PMID: 19161178 DOI: 10.1002/ibd.20867] [Citation(s) in RCA: 191] [Impact Index Per Article: 12.7] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND We evaluated the psychometric performance of the Pediatric Ulcerative Colitis Activity Index (PUCAI) in a real-life cohort from the Pediatric IBD Collaborative Research Group. METHODS Two consecutive visits of 215 children with ulcerative colitis (UC) were included (mean age 11.2 +/- 3.6 years; 112 (52%) males; 63 (29%) newly diagnosed and the others after disease duration of 24 +/- 15.6 months). Validity was assessed using several constructs of disease activity. Distributional and anchor-based strategies were used to assess the responsiveness of the PUCAI to change over time following treatment. RESULTS Reflecting feasibility, 97.6% of 770 eligible registry visits had a completed PUCAI score versus only 47.6% for a contemporaneously collected Pediatric Crohn's Disease Activity Index (odds ratio = 45.8, 95% confidence interval [CI] 28.6-73.5) obtained for children with Crohn's disease accessioned into the same database. The PUCAI score was significantly higher in patients requiring escalation of medical therapy (45 points [interquartile range, IQR, 30-60]) versus those who did not, (0 points [IQR 0-10]; P < 0.001), and was highly correlated with physician's global assessment of disease activity (r = 0.9, P < 0.001). The best cutoff to differentiate remission from active disease was 10 points (area under receiver operating characteristic curve [AUC] 0.94; 95% CI 0.90-0.97). Test-retest reliability was excellent (intraclass correlation coefficient = 0.89; 95% CI 0.84-0.92, P < 0.001) as well as responsiveness to change (AUC 0.96 [0.92-0.99]; standardized response mean 2.66). CONCLUSION This study on real-life, prospectively obtained data confirms that the PUCAI is highly feasible by virtue of the noninvasiveness, valid, and responsive index. The PUCAI can be used as a primary outcome measure to reflect disease activity in pediatric UC.
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Affiliation(s)
- Dan Turner
- Pediatric Gastroenterology Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
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Zingg U, Langton C, Addison B, Wijnhoven BPL, Forberger J, Thompson SK, Esterman AJ, Watson DI. Risk prediction scores for postoperative mortality after esophagectomy: validation of different models. J Gastrointest Surg 2009; 13:611-8. [PMID: 19050980 DOI: 10.1007/s11605-008-0761-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [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: 09/26/2008] [Accepted: 11/12/2008] [Indexed: 01/31/2023]
Abstract
BACKGROUND Different prediction models for operative mortality after esophagectomy have been developed. The aim of this study is to independently validate prediction models from Philadelphia, Rotterdam, Munich, and the ASA. METHODS The scores were validated using logistic regression models in two cohorts of patients undergoing esophagectomy for cancer from Switzerland (n = 170) and Australia (n = 176). RESULTS All scores except ASA were significantly higher in the Australian cohort. There was no significant difference in 30-day mortality or in-hospital death between groups. The Philadelphia and Rotterdam scores had a significant predictive value for 30-day mortality (p = 0.001) and in-hospital death (p = 0.003) in the pooled cohort, but only the Philadelphia score had a significant prediction value for 30-day mortality in both cohorts. Neither score showed any predictive value for in-hospital death in Australians but were highly significant in the Swiss cohort. ASA showed only a significant predictive value for 30-day mortality in the Swiss. For in-hospital death, ASA was a significant predictor in the pooled and Swiss cohorts. The Munich score did not have any significant predictive value whatsoever. CONCLUSION None of the scores can be applied generally. A better overall predictive score or specific prediction scores for each country should be developed.
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Affiliation(s)
- U Zingg
- Flinders University Department of Surgery, Flinders Medical Center, Flinders Drive, Bedford Park, Adelaide, 5042, South Australia, Australia.
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Keljo DJ, Markowitz J, Langton C, Lerer T, Bousvaros A, Carvalho R, Crandall W, Evans J, Griffiths A, Kay M, Kugathasan S, LeLeiko N, Mack D, Mamula P, Moyer MS, Oliva-Hemker M, Otley A, Pfefferkorn M, Rosh J, Hyams JS. Course and treatment of perianal disease in children newly diagnosed with Crohn's disease. Inflamm Bowel Dis 2009; 15:383-7. [PMID: 19023863 DOI: 10.1002/ibd.20767] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [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] [Indexed: 12/25/2022]
Abstract
BACKGROUND We sought to characterize perianal disease and its treatment in pediatric patients newly diagnosed with Crohn's disease. METHODS Data were obtained from the Pediatric Inflammatory Bowel Disease (IBD) Collaborative Group Registry, a prospective, multicenter observational registry recording clinical and laboratory outcomes in children under 16 years of age newly diagnosed with IBD. Patients with Crohn's disease were selected who had data on perianal disease and at least 24 months of follow-up. The records of patients with a Pediatric Crohn's Disease Activity Index perianal subscore greater than 0 were reviewed, and patients with abscesses or fistulas were selected. The therapies used and the course of their perianal disease were then assessed. RESULTS Of the 276 patients identified, 41 had perianal lesions within 30 days of diagnosis. Thirteen of these had skin tags and fissures only, whereas 28 had fistulas and/or abscesses. The latter lesions resolved by 1 year in 20 patients, and 8 had chronic/recurrent perianal disease persisting for more than 1 year following diagnosis. Patients with fistulizing disease were much more likely to be treated and were treated earlier with antibiotics, infliximab, and immunomodulators than were nonfistulizing patients. Patients who developed chronic perianal disease were more likely to have low body mass indices and required more perianal surgery than did patients whose perianal disease resolved. CONCLUSIONS Approximately 10% of newly diagnosed pediatric patients with Crohn's disease will have perianal fistulas and/or abscesses at the time of diagnosis. Most of these will resolve within a year with medical therapy alone.
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Affiliation(s)
- David J Keljo
- Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania 15213, USA.
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Kappelman MD, Bousvaros A, Hyams J, Markowitz J, Pfefferkorn M, Kugathasan S, Rosh J, Otley A, Mack D, Griffiths A, Evans J, Grand R, Langton C, Kleinman K, Finkelstein JA. Intercenter variation in initial management of children with Crohn's disease. Inflamm Bowel Dis 2007; 13:890-5. [PMID: 17286275 DOI: 10.1002/ibd.20121] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND Variation in care is a ubiquitous feature of medical practice and may lead to significant differences in health care costs, quality, and outcomes. We undertook this study to determine the extent of intercenter variation in the initial management of children newly diagnosed with Crohn's disease. METHODS We analyzed the utilization of 5 classes of medication (immunomodulators, prednisone, antibiotics, 5-aminosalicylates, and infliximab) among 311 children with newly diagnosed Crohn's disease followed at 10 North American pediatric gastroenterology centers. Multivariate logistic regression was used to compare the utilization rate of each class of medication at each of the 10 centers, adjusting for potential confounders including patient age, sex, race, disease severity, and anatomic location of disease. RESULTS Median utilization of each class of medication was: immunomodulators, 56% (range 29%-97%); prednisone, 78% (range 32%-88%); antibiotics, 29% (range 11%-68%); 5-aminosalicylates, 63.5% (range 18%-92%); and infliximab, 7.5% (range 3%-21%). Each of these treatments showed statistically significant intercenter variation in utilization (P < 0.001 for immunomodulators, prednisone, antibiotics, and 5-ASA; P = 0.02 for infliximab). After adjusting for the demographic and clinical factors listed above, intercenter variation remained significant; however, the low utilization of infliximab precluded multivariate analysis. CONCLUSIONS Widespread intercenter variation in the medical management of newly diagnosed children with Crohn's disease was observed, even after adjusting for possible differences in case mix between institutions. This variation may lead to unintended differences in health care costs and outcomes.
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Affiliation(s)
- Michael D Kappelman
- Center for Inflammatory Bowel Disease, Division of Gastroenterology and Nutrition, Children's Hospital Boston, Massachusetts 02115, USA.
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Mack DR, Langton C, Markowitz J, LeLeiko N, Griffiths A, Bousvaros A, Evans J, Kugathasan S, Otley A, Pfefferkorn M, Rosh J, Mezoff A, Moyer S, Oliva-Hemker M, Rothbaum R, Wyllie R, delRosario JF, Keljo D, Lerer T, Hyams J. Laboratory values for children with newly diagnosed inflammatory bowel disease. Pediatrics 2007; 119:1113-9. [PMID: 17545378 DOI: 10.1542/peds.2006-1865] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The goal was to determine how often common laboratory tests yield normal results at the time of diagnosis for children with inflammatory bowel disease. METHODS Data were obtained from a registry of children with newly diagnosed inflammatory bowel disease who were enrolled prospectively in 18 US/Canadian centers. Laboratory values investigated included hemoglobin level, platelet count, albumin level, and erythrocyte sedimentation rate. Disease severity was categorized by physician global assessment. RESULTS A total of 526 children (mean age: 11.6 years; 58% male; 392 with Crohn disease and 134 with ulcerative colitis) were studied. All 4 values were normal for 21% of patients with mild Crohn disease and 54% with mild ulcerative colitis. In contrast, only 3.8% of children with moderate/severe Crohn disease and 4.3% with moderate/severe ulcerative colitis had normal results for all 4 tests. The erythrocyte sedimentation rate was least likely to be normal; overall, 26% of patients with inflammatory bowel disease had a normal erythrocyte sedimentation rate, including 18% with moderate/severe disease. Hemoglobin levels were normal for 32%, platelet counts for 50%, and albumin levels for 60%. There was no clear association between Crohn disease location and either severity or number of normal laboratory values. In contrast, there were direct correlations between ulcerative colitis disease severity and both the extent of bowel inflammation and the number of abnormal laboratory tests. CONCLUSION The presence of normal screening laboratory studies should not dissuade clinicians from considering a diagnosis of inflammatory bowel disease.
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Affiliation(s)
- David R Mack
- Department of Pediatrics, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, Canada K1H 8L1.
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Langton C, Gray JS, Waters PF, Holman PJ. Naturally acquired babesiosis in a reindeer (Rangifer tarandus tarandus) herd in Great Britain. Parasitol Res 2003; 89:194-8. [PMID: 12541061 DOI: 10.1007/s00436-002-0737-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2002] [Accepted: 08/22/2002] [Indexed: 10/25/2022]
Abstract
A provisional diagnosis of babesiosis was made in a reindeer herd in Scotland when seven animals died during 1997 and 1998. Additional clinical cases occurred, but the animals recovered after treatment. Thirty-one reindeer from the herd were tested for the prevalence of exposure to Babesia by the indirect fluorescent antibody test using a bovine isolate of Babesia divergens that had been passaged through gerbils. Infection rates were determined by Giemsa-stained blood smears. In addition, molecular identification of the infecting Babesiasp. was undertaken using SSU rRNA gene sequence analysis. It is likely that the organism causing babesiosis in this reindeer herd is B. divergens.
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Affiliation(s)
- C Langton
- Department of Veterinary Pathology, Royal Veterinary College, London, UK
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Dequeker J, Reeve J, Pearson J, Bright J, Felsenberg D, Kalender W, Langton C, Laval-Jeantet A, Rüegsegger P, Van der Perre G. Multicentre European COMAC-BME study on the standardisation of bone densitometry procedures. Technol Health Care 1993; 1:127-31. [DOI: 10.3233/thc-1993-1202] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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