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Balasubramanian S, Yu S, Behera SK, Bhat AH, Camarda JA, Choueiter NF, Jone P, Lopez L, Natarajan SS, Parra DA, Parthiban A, Sachdeva R, Srivastava S, Tierney ESS. Consensus-Based Development of a Pediatric Echocardiography Complexity Score: Design, Rationale, and Results of a Quality Improvement Collaborative. J Am Heart Assoc 2024; 13:e029798. [PMID: 38390878 PMCID: PMC10944062 DOI: 10.1161/jaha.123.029798] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 11/07/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND The complexity of congenital heart disease has been primarily stratified on the basis of surgical technical difficulty, specific diagnoses, and associated outcomes. We report on the refinement and validation of a pediatric echocardiography complexity (PEC) score. METHODS AND RESULTS The American College of Cardiology Quality Network assembled a panel from 12 centers to refine a previously published PEC score developed in a single institution. The panel refined complexity categories and included study modifiers to account for complexity related to performance of the echocardiogram. Each center submitted data using the PEC scoring tool on 15 consecutive inpatient and outpatient echocardiograms. Univariate and multivariate analyses were performed to assess for independent predictors of longer study duration. Among the 174 echocardiograms analyzed, 68.9% had underlying congenital heart disease; 44.8% were outpatient; 34.5% were performed in an intensive care setting; 61.5% were follow-up; 46.6% were initial or preoperative; and 9.8% were sedated. All studies had an assigned PEC score. In univariate analysis, longer study duration was associated with several patient and study variables (age <2 years, PEC 4 or 5, initial study, preoperative study, junior or trainee scanner, and need for additional imaging). In multivariable analysis, a higher PEC score of 4 or 5 was independently associated with longer study duration after controlling for study variables and center variation. CONCLUSIONS The PEC scoring tool is feasible and applicable in a variety of clinical settings and can be used for correlation with diagnostic errors, allocation of resources, and assessment of physician and sonographer effort in performing, interpreting, and training in pediatric echocardiography.
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Affiliation(s)
| | - Sunkyung Yu
- Department of PediatricsUniversity of MichiganAnn ArborMIUSA
| | | | - Aarti H. Bhat
- Department of PediatricsUniversity of Washington and Seattle Children’s HospitalSeattleWAUSA
| | - Joseph A. Camarda
- Department of PediatricsNorthwestern University Feinberg School of MedicineChicagoILUSA
| | | | - Pei‐Ni Jone
- Department of PediatricsLurie Children’s HospitalChicagoILUSA
| | - Leo Lopez
- Department of PediatricsStanford School of MedicinePalo AltoCAUSA
| | - Shobha S. Natarajan
- Department of PediatricsPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | - David A. Parra
- Department of PediatricsVanderbilt University Medical CenterNashvilleTNUSA
| | - Anitha Parthiban
- Texas Children’s Hospital, Baylor College of MedicineHoustonTXUSA
| | - Ritu Sachdeva
- Emory University and Children’s Healthcare of AtlantaAtlantaGAUSA
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Lopez L, Saurers DL, Barker PCA, Cohen MS, Colan SD, Dwyer J, Forsha D, Friedberg MK, Lai WW, Printz BF, Sachdeva R, Soni-Patel NR, Truong DT, Young LT, Altman CA. Guidelines for Performing a Comprehensive Pediatric Transthoracic Echocardiogram: Recommendations From the American Society of Echocardiography. J Am Soc Echocardiogr 2024; 37:119-170. [PMID: 38309834 DOI: 10.1016/j.echo.2023.11.015] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
Echocardiography is a fundamental component of pediatric cardiology, and appropriate indications have been established for its use in the setting of suspected, congenital, or acquired heart disease in children. Since the publication of guidelines for pediatric transthoracic echocardiography in 2006 and 2010, advances in knowledge and technology have expanded the scope of practice beyond the use of traditional modalities such as two-dimensional, M-mode, and Doppler echocardiography to evaluate the cardiac segmental structures and their function. Adjunct modalities such as contrast, three-dimensional, and speckle-tracking echocardiography are now used routinely at many pediatric centers. Guidelines and recommendations for the use of traditional and newer adjunct modalities in children are described in detail in this document. In addition, suggested protocols related to standard operations, infection control, sedation, and quality assurance and improvement are included to provide an organizational structure for centers performing pediatric transthoracic echocardiograms.
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Affiliation(s)
- Leo Lopez
- Department of Pediatrics Cardiology, Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford, Palo Alto, California.
| | - Daniel L Saurers
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Piers C A Barker
- Duke Children's Hospital & Health Center, Duke University, Durham, North Carolina
| | - Meryl S Cohen
- Cardiac Center and Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Jeanine Dwyer
- Pediatric Heart Institute, Children's Hospital Colorado, Aurora, Colorado
| | - Daniel Forsha
- Ward Family Heart Center, Children's Mercy Kansas City Hospital, Kansas City, Missouri
| | - Mark K Friedberg
- Labatt Family Heart Centre, Division of Cardiology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Wyman W Lai
- Division of Pediatric Cardiology, University of California School of Medicine, Irvine, California; Department of Pediatrics, Children's Hospital of Orange County, Orange, California
| | - Beth F Printz
- Rady Children's Hospital San Diego and University of California, San Diego, San Diego, California
| | - Ritu Sachdeva
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Neha R Soni-Patel
- Pediatric & Adult Congenital Heart Center, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Dongngan T Truong
- University of Utah and Division of Pediatric Cardiology, Primary Children's Hospital, Salt Lake City, Utah
| | - Luciana T Young
- Seattle Children's Hospital and Pediatric Cardiology, University of Washington School of Medicine, Seattle, Washington
| | - Carolyn A Altman
- Baylor College of Medicine and Texas Children's Heart Center, Texas Children's Hospital, Houston, Texas
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Jacobs JP, Bleiweis MS, Cohen MS, Lopez L, Peek GJ, Franklin RCG, Tchervenkov CI. Defining the Spectrum of Hypoplastic Left Heart Syndrome (HLHS). World J Pediatr Congenit Heart Surg 2023; 14:741-745. [PMID: 37933696 DOI: 10.1177/21501351231189277] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
The 2021 International Paediatric and Congenital Cardiac Code and the Eleventh Revision of the International Classification of Diseases provide the following definition for hypoplastic left heart syndrome (HLHS): "Hypoplastic left heart syndrome (HLHS) is defined as a spectrum of congenital cardiovascular malformations with normally aligned great arteries without a common atrioventricular junction, characterized by underdevelopment of the left heart with significant hypoplasia of the left ventricle including atresia, stenosis, or hypoplasia of the aortic or mitral valve, or both valves, and hypoplasia of the ascending aorta and aortic arch." Although HLHS with intact ventricular septum (HLHS + IVS) and HLHS with ventricular septal defect (HLHS + VSD) are different cardiac phenotypes, both of these lesions are part of the spectrum of HLHS.
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Affiliation(s)
- Jeffrey P Jacobs
- Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, Congenital Heart Center, University of Florida, Gainesville, FL, United States of America
| | - Mark S Bleiweis
- Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, Congenital Heart Center, University of Florida, Gainesville, FL, United States of America
| | - Meryl S Cohen
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Leo Lopez
- Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Giles J Peek
- Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, Congenital Heart Center, University of Florida, Gainesville, FL, United States of America
| | - Rodney C G Franklin
- Paediatric Cardiology Department, Royal Brompton & Harefield NHS Trust, London, United Kingdom
| | - Christo I Tchervenkov
- Division of Cardiovascular Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montréal, Québec, Canada
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Moon-Grady AJ, Lee H, Lopez L, Fatusin O, Freud LR, Hogan W, Krishnan A, McFarland C, Minich LL, Morris SA, Pinto N, Presson AP, Tacy TA, Donofrio MT. Fetal Echocardiographic Z Score Pilot Project: Study Design and Impact of Gestational Age and Variable Type on Reproducibility of Measurements Within and Across Investigators. J Am Soc Echocardiogr 2023; 36:978-997. [PMID: 37302438 DOI: 10.1016/j.echo.2023.05.010] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/27/2023] [Accepted: 05/17/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Fetal echocardiography is widely available, but normative data are not robust. In this pilot study, the authors evaluated (1) the feasibility of prespecified measurements in a normal fetal echocardiogram to inform study design and (2) measurement variability to assign thresholds of clinical significance and guide analyses in larger fetal echocardiographic Z score initiatives. METHODS Images from predefined gestational age groups (16-20, >20-24, >24-28, and >28-32 weeks) were retrospectively analyzed. Fetal echocardiography expert raters attended online group training and then independently analyzed 73 fetal studies (18 per age group) in a fully crossed design of 53 variables; each observer repeated measures for 12 fetuses. Kruskal-Wallis tests were used to compare measurements across centers and age groups. Coefficients of variation (CoVs) were calculated at the subject level for each measurement as the ratio of SD to mean. Intraclass correlation coefficients were used to show inter- and intrarater reliabilities. Cohen's d > 0.8 was used to define clinically important differences. Measurements were plotted against gestational age, biparietal diameter, and femur length. RESULTS Expert raters completed each set of measurements in a mean of 23 ± 9 min/fetus. Missingness ranged from 0% to 29%. CoVs were similar across age groups for all variables (P < .05) except ductus arteriosus mean velocity and left ventricular ejection time, which were both higher at older gestational age. CoVs were >15% for right ventricular systolic and diastolic widths despite fair to good repeatability (intraclass correlation coefficient > 0.5); ductal velocities and two-dimensional measures, left ventricular short-axis dimensions, and isovolumic times all had high CoVs and high interobserver variability despite good to excellent intraobserver agreement (intraclass correlation coefficient > 0.6). CoVs did not improve when ratios (e.g., tricuspid/mitral annulus) were used instead of linear measurements. Overall, 27 variables had acceptable inter- and intraobserver repeatability, while 14 had excessive variability between readers despite good intraobserver agreement. CONCLUSIONS There is considerable variability in fetal echocardiographic quantification in clinical practice that may affect the design of multicenter fetal echocardiographic Z score studies, and not all measurements may be feasible for standard normalization. As missingness was substantial, a prospective design will be needed. Data from this pilot study may aid in the calculation of sample sizes and inform thresholds for distinguishing clinically significant from statistically significant effects.
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Affiliation(s)
- Anita J Moon-Grady
- Division of Cardiology, Department of Pediatrics, University of California, San Francisco, San Francisco, California.
| | - Hyejung Lee
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Leo Lopez
- Division of Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California
| | - Oluwatosin Fatusin
- Division of Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | | | - Whitnee Hogan
- Division of Cardiology, Department of Pediatrics, University of California, San Francisco, San Francisco, California; Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Anita Krishnan
- Children's National Hospital, Washington, District of Columbia
| | - Carol McFarland
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - L LuAnn Minich
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Shaine A Morris
- Division of Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Nelangi Pinto
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Angela P Presson
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Theresa A Tacy
- Division of Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California
| | - Mary T Donofrio
- Children's National Hospital, Washington, District of Columbia
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Travers JL, McGarry BE, Friedman S, Holaday LW, Ross JS, Lopez L, Chen K. Association of Receipt of Paycheck Protection Program Loans With Staffing Patterns Among US Nursing Homes. JAMA Netw Open 2023; 6:e2326122. [PMID: 37498597 PMCID: PMC10375300 DOI: 10.1001/jamanetworkopen.2023.26122] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 05/30/2023] [Indexed: 07/28/2023] Open
Abstract
Importance Staffing shortages in nursing homes (NHs) threaten the quality of resident care, and the COVID-19 pandemic magnified critical staffing shortages within NHs. During the pandemic, the US Congress enacted the Paycheck Protection Program (PPP), a forgivable loan program that required eligible recipients to appropriate 60% to 75% of the loan toward staffing to qualify for loan forgiveness. Objective To evaluate characteristics of PPP loan recipient NHs vs nonloan recipient NHs and whether there were changes in staffing hours at NHs that received a loan compared with those that did not. Design, Setting, and Participants This economic evaluation used national data on US nursing homes that were aggregated from the Small Business Administration, Nursing Home Compare, LTCFocus, the Centers for Medicare & Medicaid Services Payroll Based Journal, the Minimum Data Set, the Area Deprivation Index, the Healthcare Cost Report Information System, and the US Department of Agriculture Rural-Urban Continuum Codes from January 1 to December 23, 2020. Exposure Paycheck Protection Program loan receipt status. Main Outcome and Measures Staffing variables included registered nurse, licensed practical nurse (LPN), and certified nursing assistant (CNA) total hours per week. Staffing hours were examined on a weekly basis before and after loan receipt during the study period. An event-study approach was used to estimate the staffing total weekly hours at NHs that received PPP loans compared with NHs that did not receive a PPP loan. Results Among 6008 US NHs, 1807 (30.1%) received a PPP loan and 4201 (69.9%) did not. The median loan amount was $664 349 (IQR, $407 000-$1 058 300). Loan recipients were less likely to be part of a chain (733 [40.6%] vs 2592 [61.7%]) and more likely to be for profit (1342 [74.3%] vs 2877 [68.5%]), be located in nonurban settings (159 [8.8%] vs 183 [4.4%]), have a greater proportion of Medicaid-funded residents (mean [SD], 60.92% [21.58%] vs 56.78% [25.57%]), and have lower staffing quality ratings (mean [SD], 2.88 [1.20] vs 3.03 [1.22]) and overall quality star ratings (mean [SD], 3.08 [1.44] vs 3.22 [1.44]) (P < .001 for all). Twelve weeks after PPP loan receipt, NHs that received a PPP loan experienced a mean difference of 26.19 more CNA hours per week (95% CI, 14.50-37.87 hours per week) and a mean difference of 6.67 more LPN hours per week (95% CI, 1.21-12.12 hours per week) compared with nursing homes that did not receive a PPP loan. No associations were found between PPP loan receipt and weekly RN staffing hours (12 weeks: mean difference, 1.99 hours per week; 95% CI, -2.38 to 6.36 hours per week). Conclusions and Relevance In this economic evaluation, a forgivable loan program that required funding to be appropriated toward staffing was associated with a significant increase in CNA and LPN staffing hours among NH PPP loan recipients. Because the PPP loans are temporary, federal and state entities may need to institute sufficient and sustainable support to mitigate NH staffing shortages.
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Affiliation(s)
- Jasmine L. Travers
- Rory Meyers College of Nursing, New York University Grossman School of Medicine, New York
| | - Brian E. McGarry
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Steven Friedman
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Louisa W. Holaday
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joseph S. Ross
- Section of General Medicine and the National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
| | - Leo Lopez
- Institute for Public Health, University Health, University Medicine Associates, San Antonio, Texas
| | - Kevin Chen
- Office of Ambulatory Care and Population Health, New York City Health + Hospitals, New York
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New York
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Pickard SS, Armstrong AK, Balasubramanian S, Buddhe S, Crum K, Kong G, Lang SM, Lee MV, Lopez L, Natarajan SS, Norris MD, Parra DA, Parthiban A, Powell AJ, Priromprintr B, Rogers LS, Sachdeva S, Shah SS, Smith CA, Stern KWD, Xiang Y, Young LT, Sachdeva R. Appropriateness of cardiovascular computed tomography and magnetic resonance imaging in patients with conotruncal defects. J Cardiovasc Comput Tomogr 2023:S1934-5925(23)00048-5. [PMID: 36868899 DOI: 10.1016/j.jcct.2023.01.044] [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: 11/07/2022] [Revised: 12/11/2022] [Accepted: 01/24/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND To promote the rational use of cardiovascular imaging in patients with congenital heart disease, the American College of Cardiology developed Appropriate Use Criteria (AUC), but its clinical application and pre-release benchmarks have not been evaluated. We aimed to evaluate the appropriateness of indications for cardiovascular magnetic resonance (CMR) and cardiovascular computed tomography (CCT) in patients with conotruncal defects and to identify factors associated with maybe or rarely appropriate (M/R) indications. METHODS Twelve centers each contributed a median of 147 studies performed prior to AUC publication (01/2020) on patients with conotruncal defects. To incorporate patient characteristics and center-level effects, a hierarchical generalized linear mixed model was used. RESULTS Of the 1753 studies (80% CMR, and 20% CCT), 16% were rated M/R. Center M/R ranged from 4 to 39%. Infants accounted for 8.4% of studies. In multivariable analyses, patient- and study-level factors associated with M/R rating included: age <1 year (OR 1.90 [1.15-3.13]), truncus arteriosus (vs. tetralogy of Fallot, OR 2.55 [1.5-4.35]), and CCT (vs. CMR, OR 2.67 [1.87-3.83]). None of the provider- or center-level factors reached statistical significance in the multivariable model. CONCLUSIONS Most CMRs and CCTs ordered for the follow-up care of patients with conotruncal defects were rated appropriate. However, there was significant center-level variation in appropriateness ratings. Younger age, CCT, and truncus arteriosus were independently associated with higher odds of M/R rating. These findings could inform future quality improvement initiatives and further exploration of factors resulting in center-level variation.
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Affiliation(s)
- Sarah S Pickard
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | | | - Sowmya Balasubramanian
- Department of Pediatrics, University of Michigan, C.S. Mott Children's Hospital, AnnArbor, MI, USA
| | - Sujatha Buddhe
- Department of Cardiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Kimberly Crum
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Grace Kong
- Department of Pediatrics, Division of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Kravis Children's Heart Center, New York, NY, USA
| | - Sean M Lang
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marc V Lee
- Nationwide Children's Hospital, The Heart Center, Columbus, OH, USA
| | - Leo Lopez
- Department of Pediatrics, Divison of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Shobha S Natarajan
- Department of Pediatrics, Divison of Pediatric Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark D Norris
- Department of Pediatrics, University of Michigan, C.S. Mott Children's Hospital, AnnArbor, MI, USA
| | - David A Parra
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anitha Parthiban
- Department of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Bryant Priromprintr
- Department of Pediatrics, Divison of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Lindsay S Rogers
- Department of Pediatrics, Divison of Pediatric Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shagun Sachdeva
- Department of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Sanket S Shah
- Department of Pediatrics, Divison of Pediatric Cardiology, Children's Mercy Kansas City, University of Missouri, Kansas City, MO, USA
| | - Clayton A Smith
- Pediatric Biostatistics Core, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Kenan W D Stern
- Department of Pediatrics, Division of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Kravis Children's Heart Center, New York, NY, USA
| | - Yijin Xiang
- Pediatric Biostatistics Core, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Luciana T Young
- Department of Cardiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Ritu Sachdeva
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA.
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Reddy CD, Lopez L, Ouyang D, Zou JY, He B. Video-Based Deep Learning for Automated Assessment of Left Ventricular Ejection Fraction in Pediatric Patients. J Am Soc Echocardiogr 2023; 36:482-489. [PMID: 36754100 DOI: 10.1016/j.echo.2023.01.015] [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: 06/30/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Significant interobserver and interstudy variability occurs for left ventricular functional indices despite standardization of measurement techniques. Artificial intelligence models trained on adult echocardiograms are not likely to be applicable to a pediatric population. We present EchoNet-Peds, a video-based deep learning algorithm, which matches human expert performance of left ventricular (LV) segmentation and ejection fraction (EF). METHODS A large pediatric dataset of 4,467 echocardiograms were used to develop EchoNet-Peds. EchoNet-Peds was trained on 80% of the data for segmentation of the left ventricle and estimation of left ventricular EF. The remaining 20% was used to fine tune and validate the algorithm. RESULTS In both apical 4-chamber (A4C) and parasternal short-axis views (PSAX), EchoNet-Peds segments the left ventricle with a Dice similarity coefficient of 0.89. EchoNet-Peds estimates EF with a mean absolute error of 3.66% and can routinely identify pediatric patients with systolic dysfunction (area under the curve of 0.95). EchoNet-Peds was trained on pediatric echocardiograms and performed significantly better to estimate EF (p < 0.001) than an adult model applied to the same data. CONCLUSION Accurate, rapid automation of EF assessment and recognition of systolic dysfunction in a pediatric population are feasible using EchoNet-Peds with the potential for far-reaching clinical impact. In addition, the first large pediatric dataset of annotated echocardiograms is now publicly available for efforts to develop pediatric-specific artificial intelligence algorithms.
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Affiliation(s)
- Charitha D Reddy
- Department of Pediatrics, Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA, USA.
| | - Leo Lopez
- Department of Pediatrics, Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA, USA
| | - David Ouyang
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - James Y Zou
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Bryan He
- Department of Computer Science, Stanford University, Stanford, CA, USA
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Rahde Bischoff A, Bhombal S, Altman CA, Fraga MV, Punn R, Rohatgi RK, Lopez L, McNamara PJ. Targeted Neonatal Echocardiography in Patients With Hemodynamic Instability. Pediatrics 2022; 150:189890. [PMID: 36317979 DOI: 10.1542/peds.2022-056415i] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 02/25/2023] Open
Abstract
Targeted neonatal echocardiography (TNE) has been increasingly used at the bedside in neonatal care to provide an enhanced understanding of physiology, affecting management in hemodynamically unstable patients. Traditional methods of bedside assessment, including blood pressure, heart rate monitoring, and capillary refill are unable to provide a complete picture of tissue perfusion and oxygenation. TNE allows for precision medicine, providing a tool for identifying pathophysiology and to continually reassess rapid changes in hemodynamics. A relationship with cardiology is integral both in training as well as quality assurance. It is imperative that congenital heart disease is ruled out when utilizing TNE for hemodynamic management, as pathophysiology varies substantially in the assessment and management of patients with congenital heart disease. Utilizing TNE for longitudinal hemodynamic assessment requires extensive training. As the field continues to grow, guidelines and protocols for training and indications are essential for ensuring optimal use and providing a platform for quality assurance.
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Affiliation(s)
| | - Shazia Bhombal
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, California.,Contributed equally as co-first authors
| | - Carolyn A Altman
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - María V Fraga
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rajesh Punn
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Ram K Rohatgi
- Department of Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Leo Lopez
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Patrick J McNamara
- Departments of Pediatrics.,Internal Medicine, University of Iowa, Iowa City, Iowa
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Lopez L, Dviri M, Madjunkov M, Haham LM, Kuperman A, Mander P, Gallagher D, Gauthier-Fisher A, Librach C. Mesenchymal Stem/Stromal Cells: HUMAN UMBILICAL CORD PERIVASCULAR CELLS (HUCPVC) REDUCE OVARIAN FIBROSIS AND IMPROVE PREGNANCY RATE IN A MOUSE MODEL OF NATURAL OVARIAN AGING. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00183-9] [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]
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10
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Chen KL, Chen K, Holaday LW, Lopez L. Assessing Concordance Across Nonprofit Hospitals' Public Reporting on Housing as a Community Health Need in the Era of the Affordable Care Act. J Public Health Manag Pract 2022; 28:E615-E618. [PMID: 33938486 PMCID: PMC9994632 DOI: 10.1097/phh.0000000000001357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although the Affordable Care Act requires nonprofit hospital organizations to report how they identify and invest in community health needs, the utility of mandated reporting documents for tracking investments in the social determinants of health has been questioned. Using public reporting documents and focusing on housing as a social determinant of health, we describe how nonprofit hospital organizations in 5 communities with the highest rates of homelessness document needs and investments related to housing on their Community Health Needs Assessments, Implementation Strategies, and Schedule H (990H) tax forms. Of 47 organizations, 55% identified housing as a health need, 36% described housing-related implementation strategies, and 26% reported relevant 990H spending. Overall concordance among identified needs, strategies, and spending was low, with only 15% of organizations addressing housing across all 3 documents. Regulatory reform could help promote accountability and transparency in organizations' efforts to address housing and other health-related social needs.
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Affiliation(s)
- Katherine L Chen
- National Clinician Scholars Program, University of California, Los Angeles, California (Dr K. L. Chen); Division of General Internal Medicine, Cedars Sinai Medical Center, Los Angeles, California (Dr K. L. Chen); Office of Ambulatory Care, New York City Health + Hospitals, New York City, New York (Drs K. Chen and Lopez); Division of General Internal Medicine and Clinical Innovation (Dr K. Chen) and Department of Population Health (Dr Lopez), New York University School of Medicine, New York City, New York; VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, West Haven, Connecticut (Dr Holaday); and National Clinician Scholars Program, Yale University, New Haven, Connecticut (Dr Holaday)
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Lopez L, Chen K, Hart L, Johnson AK. Access and Analytics: What the Military Can Teach Us About Health Equity. Am J Public Health 2021; 111:2089-2090. [PMID: 34878876 PMCID: PMC8667823 DOI: 10.2105/ajph.2021.306535] [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] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Leo Lopez
- Leo Lopez III is with New York City Health + Hospitals and the Division of Healthcare Delivery Science, Department of Population Health, New York University Grossman School of Medicine, New York, NY. Kevin Chen and Amanda K. Johnson are with New York City Health + Hospitals and the Division of General Internal Medicine & Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New York, NY. Lou Hart is with the Yale New Haven Health System, New Haven, CT. Note. The views expressed in this editorial are solely those of the authors and do not reflect the views of New York City Health + Hospitals, the New York University Grossman School of Medicine, or the Yale New Haven Health System
| | - Kevin Chen
- Leo Lopez III is with New York City Health + Hospitals and the Division of Healthcare Delivery Science, Department of Population Health, New York University Grossman School of Medicine, New York, NY. Kevin Chen and Amanda K. Johnson are with New York City Health + Hospitals and the Division of General Internal Medicine & Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New York, NY. Lou Hart is with the Yale New Haven Health System, New Haven, CT. Note. The views expressed in this editorial are solely those of the authors and do not reflect the views of New York City Health + Hospitals, the New York University Grossman School of Medicine, or the Yale New Haven Health System
| | - Lou Hart
- Leo Lopez III is with New York City Health + Hospitals and the Division of Healthcare Delivery Science, Department of Population Health, New York University Grossman School of Medicine, New York, NY. Kevin Chen and Amanda K. Johnson are with New York City Health + Hospitals and the Division of General Internal Medicine & Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New York, NY. Lou Hart is with the Yale New Haven Health System, New Haven, CT. Note. The views expressed in this editorial are solely those of the authors and do not reflect the views of New York City Health + Hospitals, the New York University Grossman School of Medicine, or the Yale New Haven Health System
| | - Amanda K Johnson
- Leo Lopez III is with New York City Health + Hospitals and the Division of Healthcare Delivery Science, Department of Population Health, New York University Grossman School of Medicine, New York, NY. Kevin Chen and Amanda K. Johnson are with New York City Health + Hospitals and the Division of General Internal Medicine & Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New York, NY. Lou Hart is with the Yale New Haven Health System, New Haven, CT. Note. The views expressed in this editorial are solely those of the authors and do not reflect the views of New York City Health + Hospitals, the New York University Grossman School of Medicine, or the Yale New Haven Health System
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Lopez L, Dhodapkar M, Gross CP. US Nonprofit Hospitals' Community Health Needs Assessments and Implementation Strategies in the Era of the Patient Protection and Affordable Care Act. JAMA Netw Open 2021; 4:e2122237. [PMID: 34427683 PMCID: PMC8385593 DOI: 10.1001/jamanetworkopen.2021.22237] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/14/2022] Open
Abstract
This cross-sectional study examines the proportion of US nonprofit hospitals with community health needs assessments and implementation strategies as required by the Patient Protection and Affordable Care Act.
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Affiliation(s)
- Leo Lopez
- National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Cary P. Gross
- National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Cancer Outcomes Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
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Jacobs JP, Franklin RCG, Béland MJ, Spicer DE, Colan SD, Walters HL, Bailliard F, Houyel L, St Louis JD, Lopez L, Aiello VD, Gaynor JW, Krogmann ON, Kurosawa H, Maruszewski BJ, Stellin G, Weinberg PM, Jacobs ML, Boris JR, Cohen MS, Everett AD, Giroud JM, Guleserian KJ, Hughes ML, Juraszek AL, Seslar SP, Shepard CW, Srivastava S, Cook AC, Crucean A, Hernandez LE, Loomba RS, Rogers LS, Sanders SP, Savla JJ, Tierney ESS, Tretter JT, Wang L, Elliott MJ, Mavroudis C, Tchervenkov CI. Nomenclature for Pediatric and Congenital Cardiac Care: Unification of Clinical and Administrative Nomenclature - The 2021 International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Revision of the International Classification of Diseases (ICD-11). World J Pediatr Congenit Heart Surg 2021; 12:E1-E18. [PMID: 34304616 DOI: 10.1177/21501351211032919] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 11/15/2022]
Abstract
Substantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code (IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases (ICD-11). The most recent publication of the IPCCC was in 2017. This manuscript provides an updated 2021 version of the IPCCC. The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCC and ICD-11 is the IPCCC ICD-11 Nomenclature and is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHD through 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHO ICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHD thought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.The members of ISNPCHD realize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCC that was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHD will again publish updated versions of IPCCC, as IPCCC continues to evolve.
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Affiliation(s)
- Jeffrey P Jacobs
- Congenital Heart Center, UF Health Shands Hospital, Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida, United States of America
| | - Rodney C G Franklin
- Paediatric Cardiology Department, Royal Brompton & Harefield NHS Trust, London, United Kingdom
| | - Marie J Béland
- Division of Paediatric Cardiology, The Montreal Children's Hospital of the McGill University Health Centre, Montréal, Québec, Canada
| | - Diane E Spicer
- Congenital Heart Center, UF Health Shands Hospital, Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida, United States of America.,Johns Hopkins All Children's Hospital, Johns Hopkins University, Saint Petersburg, Florida, United States of America
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Harvard University, Boston, Massachusetts, United States of America
| | - Henry L Walters
- Cardiovascular Surgery, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Frédérique Bailliard
- Bailliard Henry Pediatric Cardiology, Raleigh, North Carolina, United States of America.,Duke University, Durham, North Carolina, United States of America
| | - Lucile Houyel
- Congenital and Pediatric Medico-Surgical Unit, Necker Hospital-M3C, Paris, France
| | - James D St Louis
- Department of Surgery and Pediatrics, Children Hospital of Georgia, Augusta University, Augusta, Georgia
| | - Leo Lopez
- Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Vera D Aiello
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - J William Gaynor
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Otto N Krogmann
- Pediatric Cardiology-Congenital Heart Disease, Heart Center Duisburg, Duisburg, Germany
| | - Hiromi Kurosawa
- Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Bohdan J Maruszewski
- Department for Pediatric and Congenital Heart Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Giovanni Stellin
- Pediatric and Congenital Cardiac Surgical Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Paul Morris Weinberg
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | | | - Jeffrey R Boris
- Jeffrey R. Boris, MD LLC, Moylan, Pennsylvania, United States of America
| | - Meryl S Cohen
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Allen D Everett
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Jorge M Giroud
- All Children's Hospital, Saint Petersburg, Florida, United States of America
| | - Kristine J Guleserian
- Congenital Heart Surgery, Medical City Children's Hospital, Dallas, Texas, United States of America
| | - Marina L Hughes
- Cardiology Department, Norfolk and Norwich University Hospital NHS Trust, United Kingdom
| | - Amy L Juraszek
- Terry Heart Institute, Wolfson Children's Hospital, Jacksonville, Florida, United States of America
| | - Stephen P Seslar
- Department of Pediatrics, Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, United States of America
| | - Charles W Shepard
- Children's Heart Clinic of Minneapolis, Minneapolis, Minnesota, United States of America
| | - Shubhika Srivastava
- Division of Cardiology, Department of Cardiovascular Medicine, Nemours Cardiac Center at the Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States of America
| | - Andrew C Cook
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Adrian Crucean
- Congenital Heart Surgery, Birmingham Women's and Children's Foundation Trust Hospital, University of Birmingham, Birmingham, United Kingdom
| | - Lazaro E Hernandez
- Joe DiMaggio Children's Hospital Heart Institute, Hollywood, Florida, United States of America
| | - Rohit S Loomba
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois, United States of America
| | - Lindsay S Rogers
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Stephen P Sanders
- Cardiovascular Surgery, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Jill J Savla
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Elif Seda Selamet Tierney
- Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Justin T Tretter
- Department of Pediatrics, Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Lianyi Wang
- Heart Centre, First Hospital of Tsinghua University, Beijing, China
| | | | - Constantine Mavroudis
- Johns Hopkins University, Baltimore, Maryland, United States of America.,Peyton Manning Children's Hospital, Indianapolis, Indiana, United States of America
| | - Christo I Tchervenkov
- Division of Cardiovascular Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montréal, Québec, Canada
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Lopez L, Shuster Hyman H, Gasner A, Khan H, Marco E, Mouazz S, Kauffman A, Gallagher D, Gauthier-Fisher A, Librach C. Systemically administered human umbilical cord perivascular cells (HUCPVC) prevent tumor growth in a human melanoma tumor-bearing mouse model. Cytotherapy 2021. [DOI: 10.1016/s1465324921003509] [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: 11/25/2022]
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Al-Mousily MF, Lopez L, Muniz JC, Sasaki N, Seltzer I, Gruber J, Welch E. Aortic size in children: Systolic measurements are different from diastolic measurements. Ann Pediatr Cardiol 2021; 14:165-169. [PMID: 34103855 PMCID: PMC8174627 DOI: 10.4103/apc.apc_157_19] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 11/30/2020] [Accepted: 12/06/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Current guidelines recommended aortic measurements during diastole in adults and during systole in children. Recent studies in adults have demonstrated noteworthy differences in aortic measurements during systole and diastole in the same subjects. In the present study, we aimed to characterize systolic and diastolic differences in aortic measurements in healthy children. Materials and Methods : This retrospective study included 272 children who had a complete echocardiogram and no heart disease. Aortic measurements at the annulus (ANN), aortic root (AOR), sinotubular junction (STJ), and ascending aorta (AAO) were performed. Systolic and diastolic values were compared by calculating the mean systolic to diastolic (SD) percent difference for each segment; if the SD difference was >5%, it was considered clinically important. Similar measurements were conducted by another observer in 18% of the subjects. Results: Systolic measurements were larger than diastolic measurements with mean SD percent differences >5% (P < 0.001) for the AOR (7.3% ± 5.5%), STJ (10.24% ± 7.1%), and AAO (9.8% ± 7.4%). There was no clinically significant SD difference for the ANN. There was an excellent intraclass correlation coefficient between observers (0.982–0.995). Conclusions: Systolic measurements for the AOR, STJ, and AAO were larger than diastolic measurements. Normal reference values are utilized to design treatment for patients with abnormal aortic sizes, and the timing in the cardiovascular cycle used to decide the reference values should be equivalent to the timing used to make measurements in clinical practice. This is particularly imperative as patients transition their care from a pediatric to an adult cardiologist.
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Affiliation(s)
- Mohammad F Al-Mousily
- Department of Cardiology, Nicklaus Children's Hospital, Miami, FL, USA.,Department of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Leo Lopez
- Department of Cardiology, Nicklaus Children's Hospital, Miami, FL, USA.,Department of Pediatric Cardiology, Stanford, Palo Alto, CA, USA
| | - Juan Carlos Muniz
- Department of Cardiology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Nao Sasaki
- Department of Cardiology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Irwin Seltzer
- Department of Cardiology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Joshua Gruber
- Department of Cardiology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Elizabeth Welch
- Department of Cardiology, Nicklaus Children's Hospital, Miami, FL, USA
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Affiliation(s)
- Leo Lopez
- New York City Health + Hospitals, New York, New York
| | - Louis H Hart
- New York City Health + Hospitals, New York, New York
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Adamson GT, Houyel L, McElhinney DB, Maskatia SA, Ma M, Hanley FL, Lopez L. Unilateral Branch Pulmonary Artery Origin From a Solitary Arterial Trunk With Major Aortopulmonary Collaterals to the Contralateral Lung: Anatomic and Developmental Considerations. Semin Thorac Cardiovasc Surg 2021; 33:780-786. [DOI: 10.1053/j.semtcvs.2020.11.009] [Citation(s) in RCA: 3] [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] [Received: 10/05/2020] [Accepted: 11/05/2020] [Indexed: 11/11/2022]
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Lopez L, Frommelt PC, Colan SD, Trachtenberg FL, Gongwer R, Stylianou M, Bhat A, Burns KM, Cohen MS, Dragulescu A, Freud LR, Frommelt MA, Lytrivi ID, Mahgerefteh J, McCrindle BW, Pignatelli R, Prakash A, Sachdeva R, Soslow JH, Spurney C, Taylor CL, Thankavel PP, Thorsson T, Tretter JT, Young LT, LuAnn Minich L. Pediatric Heart Network Echocardiographic Z Scores: Comparison with Other Published Models. J Am Soc Echocardiogr 2020; 34:185-192. [PMID: 33189460 DOI: 10.1016/j.echo.2020.09.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 07/23/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Different methods have resulted in variable Z scores for echocardiographic measurements. Using the measurements from 3,215 healthy North American children in the Pediatric Heart Network (PHN) echocardiographic Z score database, the authors compared the PHN model with previously published Z score models. METHODS Z scores were derived for cardiovascular measurements using four models (PHN, Boston, Italy, and Detroit). Model comparisons were performed by evaluating (1) overlaid graphs of measurement versus body surface area with curves at Z = -2, 0, and +2; (2) scatterplots of PHN versus other Z scores with correlation coefficients; (3) Bland-Altman plots of PHN versus other Z scores; and (4) comparison of median Z scores for each model. RESULTS For most measurements, PHN Z score curves were similar to Boston and Italian curves but diverged from Detroit curves at high body surface areas. Correlation coefficients were high when comparing the PHN model with the others, highest with Boston (mean, 0.99) and lowest with Detroit (mean, 0.90). Scatterplots suggested systematic differences despite high correlations. Bland-Altman plots also revealed poor agreement at both extremes of size and a systematic bias for most when comparing PHN against Italian and Detroit Z scores. There were statistically significant differences when comparing median Z scores between the PHN and other models. CONCLUSIONS Z scores from the multicenter PHN model correlated well with previous single-center models, especially the Boston model, which also had a large sample size and similar methodology. The Detroit Z scores diverged from the PHN Z scores at high body surface area, possibly because there were more subjects in this category in the PHN database. Despite excellent correlation, significant differences in Z scores between the PHN model and others were seen for many measurements. This is important when comparing publications using different models and for clinical care, particularly when Z score thresholds are used to guide diagnosis and management.
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Affiliation(s)
- Leo Lopez
- Stanford University School of Medicine, Palo Alto, California.
| | | | | | | | | | - Mario Stylianou
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Aarti Bhat
- Seattle Children's Hospital, Seattle, Washington
| | - Kristin M Burns
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Meryl S Cohen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | | | | | | | | | - Carolyn L Taylor
- Medical University of South Carolina, Charleston, South Carolina
| | | | | | | | - Luciana T Young
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Zegri Reiriz I, Garcia-Coscuella D, Moreno T, Ortega R, Ruiz A, Mesado N, Aran F, Brossa V, Camprecios M, Lopez L, Roig E, Mirabet S. Urinary chlorine: a potential biomarker of diuretic resistant patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1208] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Natriuresis is gaining growing interest in identifying diuretic resistance (DR) patients. However, it has not been proved useful beyond the first day with intravenous (iv) furosemide. Moreover, data regarding urinary chlorine (uCl) or urinary potassium (uK) are scarce. We sought to assess the urine electrolyte pattern in acute heart failure (AHF) outpatients to identify those who will present DR.
Methods
Single-center prospective registry of outpatients with AHF who need iv furosemide. In visit 1 (V1), baseline spot urine sample was collected. Furosemide iv bolus plus intensification of oral diuretics were performed. In control visit (V2), baseline spot urine sample was collected and congestion data were evaluated. Urine electrolytes were assessed in relation to DR (defined as need of iv furosemide in V2 due to persistent congestion).
Results
From June to December 2019, 76 patients were included: median age of 75.5 years (68.2–82), glomerular filtration 40 ml/min/1.73m2 (29.2–59.2) and NT-proBNP 3340 ng/L (1296–7044).
In V1, DR patients showed higher levels of uK and lower uNa/uK than NDR (p=0.014 and p=0.007, respectively). In V2, after a median of 6 (6–15) days of intensified diuretic treatment, uNa and uCl dropped with adequate decongestion but not in DR patients (p=0.020 and p=0.001, respectively). Thus, DR patients showed in V2 higher uCl and similar uNa than NDR (table).
Conclusions
After several days of intensified diuretic treatment, uCl and uNa dropped during proper decongestion but not in DR patients, showing higher levels of uCl than NDR. Mantained levels of uCl could help to identify patients with persistent congestion.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | | | - T Moreno
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - R Ortega
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Ruiz
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - N Mesado
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - F Aran
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - V Brossa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Camprecios
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - L Lopez
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - E Roig
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - S Mirabet
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Castaneda-Palacio S, Martinez-Sanchez L, Lopez L, Villegas J, Herrera-Almanza L, Correa M, Cuartas-Agudelo Y, Cardona R, Mejía G, Lopera J. CHARACTERIZATION OF HODGKIN LYMPHOMA PATIENTS IN A HIGHLY COMPLEX HEALTH INSTITUTION IN THE MEDELLÍN - COLOMBIA. Hematol Transfus Cell Ther 2020. [DOI: 10.1016/j.htct.2020.10.343] [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: 11/29/2022] Open
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Sachdeva R, Valente AM, Armstrong AK, Cook SC, Han BK, Lopez L, Lui GK, Pickard SS, Powell AJ, Bhave NM, Sachdeva R, Valente AM, Pickard SS, Baffa JM, Banka P, Cohen SB, Glickstein JS, Kanter JP, Kanter RJ, Kim YY, Kipps AK, Latson LA, Lin JP, Parra DA, Rodriguez FH, Saarel EV, Srivastava S, Stephenson EA, Stout KK, Zaidi AN, Gluckman TJ, Aggarwal NR, Bhave NM, Dehmer GJ, Gilbert ON, Kumbhani DJ, Price AL, Winchester DE, Gulati M, Dehmer GJ, Doherty JU, Bhave NM, Daugherty SL, Dean LS, Desai MY, Gillam LD, Mehrotra P, Sachdeva R, Winchester DE. ACC/AHA/ASE/HRS/ISACHD/SCAI/SCCT/SCMR/SOPE 2020 Appropriate Use Criteria for Multimodality Imaging During the Follow-Up Care of Patients With Congenital Heart Disease: A Report of the American College of Cardiology Solution Set Oversight Committee and Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Pediatric Echocardiography. J Am Soc Echocardiogr 2020; 33:e1-e48. [PMID: 33010859 DOI: 10.1016/j.echo.2020.04.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The American College of Cardiology (ACC) collaborated with the American Heart Association, American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and the Society of Pediatric Echocardiography to develop Appropriate Use Criteria (AUC) for multimodality imaging during the follow-up care of patients with congenital heart disease (CHD). This is the first AUC to address cardiac imaging in adult and pediatric patients with established CHD. A number of common patient scenarios (also termed "indications") and associated assumptions and definitions were developed using guidelines, clinical trial data, and expert opinion in the field of CHD.1 The indications relate primarily to evaluation before and after cardiac surgery or catheter-based intervention, and they address routine surveillance as well as evaluation of new-onset signs or symptoms. The writing group developed 324 clinical indications, which they separated into 19 tables according to the type of cardiac lesion. Noninvasive cardiac imaging modalities that could potentially be used for these indications were incorporated into the tables, resulting in a total of 1,035 unique scenarios. These scenarios were presented to a separate, independent panel for rating, with each being scored on a scale of 1 to 9, with 1 to 3 categorized as "Rarely Appropriate," 4 to 6 as "May Be Appropriate," and 7 to 9 as "Appropriate." Forty-four percent of the scenarios were rated as Appropriate, 39% as May Be Appropriate, and 17% as Rarely Appropriate. This AUC document will provide guidance to clinicians in the care of patients with established CHD by identifying the reasonable imaging modality options available for evaluation and surveillance of such patients. It will also serve as an educational and quality improvement tool to identify patterns of care and reduce the number of Rarely Appropriate tests in clinical practice.
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Lopez L, Silvestri D, Ross JS. Transparency and Accountability of Medicaid Section 1115 Waiver Demonstration Programs Under the Affordable Care Act. JAMA Netw Open 2020; 3:e2022035. [PMID: 33104203 PMCID: PMC7588940 DOI: 10.1001/jamanetworkopen.2020.22035] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This cross-sectional study examines US states’ compliance with both Patient Protection and Affordable Care Act demonstration program annual reporting and Medicaid guidelines for Section 1115 experimental program evaluations.
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Affiliation(s)
- Leo Lopez
- National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - David Silvestri
- National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
- NYC Health + Hospitals, New York, New York
| | - Joseph S. Ross
- National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale–New Haven Health System, New Haven, Connecticut
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Abstract
This cross-sectional analysis of a national sample of nonprofit, acute care hospital organizations assesses how these organizations distribute spending for community-building activities among the 9 domains allowed by the Internal Revenue Service.
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Affiliation(s)
- Kevin Chen
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut
| | - Katherine L. Chen
- National Clinician Scholars Program, UCLA (University of California, Los Angeles), Los Angeles
| | - Leo Lopez
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut
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Russo A, Pavan N, Lopez L, Piechaud T, Hoepffner J, Roche J, Gaboardi F, Gaston R. Heart-shaped neobladder: analysis of perioperative, functional and oncological outcomes. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35626-3] [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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Brienen RJW, Caldwell L, Duchesne L, Voelker S, Barichivich J, Baliva M, Ceccantini G, Di Filippo A, Helama S, Locosselli GM, Lopez L, Piovesan G, Schöngart J, Villalba R, Gloor E. Forest carbon sink neutralized by pervasive growth-lifespan trade-offs. Nat Commun 2020; 11:4241. [PMID: 32901006 PMCID: PMC7479146 DOI: 10.1038/s41467-020-17966-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 07/27/2020] [Indexed: 11/09/2022] Open
Abstract
Land vegetation is currently taking up large amounts of atmospheric CO2, possibly due to tree growth stimulation. Extant models predict that this growth stimulation will continue to cause a net carbon uptake this century. However, there are indications that increased growth rates may shorten trees' lifespan and thus recent increases in forest carbon stocks may be transient due to lagged increases in mortality. Here we show that growth-lifespan trade-offs are indeed near universal, occurring across almost all species and climates. This trade-off is directly linked to faster growth reducing tree lifespan, and not due to covariance with climate or environment. Thus, current tree growth stimulation will, inevitably, result in a lagged increase in canopy tree mortality, as is indeed widely observed, and eventually neutralise carbon gains due to growth stimulation. Results from a strongly data-based forest simulator confirm these expectations. Extant Earth system model projections of global forest carbon sink persistence are likely too optimistic, increasing the need to curb greenhouse gas emissions.
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Affiliation(s)
- R J W Brienen
- School of Geography, University of Leeds, Leeds, LS2 9JT, UK.
| | - L Caldwell
- School of Geography, University of Leeds, Leeds, LS2 9JT, UK
| | - L Duchesne
- Ministère des Forêts, de la Faune et des Parcs, Direction de la recherche forestière, 2700 Einstein Street, Quebec, QC, G1P 3W8, Canada
| | - S Voelker
- Department of Environmental and Forest Biology, SUNY-ESF, Syracuse, New York, NY, 13210, USA
| | - J Barichivich
- Laboratoire des Sciences du Climat et de l'Environnement, IPSL, CNRS/CEA/UVSQ, 91191, Gif sur Yvette, France.,Instituto de Geografía, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - M Baliva
- Department of Agriculture and Forest Sciences (DAFNE), University of Tuscia, 01100, Viterbo, Via SC de Lellis, Italy
| | - G Ceccantini
- University of São Paulo, Institute of Biosciences, Department of Botany, Rua do Matão, 277, São Paulo, SP, 05508-090, Brazil
| | - A Di Filippo
- Department of Agriculture and Forest Sciences (DAFNE), University of Tuscia, 01100, Viterbo, Via SC de Lellis, Italy
| | - S Helama
- Natural Resources Institute Finland, Ounasjoentie 6, 96200, Rovaniemi, Finland
| | - G M Locosselli
- University of São Paulo, Institute of Biosciences, Department of Botany, Rua do Matão, 277, São Paulo, SP, 05508-090, Brazil
| | - L Lopez
- Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales (IANIGLA), CONICET-Mendoza, C.C. 330, (5500), Mendoza, Argentina
| | - G Piovesan
- Department of Agriculture and Forest Sciences (DAFNE), University of Tuscia, 01100, Viterbo, Via SC de Lellis, Italy
| | - J Schöngart
- Instituto Nacional de Pesquisas Da Amazônia (INPA), Coordenação de Dinâmica Ambiental (CODAM), Av. André Araújo 2936, 69067-375, Manaus, Brazil
| | - R Villalba
- Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales (IANIGLA), CONICET-Mendoza, C.C. 330, (5500), Mendoza, Argentina
| | - E Gloor
- School of Geography, University of Leeds, Leeds, LS2 9JT, UK
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Stern KWD, McCracken CE, Gillespie SE, Lang SM, Statile CJ, Lopez L, Verghese GR, Choueiter NF, Sachdeva R. Physician variation in ordering of transthoracic echocardiography in outpatient pediatric cardiac clinics. Echocardiography 2020; 37:1056-1064. [DOI: 10.1111/echo.14756] [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] [Received: 03/24/2020] [Revised: 05/06/2020] [Accepted: 05/19/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Kenan W. D. Stern
- Icahn School of Medicine at Mount Sinai Children’s Heart Center Kravis Children’s Hospital New York New York USA
| | | | - Scott E. Gillespie
- Department of Pediatrics Emory University School of Medicine Atlanta GeorgiaUSA
| | - Sean M. Lang
- The Heart Institute Cincinnati Children’s Hospital Medical Center University of Cincinnati College of Medicine Cincinnati Ohio USA
| | - Christopher J. Statile
- The Heart Institute Cincinnati Children’s Hospital Medical Center University of Cincinnati College of Medicine Cincinnati Ohio USA
| | - Leo Lopez
- Stanford School of Medicine Betty Irene Moore Children's Heart Center Lucile Packard Children’s Hospital Palo Alto California USA
| | - George R. Verghese
- Northwestern University Feinberg School of Medicine The Heart Center Ann & Robert H. Lurie Children’s Hospital of Chicago Chicago Illinois USA
| | - Nadine F. Choueiter
- Albert Einstein College of Medicine Pediatric Heart Center The Children’s Hospital at Montefiore Bronx New York USA
| | - Ritu Sachdeva
- Sibley Heart Center Cardiology Emory University School of Medicine Children's Healthcare of Atlanta Atlanta Georgia USA
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Pusztai A, Hamar A, Horváth Á, Végh E, Bodnár N, Kerekes G, Czókolyová M, Szamosi S, Bodoki L, Hodosi K, Domjan A, Nagy G, Szöllösi I, Lopez L, Matsuura E, Prohászka Z, Szántó S, Nagy Z, Shoenfeld Y, Szekanecz Z, Szücs G. THU0181 SOLUBLE VASCULAR BIOMARKERS IN RHEUMATOID ARTHRITIS AND ANKYLOSING SPONDYLITIS: EFFECTS OF ONE-YEAR ANTI-TNF-Α THERAPY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Background:Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) have been associated with inflammatory atherosclerosis, increased cardiovascular (CV) morbidity and mortality. Numerous proteins may serve as biomarkers of inflammatory atherosclerosis. The treatment of arthritis by tumour necrosis factor α (TNF-α) inhibitors may decrease the serum concentrations of these biomarkers.Objectives:In this study we wished to determine circulating levels of oxidized LDL (oxLDL) - β2 glycoprotein I (β2GPI) complexes (AtherOx), anti-hsp60 antibodies, soluble urokinase plasminogen activator receptor (sUPAR) and N-terminal B-type natriuretic peptide (NT-proBNP) in sera of RA and AS patients. We also wished to assess the effects of anti-TNF treatment on these biomarkers.Methods:Altogether 53 arthritis patients including 36 RA patients treated with either etanercept (ETN) or certolizumab pegol (CZP) and 17 AS patients treated with ETN were included in a 12-month follow-up study.Circulating oxLDL/β2gpI complexes, anti-human Hsp60 immunoglobulin G (IgG) levels and BNP8-29fragment levels were assessed by ELISA. suPAR levels were assessed by suPARnostic®Quick Triage test. All laboratory assessments were performed at baseline, as well as 6 and 12 months after treatment initiation. Results were associated with DAS28, BASDAI, CRP.Results:In the mixed cohort of 53 arthritis patients, the circulating levels of oxLDL/β2gpI significantly decreased after 12 months of anti-TNF therapy (0.20±0.11 U/ml) compared to baseline (0.24±0.10 U/ml; p=0.014). There was a tendency of non-significant decrease after 6 months (0.23±0.14 U/ml) versus baseline. Anti-Hsp60 antibody levels did not change after 6 months (158.6±138.6 AU/ml) and 12 months (167.3±143.3 AU/ml) compared to baseline (170.3±140.4 AU/ml). Among the patients, 21.2% had low, 36.4% “observe”, 9.1% high and 33.3% critical suPAR levels. suPAR levels showed a tendency of non-significant decrease after 6 months (11.3±17.7 ng/ml) and 12 months (10.3±15.3 ng/ml) versus baseline (11.5±16.4 ng/ml). However, when the four serum level categories described above were considered, suPAR concentrations exerted significant decrease in RA patients with critical suPAR levels (>9ng/ml) (p=0.04). Similarly, BNP fragment levels showed only a tendency of decrease after 6 months (518.2±422.4 pmol/l) and 12 months (484.1±418.2 pmol/l) versus baseline (530.8±441.8 pmol/l). However, serum BNP levels at baseline and after 12 months were significantly increased in CCP positive compared to CCP negative RA patients (baseline: 670.6±323.0 versus 138.0±436.4 pmol/l; p=0.030 and 12 months: 652.9±283.2 versus 456.5±423.1 pmol/l; p=0.021), as well as in RF positive compared to RF negative RA patients (baseline: 680.6±381.6 versus 292.9±198.3 pmol/l; p=0.007 and 12 months: 668.9±346.5 versus 312.2±207.0 pmol/l; p=0.001).Conclusion:One-year anti-TNF therapy significantly decreased circulating oxLDL/β2gpI complex levels. This therapy also decreased suPAR levels in patients with critically high suPAR. BNP fragment levels were associated with seropositivity in RA. These vascular biomarkers may reflect the effects of TNF inhibition on endothelial activation.Acknowledgments:This study was sponsored by an investigator-initiated grant from Pfizer.Disclosure of Interests:Anita Pusztai: None declared, Attila Hamar: None declared, Ágnes Horváth: None declared, Edit Végh: None declared, Nóra Bodnár: None declared, György Kerekes: None declared, Monika Czókolyová: None declared, Szilvia Szamosi: None declared, Levente Bodoki: None declared, Katalin Hodosi: None declared, Andrea Domjan: None declared, Gábor Nagy: None declared, Ibolya Szöllösi: None declared, Luis Lopez Employee of: Retired employee of Corgenix Inc., Eiji Matsuura: None declared, Zoltán Prohászka: None declared, Sándor Szántó: None declared, Zoltán Nagy: None declared, Yehuda Shoenfeld: None declared, Zoltán Szekanecz Grant/research support from: Pfizer, UCB, Consultant of: Sanofi, MSD, Abbvie, Pfizer, Roche, Novertis, Lilly, Gedeon Richter, Amgen, Gabriella Szücs: None declared
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Annavajjhala V, Valente AM, Lopez L, Sachdeva R, Glickstein JS, Natarajan SS, Buddhe S, Altmann K, Soriano BD, Colquitt JL, Altman CA, Sasaki N, Sakarovitch C, Tacy TA, Geva T, Selamet Tierney ES. Echocardiographic surveillance in children after tetralogy of Fallot repair: Adherence to guidelines? Int J Cardiol 2020; 307:31-35. [DOI: 10.1016/j.ijcard.2019.09.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/14/2019] [Accepted: 09/27/2019] [Indexed: 11/26/2022]
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Truong D, Lopez L, Frommelt PC, Stelter J, Ni B, Cohen MS, Prakash A, Colan SD, Spurney C, Soslow J, Pearson GD, Mahgerefteh J, Sachdeva R, Pignatelli R, Trachtenberg F, Stylianou M, Altmann K, Rathge KA, Camarda J, Chowdhury S, Dragulescu A, Frommelt M, Garuba O, Soriano B, Srivastava S, Thankavel P, van der Velde ME, Minich LL. Challenges and lessons learned from the Pediatric Heart Network Normal Echocardiogram Database study. Cardiol Young 2020; 30:456-461. [PMID: 32180543 PMCID: PMC7255408 DOI: 10.1017/s1047951120000438] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The Pediatric Heart Network Normal Echocardiogram Database Study had unanticipated challenges. We sought to describe these challenges and lessons learned to improve the design of future studies. METHODS Challenges were divided into three categories: enrolment, echocardiographic imaging, and protocol violations. Memoranda, Core Lab reports, and adjudication logs were reviewed. A centre-level questionnaire provided information regarding local processes for data collection. Descriptive statistics were used, and chi-square tests determined differences in imaging quality. RESULTS For the 19 participating centres, challenges with enrolment included variations in Institutional Review Board definitions of "retrospective" eligibility, overestimation of non-White participants, centre categorisation of Hispanic participants that differed from National Institutes of Health definitions, and exclusion of potential participants due to missing demographic data. Institutional Review Board amendments resolved many of these challenges. There was an unanticipated burden imposed on centres due to high numbers of echocardiograms that were reviewed but failed to meet submission criteria. Additionally, image transfer software malfunctions delayed Core Lab image review and feedback. Between the early and late study periods, the proportion of unacceptable echocardiograms submitted to the Core Lab decreased (14 versus 7%, p < 0.01). Most protocol violations were from eligibility violations and inadvertent protected health information disclosure (overall 2.5%). Adjudication committee reviews led to protocol changes. CONCLUSIONS Numerous challenges encountered during the Normal Echocardiogram Database Study prolonged study enrolment. The retrospective design and flaws in image transfer software were key impediments to study completion and should be considered when designing future studies collecting echocardiographic images as a primary outcome.
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Affiliation(s)
- Dongngan Truong
- University of Utah and Primary Children’s Hospital,
Salt Lake City, UT, USA
| | - Leo Lopez
- Stanford University, Palo Alto, CA, USA
| | | | | | - Brenda Ni
- New England Research Institutes, Watertown, MA, USA
| | - Meryl S. Cohen
- Children’s Hospital of Philadelphia, Philadelphia,
PA, USA
| | | | | | | | | | - Gail D. Pearson
- National Heart, Lung, and Blood Institute, NIH, Bethesda,
MD, USA
| | - Joseph Mahgerefteh
- Children’s Hospital at Montefiore, Albert Einstein
School of Medicine, New York City, NY, USA
| | - Ritu Sachdeva
- Emory University School of Medicine, Atlanta, GA,
USA
| | | | | | - Mario Stylianou
- National Heart, Lung, and Blood Institute, NIH, Bethesda,
MD, USA
| | - Karen Altmann
- Columbia University Medical Center, New York City, NY,
USA
| | | | - Joseph Camarda
- Ann and Robert H. Lurie Children’s Hospital,
Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Olukayode Garuba
- Texas Children’s Hospital/Baylor College of
Medicine, Houston, TX, USA
| | - Brian Soriano
- Seattle Children’s Heart Center, University of
Washington School of Medicine, Seattle, WA, USA
| | | | | | - Mary E. van der Velde
- Congenital Heart Center, C.S. Mott Children’s
Hospital, University of Michigan, Ann Arbor, MI, USA
| | - L. LuAnn Minich
- University of Utah and Primary Children’s Hospital,
Salt Lake City, UT, USA
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VIZCARRA A, Hermida O, Iturrez S, Labombarda J, Simon M, Lopez L, Sosa R, Ojeda M, Villalva C, Torrens A. SUN-251 90% of Arterio Venous Fistula Autologous, Transposition brachiobasilic. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.786] [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: 10/24/2022] Open
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31
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Frommelt P, Lopez L, Dimas VV, Eidem B, Han BK, Ko HH, Lorber R, Nii M, Printz B, Srivastava S, Valente AM, Cohen MS. Recommendations for Multimodality Assessment of Congenital Coronary Anomalies: A Guide from the American Society of Echocardiography: Developed in Collaboration with the Society for Cardiovascular Angiography and Interventions, Japanese Society of Echocardiography, and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2020; 33:259-294. [PMID: 32143778 DOI: 10.1016/j.echo.2019.10.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Peter Frommelt
- Children's Hospital of Wisconsin and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Leo Lopez
- Stanford University, Palo Alto, California
| | | | | | - B Kelly Han
- Children's Minnesota and the Minneapolis Heart Institute, Minneapolis, Minnesota
| | - H Helen Ko
- Kravis Children's Hospital, Mount Sinai Medical Center, New York, New York
| | - Richard Lorber
- Baylor College of Medicine, Children's Hospital of San Antonio, San Antonio, Texas
| | - Masaki Nii
- Shizuoka Children's Hospital, Shizuoka, Shizuoka, Japan
| | - Beth Printz
- University of California San Diego and Rady Children's Hospital, San Diego, California
| | | | - Anne Marie Valente
- Boston Children's Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Meryl S Cohen
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Sachdeva R, Valente AM, Armstrong AK, Cook SC, Han BK, Lopez L, Lui GK, Pickard SS, Powell AJ, Bhave NM, Sachdeva R, Valente AM, Pickard SS, Baffa JM, Banka P, Cohen SB, Glickstein JS, Kanter JP, Kanter RJ, Kim YY, Kipps AK, Latson LA, Lin JP, Parra DA, Rodriguez FH, Saarel EV, Srivastava S, Stephenson EA, Stout KK, Zaidi AN. ACC/AHA/ASE/HRS/ISACHD/SCAI/SCCT/SCMR/SOPE 2020 Appropriate Use Criteria for Multimodality Imaging During the Follow-Up Care of Patients With Congenital Heart Disease: A Report of the American College of Cardiology Solution Set Oversight Committee and Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Pediatric Echocardiography. J Am Coll Cardiol 2020; 75:657-703. [PMID: 31918898 DOI: 10.1016/j.jacc.2019.10.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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33
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Frommelt PC, Minich LL, Trachtenberg FL, Altmann K, Camarda J, Cohen MS, Colan SD, Dragulescu A, Frommelt MA, Johnson TR, Kovalchin JP, Lin L, Mahgerefteh J, Nutting A, Parra DA, Pearson GD, Pignatelli R, Sachdeva R, Soriano BD, Spurney C, Srivastava S, Statile CJ, Stelter J, Stylianou M, Thankavel PP, Tierney ES, van der Velde ME, Lopez L. Challenges With Left Ventricular Functional Parameters: The Pediatric Heart Network Normal Echocardiogram Database. J Am Soc Echocardiogr 2019; 32:1331-1338.e1. [PMID: 31351792 DOI: 10.1016/j.echo.2019.05.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 02/06/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The reliability of left ventricular (LV) systolic functional indices calculated from blinded echocardiographic measurements of LV size has not been tested in a large cohort of healthy children. The objective of this study was to estimate interobserver variability in standard measurements of LV size and systolic function in children with normal cardiac anatomy and qualitatively normal function. METHODS The Pediatric Heart Network Normal Echocardiogram Database collected normal echocardiograms from healthy children ≤18 years old distributed equally by age, gender, and race. A core lab used two-dimensional echocardiograms to measure LV dimensions from which a separate data coordinating center calculated LV volumes and systolic functional indices. To evaluate interobserver variability, two independent expert pediatric echocardiographic observers remeasured LV dimensions on a subset of studies, while blinded to calculated volumes and functional indices. RESULTS Of 3,215 subjects with measurable images, 552 (17%) had a calculated LV shortening fraction (SF) < 25% and/or LV ejection fraction (EF) < 50%; the subjects were significantly younger and smaller than those with normal values. When the core lab and independent observer measurements were compared, individual LV size parameter intraclass correlation coefficients were high (0.81-0.99), indicating high reproducibility. The intraclass correlation coefficients were lower for SF (0.24) and EF (0.56). Comparing reviewers, 40/56 (71%) of those with an abnormal SF and 36/104 (35%) of those with a normal SF based on core lab measurements were calculated as abnormal from at least one independent observer. In contrast, an abnormal EF was less commonly calculated from the independent observers' repeat measures; only 9/47 (19%) of those with an abnormal EF and 8/113 (7%) of those with a normal EF based on core lab measurements were calculated as abnormal by at least one independent observer. CONCLUSIONS Although blinded measurements of LV size show good reproducibility in healthy children, subsequently calculated LV functional indices reveal significant variability despite qualitatively normal systolic function. This suggests that, in clinical practice, abnormal SF/EF values may result in repeat measures of LV size to match the subjective assessment of function. Abnormal LV functional indices were more prevalent in younger, smaller children.
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Affiliation(s)
| | | | | | - Karen Altmann
- Columbia University Medical Center, New York, New York
| | | | - Meryl S Cohen
- Children's Hospital of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | | | - Lina Lin
- New England Research Institute, Boston, Massachusetts
| | | | - Arni Nutting
- Medical University of South Carolina, Charleston, South Carolina
| | - David A Parra
- Vanderbilt Medical Center (D.A.P.), Nashville, Tennessee
| | - Gail D Pearson
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Ritu Sachdeva
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | | | - Mario Stylianou
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | | | | | - Leo Lopez
- Stanford University, Palo Alto, California
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Lopez L, Colan SD. How Well Does the Neonatal Heart Measure Up? J Am Soc Echocardiogr 2019; 32:906-908. [DOI: 10.1016/j.echo.2019.04.423] [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] [Received: 04/30/2019] [Revised: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 11/17/2022]
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Douglas PS, Carabello BA, Lang RM, Lopez L, Pellikka PA, Picard MH, Thomas JD, Varghese P, Wang TY, Weissman NJ, Wilgus R. 2019 ACC/AHA/ASE Key Data Elements and Definitions for Transthoracic Echocardiography: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Cardiovascular Endpoints Data Standards) and the American Society of Echocardiography. Circ Cardiovasc Imaging 2019; 12:e000027. [PMID: 31233331 DOI: 10.1161/hci.0000000000000027] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mirabet S, Brossa V, Vanrell C, Lopez L, Roig E. Cervical Abnormalities and Gynecological Neoplasms in Heart Transplanted Recipients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.997] [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: 11/24/2022] Open
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Gonyea J, O’Donnell A, Mitchell S, Lopez L. RELIGIOSITY, RELIGIOUS COPING AND THE PSYCHOLOGICAL WELL-BEING OF LATINO CAREGIVERS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1477] [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: 11/13/2022] Open
Affiliation(s)
- J Gonyea
- Boston University School of Social Work
| | | | | | - L Lopez
- Boston University School of Social Work
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Silberbach M, Roos-Hesselink JW, Andersen NH, Braverman AC, Brown N, Collins RT, De Backer J, Eagle KA, Hiratzka LF, Johnson WH, Kadian-Dodov D, Lopez L, Mortensen KH, Prakash SK, Ratchford EV, Saidi A, van Hagen I, Young LT. Cardiovascular Health in Turner Syndrome: A Scientific Statement From the American Heart Association. Circ: Genomic and Precision Medicine 2018; 11:e000048. [DOI: 10.1161/hcg.0000000000000048] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Mortensen KH, Young L, De Backer J, Silberbach M, Collins RT, Duijnhouwer AL, Pandya B, Gravholt CH, Lopez L, Roos-Hesselink JW. Cardiovascular imaging in Turner syndrome: state-of-the-art practice across the lifespan. Heart 2018; 104:1823-1831. [DOI: 10.1136/heartjnl-2017-312658] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/29/2018] [Accepted: 06/29/2018] [Indexed: 01/15/2023] Open
Abstract
Cardiovascular imaging is essential to providing excellent clinical care for girls and women with Turner syndrome (TS). Congenital and acquired cardiovascular diseases are leading causes of the lifelong increased risk of premature death in TS. Non-invasive cardiovascular imaging is crucial for timely diagnosis and treatment planning, and a systematic and targeted imaging approach should combine echocardiography, cardiovascular magnetic resonance and, in select cases, cardiac CT. In recent decades, evidence has mounted for the need to perform cardiovascular imaging in all females with TS irrespective of karyotype and phenotype. This is due to the high incidence of outcome-determining lesions that often remain subclinical and occur in patterns specific to TS. This review provides an overview of state-of-the-art cardiovascular imaging practice in TS, by means of a review of the most recent literature, in the context of a recent consensus statement that has highlighted the role of cardiovascular diseases in these females.
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Lopez L, Zohni K, Garcia M, Filice M, Szaraz P, Baram S, Glass K, Gauthier-Fisher A, Librach C. Intra-gonadal delivery of first trimester human umbilical cord perivascular cells (FTM HUCPVC) prior to chemotherapy has a protective effect in rodent models of alkylating agent-induced testicular and ovarian damage. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.1047] [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: 11/29/2022]
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Diaz-Riera E, Lopez L, Garcia-Arguinzonis M, Badimon L, Garcia-Moll X, Padro T. 4938Differential urine proteomic signature in early phase of renal insufficiency in patients with acute heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.4938] [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: 11/13/2022] Open
Affiliation(s)
- E Diaz-Riera
- Hospital de la Santa Creu i Sant Pau, Program ICCC Cardiovascular Sciences - IIB Sant Pau, Barcelona, Spain
| | - L Lopez
- Hospital de la Santa Creu i Sant Pau, Department of Cardiology, Barcelona, Spain
| | - M Garcia-Arguinzonis
- Hospital de la Santa Creu i Sant Pau, Program ICCC Cardiovascular Sciences - IIB Sant Pau, Barcelona, Spain
| | - L Badimon
- Hospital de la Santa Creu i Sant Pau, Program ICCC Cardiovascular Sciences, IIB-SantPau, UAB, CiberCV, Barcelona, Spain
| | - X Garcia-Moll
- Hospital de la Santa Creu i Sant Pau, Department of Cardiology, CiberCV, Barcelona, Spain
| | - T Padro
- Hospital de la Santa Creu i Sant Pau, Program ICCC Cardiovascular Sciences, IIB-Sant Pau, CiberCV, Barcelona, Spain
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Lopez L, Dier K, Vasudevan A, Bottiglieri T, McCullough P. Association of urinary 11-dehydro-thromboxane B2 and F2-isoprostanes with mortality in aspirin-treated stable coronary artery disease patients. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.242] [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: 10/28/2022]
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Ames P, Di Girolamo G, D'Andrea G, Iannaccone L, Lopez L, Margaglione M. The oxidized low-density lipoprotein/b2-glycoprotein I complex in rtherothrombosis. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.656] [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: 10/28/2022]
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Papadopoulos I, Zorba A, Koulouglioti C, Ali S, Aagard M, Akman O, Alpers LM, Apostolara P, Biles J, Martín-García Á, González-Gil T, Kouta C, Krepinska R, Kumar BN, Lesińska-Sawicka M, Lopez L, Malliarou M, Nagórska M, Nissim S, Nortvedt L, Oter-Quintana C, Ozturk C, Pangilinan SB, Papp K, Eldar Regev O, Rubiano FO, Tolentino Diaz MY, Tóthová V, Vasiliou M. International study on nurses' views and experiences of compassion. Int Nurs Rev 2018; 63:395-405. [PMID: 27557745 DOI: 10.1111/inr.12298] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 12/01/2022]
Abstract
BACKGROUND Compassion is considered the cornerstone of nursing practice. However, the recent failures in delivering high-quality compassionate nursing care in the UK's National Health Service have brought the topic of compassion to the attention of the public, service providers, policy makers and academics. AIM The aim of this study was to explore the nurses' views and experiences of a number of compassion-related issues in nursing and describe similarities and differences at an international level as well as from the different nursing roles of the participating nurses. METHODS An exploratory, cross-sectional descriptive study, using the International Online Compassion Questionnaire. A total of 1323 nurses from 15 countries completed the questionnaire. RESULTS The majority of participants (59.5%) defined compassion as "Deep awareness of the suffering of others and wish to alleviate it" but definitions of compassion varied by country. Of participants, 69.6% thought compassion was very important in nursing and more than half (59.6%) of them argued that compassion could be taught. However, only 26.8% reported that the correct amount and level of teaching is provided. The majority of the participants (82.6%) stated that their patients prefer knowledgeable nurses with good interpersonal skills. Only 4.3% noted that they are receiving compassion from their managers. A significant relationship was found between nurses' experiences of compassion and their views about teaching of compassion. CONCLUSION Our study is unique in identifying the views and experiences of nurses from 15 different countries worldwide. The findings reveal that compassion is neither addressed adequately in nursing education nor supported in the practice environment by managers. LIMITATIONS Self-report bias was inherent to our survey study design. Furthermore, the individual cultural differences and similarities in the findings are difficult to extrapolate owing to the fact that our analysis was at country level, as well as at the level of the participating nurses. IMPLICATIONS FOR NURSING POLICY Understanding the influence of culture on nurses' views about compassion is critical in the current multicultural healthcare environment and merits further research. This will potentially drive changes in nursing education (ensuring that compassion is taught to nurses) and in the way healthcare leaders and managers foster a compassionate culture within their organizations (e.g. by leading by example and compassionate to their staff).
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Affiliation(s)
- I Papadopoulos
- Research Centre for Transcultural Studies in Health, Middlesex University, London, UK
| | - A Zorba
- Middlesex University, London, UK
| | - C Koulouglioti
- Research and Innovation Department, Western Sussex Hospitals NHS Foundation Trust, Worthing, UK
| | - S Ali
- Research Centre for Transcultural Studies in Health, Middlesex University, London, UK
| | - M Aagard
- Walden University, Minneapolis, MN, USA
| | - O Akman
- Istanbul Sabahattin Zaim University, Istanbul, Turkey
| | - L-M Alpers
- Lovisenberg Diaconal Hospital/Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - P Apostolara
- National and Kapodistrian Univeristy of Athens, Athens, Greece
| | - J Biles
- Charles Sturt University, Abury, NSW, Australia
| | - Á Martín-García
- Centro de San Blas, Servicio Madrileño de Salud, Madrid, Spain
| | - T González-Gil
- Nursing Section Department, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - C Kouta
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
| | - R Krepinska
- School of Nursing, Havlíčkův Brod, Czech Republic
| | - B N Kumar
- Norwegian Centre for Minority Health Research, Oslo University Hospital, Oslo, Norway
| | | | - L Lopez
- Universidad Nacional de Colombia - Bogotá - Facultad de Enfermería., Colombia
| | - M Malliarou
- Technological Institution of Thessaly, Larisa, Greece
| | | | - S Nissim
- Wolfson Academic Nursing School, Tel Aviv University, Tel Aviv, Israel
| | - L Nortvedt
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - C Oter-Quintana
- Nursing Section Department, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - C Ozturk
- Istanbul Sabahattin Zaim University, Istanbul, Turkey
| | | | - K Papp
- Faculty of Health, University of Debrecen, Debrecen, Hungary
| | - O Eldar Regev
- The Max Stern Yezreel Valley College, Yezreel Valley, Israel
| | - F O Rubiano
- Bataan Peninsula State University, Balanga, Philippines
| | | | - V Tóthová
- Faculty of Health and Social Studies, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - M Vasiliou
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
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Stern KWD, Gulesserian T, Choi J, Lang SM, Statile CJ, Michelfelder EC, McLaughlin ES, Nguyen T, Lopez L, Verghese GR, Hsu DT, Sachdeva R. Factors Influencing Pediatric Outpatient Transthoracic Echocardiography Utilization Before Appropriate Use Criteria Release: A Multicenter Study. J Am Soc Echocardiogr 2017; 30:1225-1233. [PMID: 29202952 DOI: 10.1016/j.echo.2017.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 06/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although pediatric appropriate use criteria (AUC) for outpatient transthoracic echocardiography (TTE) are available, little is known about TTE utilization patterns before their release. The aims of this study were to determine the relation between AUC and TTE utilization and to identify patient and physician factors associated with discordance between the AUC and clinical practice. METHODS A retrospective review of 3,000 initial outpatient pediatric cardiology encounters at six centers was performed. Investigator-determined indications were classified using AUC definitions. Concordance between AUC and TTE utilization was determined. Multivariate analysis was performed to identify patient and physician factors associated with TTE's being performed for rarely appropriate and TTE's not being performed for appropriate indications. RESULTS Concordance between AUC and TTE utilization was 88%. TTE was performed for rarely appropriate indications in 9% and was associated with patient age < 3 months, indications of murmur, noninvasive imaging physician subspecialty, and physician volume. No TTE was ordered for appropriate indications in 3% and was associated with indications including prior test result (primarily abnormal electrocardiographic findings), older patients, and physician subspecialty other than generalist or imaging. There was high variability in TTE utilization among centers. CONCLUSIONS There was a reasonable degree of concordance between AUC and clinical practice before AUC publication. Several patient and physician factors were associated with discordance with the AUC. These findings should be considered in efforts to disseminate the AUC and in the development of future iterations. The causes for variation among centers deserve further exploration.
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Affiliation(s)
- Kenan W D Stern
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, New York.
| | - Talin Gulesserian
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, New York
| | - Jaeun Choi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Sean M Lang
- Pediatric Cardiology Section, Arkansas Children's Hospital, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas
| | - Christopher J Statile
- Cincinnati Children's Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Erik C Michelfelder
- Cincinnati Children's Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ericka S McLaughlin
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine and Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Tuan Nguyen
- Division of Pediatric Cardiology, Nicklaus Children's Hospital, Florida International University College of Medicine, Miami, Florida
| | - Leo Lopez
- Division of Pediatric Cardiology, Nicklaus Children's Hospital, Florida International University College of Medicine, Miami, Florida
| | - George R Verghese
- Section of Pediatric Cardiology, Brenner Children's Hospital, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Daphne T Hsu
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, New York
| | - Ritu Sachdeva
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine and Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia
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Lopez L, Colan S, Stylianou M, Granger S, Trachtenberg F, Frommelt P, Pearson G, Camarda J, Cnota J, Cohen M, Dragulescu A, Frommelt M, Garuba O, Johnson T, Lai W, Mahgerefteh J, Pignatelli R, Prakash A, Sachdeva R, Soriano B, Soslow J, Spurney C, Srivastava S, Taylor C, Thankavel P, van der Velde M, Minich L. Relationship of Echocardiographic Z Scores Adjusted for Body Surface Area to Age, Sex, Race, and Ethnicity: The Pediatric Heart Network Normal Echocardiogram Database. Circ Cardiovasc Imaging 2017; 10:e006979. [PMID: 29138232 PMCID: PMC5812349 DOI: 10.1161/circimaging.117.006979] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/19/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Published nomograms of pediatric echocardiographic measurements are limited by insufficient sample size to assess the effects of age, sex, race, and ethnicity. Variable methodologies have resulted in a wide range of Z scores for a single measurement. This multicenter study sought to determine Z scores for common measurements adjusted for body surface area (BSA) and stratified by age, sex, race, and ethnicity. METHODS AND RESULTS Data collected from healthy nonobese children ≤18 years of age at 19 centers with a normal echocardiogram included age, sex, race, ethnicity, height, weight, echocardiographic images, and measurements performed at the Core Laboratory. Z score models involved indexed parameters (X/BSAα) that were normally distributed without residual dependence on BSA. The models were tested for the effects of age, sex, race, and ethnicity. Raw measurements from models with and without these effects were compared, and <5% difference was considered clinically insignificant because interobserver variability for echocardiographic measurements are reported as ≥5% difference. Of the 3566 subjects, 90% had measurable images. Appropriate BSA transformations (BSAα) were selected for each measurement. Multivariable regression revealed statistically significant effects by age, sex, race, and ethnicity for all outcomes, but all effects were clinically insignificant based on comparisons of models with and without the effects, resulting in Z scores independent of age, sex, race, and ethnicity for each measurement. CONCLUSIONS Echocardiographic Z scores based on BSA were derived from a large, diverse, and healthy North American population. Age, sex, race, and ethnicity have small effects on the Z scores that are statistically significant but not clinically important.
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Affiliation(s)
- Leo Lopez
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.).
| | - Steven Colan
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Mario Stylianou
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Suzanne Granger
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Felicia Trachtenberg
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Peter Frommelt
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Gail Pearson
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Joseph Camarda
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - James Cnota
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Meryl Cohen
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Andreea Dragulescu
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Michele Frommelt
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Olukayode Garuba
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Tiffanie Johnson
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Wyman Lai
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Joseph Mahgerefteh
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Ricardo Pignatelli
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Ashwin Prakash
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Ritu Sachdeva
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Brian Soriano
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Jonathan Soslow
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Christopher Spurney
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Shubhika Srivastava
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Carolyn Taylor
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Poonam Thankavel
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - Mary van der Velde
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
| | - LuAnn Minich
- From the Nicklaus Children's Hospital, Miami, FL (L.L.); Boston Children's Hospital, MA (S.C., A.P.); National Heart, Lung, and Blood Institute, Bethesda, MD (M.S., G.P.); New England Research Institutes, Watertown, MA (S.G., F.T.); Children's Hospital of Wisconsin, Milwaukee (P.F., M.F.); Ann & Robert Lurie Children's Hospital, Chicago, IL (J. Camarda); Cincinnati Children's Hospital Medical Center, OH (J. Cnota); Children's Hospital of Philadelphia, PA (M.C.); Hospital for Sick Children, Toronto, ON, Canada (A.D.); Texas Children's Hospital, Houston (O.G., R.P.); Riley Hospital for Children at Indiana University Health, Indianapolis (T.J.); Children's Hospital of Orange County, CA (W.L.); Children's Hospital at Montefiore, Bronx, NY (J.M.); Children's Healthcare of Atlanta, GA (R.S.); Seattle Children's Hospital, WA (B.S.); Vanderbilt University Medical Center, Nashville, TN (J.S.); Children's National Health System, Washington, DC (C.S.); Mount Sinai Medical Center, New York, NY (S.S.); Medical University of South Carolina, Charleston (C.T.); Children's Health Dallas, TX (P.T.); CS Mott Children's Hospital, Ann Arbor, MI (M.v.d.V.); and University of Utah, Salt Lake City (L.M.)
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Sachdeva R, Kelleman MS, McCracken CE, Campbell RM, Lai WW, Lopez L, Stern KW, Welch E, Douglas PS. Physician Attitudes toward the First Pediatric Appropriate Use Criteria and Engagement With Educational Intervention to Improve the Appropriateness of Outpatient Echocardiography. J Am Soc Echocardiogr 2017; 30:926-931.e2. [DOI: 10.1016/j.echo.2017.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Indexed: 01/12/2023]
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Boris JR, Béland MJ, Bergensen LJ, Colan SD, Dangel J, Daniels CJ, Davis C, Everett AD, Franklin R, Gaynor JW, Gray DT, Hirsch-Romano JC, Jacobs JP, Jacobs M, Jeffries H, Krogmann ON, Lomotan EA, Lopez L, Marelli A, Martin GR, Matherne GP, Mavroudis C, McCardle K, Pearson GD, Rosenthal G, Scott JS, Serwer GA, Seslar SS, Shaddy R, Slesnick T, Vener DF, Walters HL, Weinberg PM. 2017 AHA/ACC Key Data Elements and Definitions for Ambulatory Electronic Health Records in Pediatric and Congenital Cardiology: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards. Circ Cardiovasc Qual Outcomes 2017; 10:HCQ.0000000000000027. [DOI: 10.1161/hcq.0000000000000027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/16/2022]
Affiliation(s)
| | - Marie J. Béland
- Together with the National Association of Children’s Hospitals, these organizations have merged and now comprise the Children’s Hospital Association . International Society for Nomenclature of Paediatric and Congenital Heart Disease Representative. Child Health Corporation of America Representative. Association of European Pediatric Cardiologists Representative. The Society of Thoracic Surgeons Representative. ACC/AHA Task Force on Clinical Data Standards Liaison to the Writing Committee
| | | | - Steven D. Colan
- Together with the National Association of Children’s Hospitals, these organizations have merged and now comprise the Children’s Hospital Association . International Society for Nomenclature of Paediatric and Congenital Heart Disease Representative. Child Health Corporation of America Representative. Association of European Pediatric Cardiologists Representative. The Society of Thoracic Surgeons Representative. ACC/AHA Task Force on Clinical Data Standards Liaison to the Writing Committee
| | | | | | | | | | - Rodney Franklin
- Together with the National Association of Children’s Hospitals, these organizations have merged and now comprise the Children’s Hospital Association . International Society for Nomenclature of Paediatric and Congenital Heart Disease Representative. Child Health Corporation of America Representative. Association of European Pediatric Cardiologists Representative. The Society of Thoracic Surgeons Representative. ACC/AHA Task Force on Clinical Data Standards Liaison to the Writing Committee
| | | | | | - Jennifer C. Hirsch-Romano
- Together with the National Association of Children’s Hospitals, these organizations have merged and now comprise the Children’s Hospital Association . International Society for Nomenclature of Paediatric and Congenital Heart Disease Representative. Child Health Corporation of America Representative. Association of European Pediatric Cardiologists Representative. The Society of Thoracic Surgeons Representative. ACC/AHA Task Force on Clinical Data Standards Liaison to the Writing Committee
| | - Jeffrey P. Jacobs
- Together with the National Association of Children’s Hospitals, these organizations have merged and now comprise the Children’s Hospital Association . International Society for Nomenclature of Paediatric and Congenital Heart Disease Representative. Child Health Corporation of America Representative. Association of European Pediatric Cardiologists Representative. The Society of Thoracic Surgeons Representative. ACC/AHA Task Force on Clinical Data Standards Liaison to the Writing Committee
| | - Marshall Jacobs
- Together with the National Association of Children’s Hospitals, these organizations have merged and now comprise the Children’s Hospital Association . International Society for Nomenclature of Paediatric and Congenital Heart Disease Representative. Child Health Corporation of America Representative. Association of European Pediatric Cardiologists Representative. The Society of Thoracic Surgeons Representative. ACC/AHA Task Force on Clinical Data Standards Liaison to the Writing Committee
| | - Howard Jeffries
- Together with the National Association of Children’s Hospitals, these organizations have merged and now comprise the Children’s Hospital Association . International Society for Nomenclature of Paediatric and Congenital Heart Disease Representative. Child Health Corporation of America Representative. Association of European Pediatric Cardiologists Representative. The Society of Thoracic Surgeons Representative. ACC/AHA Task Force on Clinical Data Standards Liaison to the Writing Committee
| | | | | | | | | | | | | | | | | | | | | | | | - Gerald A. Serwer
- Together with the National Association of Children’s Hospitals, these organizations have merged and now comprise the Children’s Hospital Association . International Society for Nomenclature of Paediatric and Congenital Heart Disease Representative. Child Health Corporation of America Representative. Association of European Pediatric Cardiologists Representative. The Society of Thoracic Surgeons Representative. ACC/AHA Task Force on Clinical Data Standards Liaison to the Writing Committee
| | | | | | | | - David F. Vener
- Together with the National Association of Children’s Hospitals, these organizations have merged and now comprise the Children’s Hospital Association . International Society for Nomenclature of Paediatric and Congenital Heart Disease Representative. Child Health Corporation of America Representative. Association of European Pediatric Cardiologists Representative. The Society of Thoracic Surgeons Representative. ACC/AHA Task Force on Clinical Data Standards Liaison to the Writing Committee
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Sole Gonzalez E, Capellades-Olivella H, Mirabet S, Brossa V, Lopez L, Sionis A, Rivas-Lasarte M, Alvarez-Garcia J, Pirla-Buxo M, Mesado-Batalla N, Gomis-Pastor M, Rivilla M, Tauron M, Roig E. P3378Is sidenafil treatment associated with higher rate of vasoplegia after heart transplantation? Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3378] [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: 11/12/2022] Open
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Palau Sampio P, Dominguez Mafe E, Lopez L, Ramon Ferrandis J, Gonzalez J, Heredia R, Santas Olmeda E, Melero Lloret J, Navarro Bellver A, Chorro Gasco F, Sanchis Fores J, Nunez Villota E. P4399Inspiratory muscle training and functional electrical stimulation in heart failure with preserved ejection fraction: results from a randomized clinical trial. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4399] [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: 11/12/2022] Open
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