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Chogle A, El-Chammas K, Santucci N, Grimm M, Dorfman L, Graham K, Kelly DR, Dranove JE, Rosen R, Nurko S, Croffie J, Balakrishnan K, Chiou EH, Zhang L, Simpson P, Karrento K. A multicenter registry study on percutaneous electrical nerve field stimulation for pediatric disorders of gut-brain interaction. J Pediatr Gastroenterol Nutr 2024; 78:817-826. [PMID: 38451058 DOI: 10.1002/jpn3.12174] [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: 08/02/2023] [Revised: 01/02/2024] [Accepted: 02/03/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Percutaneous electrical nerve field stimulation (PENFS) has demonstrated promise in single-center trials for pediatric abdominal pain-related disorders of gut-brain interaction (DGBI). Our aim was to explore efficacy of PENFS as standard therapy for DGBI in a registry involving multiple pediatric gastroenterology referral centers. METHODS This was a multicenter, prospective open-label registry of children (8-18 years) undergoing PENFS for DGBI at seven tertiary care gastroenterology clinics. DGBI subtypes were classified by Rome IV criteria. Parents and patients completed Abdominal Pain Index (API), Nausea Severity Scale (NSS), and Functional Disability Inventory (FDI) questionnaires before, during therapy and at follow-up visits up to 1 year later. RESULTS A total of 292 subjects were included. Majority (74%) were female with median (interquartile range [IQR]) age 16.3 (14.0, 17.7) years. Most (68%) met criteria for functional dyspepsia and 61% had failed ≥4 pharmacologic therapies. API, NSS, and FDI scores showed significant declines within 3 weeks of therapy, persisting long-term in a subset. Baseline (n = 288) median (IQR) child-reported API scores decreased from 2.68 (1.84, 3.58) to 1.99 (1.13, 3.27) at 3 weeks (p < 0.001) and 1.81 (0.85, 3.20) at 3 months (n = 75; p < 0.001). NSS scores similarly improved from baseline, persisting at three (n = 74; p < 0.001) and 6 months later (n = 55; p < 0.001). FDI scores displayed similar reductions at 3 months (n = 76; p = 0.01) but not beyond. Parent-reported scores were consistent with child reports. CONCLUSIONS This large, comprehensive, multicenter registry highlights efficacy of PENFS for gastrointestinal symptoms and functionality for pediatric DGBI.
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Affiliation(s)
- Ashish Chogle
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Orange County, Orange, California, USA
| | - Khalil El-Chammas
- Department of Pediatrics, Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Neha Santucci
- Department of Pediatrics, Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Monica Grimm
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition & Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lev Dorfman
- Department of Pediatrics, Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kahleb Graham
- Department of Pediatrics, Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Daniel R Kelly
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Atrium Health Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Jason E Dranove
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Atrium Health Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Rachel Rosen
- Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Joseph Croffie
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology & Nutrition, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Keshawadhana Balakrishnan
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Eric H Chiou
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Liyun Zhang
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition & Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pippa Simpson
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition & Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katja Karrento
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition & Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Hidestrand P, Svensson B, Simpson P, Liuba P, Weismann CG. Impact of Underweight, Overweight, and Obesity on Health-Related Quality of Life in Children with Tetralogy of Fallot Variants. Pediatr Cardiol 2024:10.1007/s00246-024-03416-w. [PMID: 38506963 DOI: 10.1007/s00246-024-03416-w] [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: 10/25/2023] [Accepted: 01/10/2024] [Indexed: 03/22/2024]
Abstract
Traditional cardiovascular risk factors put patients with congenital heart disease (CHD) at increased risk for cardiovascular morbidity and mortality. The aim of this study was to evaluate whether body mass index (BMI) is associated with health-related quality of life (HRQoL) in patients with variants of Tetralogy of Fallot (TOF). Patients and parents of children with variants of TOF-CHD were asked to fill out the PedsQL 4.0 questionnaire and provide weight and length. Patients were categorized into low, normal, and high BMI percentiles. Other demographic data were obtained from the Swedish national registry for congenital heart disease (SWEDCON). Statistical analyses included non-parametric Mann-Whitney U test, Fisher exact, and Chi-square tests. Eighty-five patients were included. Twelve were overweight or obese, 57 had a normal BMI, and 16 were underweight. There was a significant difference in age and gender between the groups. Comparing overweight/obese children to those with normal BMI, physical and social functioning were impaired, while emotional and school function were comparable between the groups. This applied to both child and parental assessment. When comparing underweight to normal weight children, school functioning assessed by the parent was the only domain significantly different from patients with a normal BMI. Children with variants of TOF and overweight/obesity have lower HRQoL, particularly in physical and social functioning, while underweight children may have impaired school functioning. We suggest that preventive measures aimed at maintaining a normal weight should be taken early in life to reduce long-term cardiovascular risk in the CHD population.
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Affiliation(s)
- Pip Hidestrand
- Department of Pediatric Cardiology, Skåne University Hospital, Lund University, Lund, Sweden.
- Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Birgitta Svensson
- Department of Pediatric Cardiology, Skåne University Hospital, Lund University, Lund, Sweden
- Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Pippa Simpson
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Petru Liuba
- Department of Pediatric Cardiology, Skåne University Hospital, Lund University, Lund, Sweden
- Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Constance G Weismann
- Department of Pediatric Cardiology, Skåne University Hospital, Lund University, Lund, Sweden
- Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilian University, Munich, Germany
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Uyar D, Michener CM, Bishop E, Hopp E, Simpson P, Zhang L, Rader JS, Rose PG, Mahdi HS, Debernardo R, Christian Q, Bradley W. Carboplatin, paclitaxel, and pembrolizumab followed by pembrolizumab maintenance for primary treatment of incompletely resected epithelial ovarian cancer. Front Oncol 2024; 14:1291090. [PMID: 38410102 PMCID: PMC10894939 DOI: 10.3389/fonc.2024.1291090] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/15/2024] [Indexed: 02/28/2024] Open
Abstract
Objective Incompletely resected epithelial ovarian cancer represents a poor prognostic subset of patients. Novel treatment strategies are needed to improve outcomes for this population. We evaluated a treatment strategy combining platinum-based chemotherapy with pembrolizumab followed by pembrolizumab maintenance therapy in the first-line treatment after incomplete resection of epithelial ovarian cancer patients. Methods This was a single-arm, non-randomized pilot study of carboplatin, taxane, and immune checkpoint inhibitor, pembrolizumab, followed by 12 months of maintenance pembrolizumab in patients with incompletely resected epithelial ovarian cancer (EOC). Results A total of 29 patients were enrolled and evaluated for efficacy and safety. The best response to therapy was complete response in 16 (55%) patients, partial response in 9 (31%) patients, and 3 (10%) patients with progression of disease. The median progression-free survival (PFS) was 13.2 months. Grade 3 and 4 toxicities occurred in 20% of patients. In all, 7 patients discontinued therapy due to adverse events. Quality-of-life scores remained high during therapy. Response to therapy did not correlate with PD-L1 tumor expression. Conclusions Combination platinum-taxane therapy with pembrolizumab did not increase median progression-free survival in this cohort of patients. Key message EOC is an immunogenic disease, but immune checkpoint inhibitor therapy has yet to impact outcomes. The current study utilized pembrolizumab in combination with standard chemotherapy followed by a maintenance treatment strategy in incompletely resected EOC. Progression-free survival was not extended in this poor prognostic group with combined chemotherapy and immunotherapy. Clinical trial registration https://clinicaltrials.gov/, identifier NCT 027766582.
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Affiliation(s)
- Denise Uyar
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Chad M. Michener
- Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Erin Bishop
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Elizabeth Hopp
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Pippa Simpson
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Liyun Zhang
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Janet S. Rader
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Peter G. Rose
- Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Haider S. Mahdi
- Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Robert Debernardo
- Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Qiana Christian
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - William Bradley
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, United States
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Tarbell SE, Olufs EL, Fischer PR, Chelimsky G, Numan MT, Medow M, Abdallah H, Ahrens S, Boris JR, Butler IJ, Chelimsky TC, Coleby C, Fortunato JE, Gavin R, Gilden J, Gonik R, Klaas K, Marsillio L, Marriott E, Pace LA, Pianosi P, Simpson P, Stewart J, Van Waning N, Weese-Mayer DE. Assessment of comorbid symptoms in pediatric autonomic dysfunction. Clin Auton Res 2023; 33:843-858. [PMID: 37733160 DOI: 10.1007/s10286-023-00984-4] [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] [Received: 08/07/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE Pediatric patients with autonomic dysfunction and orthostatic intolerance (OI) often present with co-existing symptoms and signs that might or might not directly relate to the autonomic nervous system. Our objective was to identify validated screening instruments to characterize these comorbidities and their impact on youth functioning. METHODS The Pediatric Assembly of the American Autonomic Society reviewed the current state of practice for identifying symptom comorbidities in youth with OI. The assembly includes physicians, physician-scientists, scientists, advanced practice providers, psychologists, and a statistician with expertise in pediatric disorders of OI. A total of 26 representatives from the various specialties engaged in iterative meetings to: (1) identify and then develop consensus on the symptoms to be assessed, (2) establish committees to review the literature for screening measures by member expertise, and (3) delineate the specific criteria for systematically evaluating the measures and for making measure recommendations by symptom domains. RESULTS We review the measures evaluated and recommend one measure per system/concern so that assessment results from unrelated clinical centers are comparable. We have created a repository to apprise investigators of validated, vetted assessment tools to enhance comparisons across cohorts of youth with autonomic dysfunction and OI. CONCLUSION This effort can facilitate collaboration among clinical settings to advance the science and clinical treatment of these youth. This effort is essential to improving management of these vulnerable patients as well as to comparing research findings from different centers.
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Affiliation(s)
- Sally E Tarbell
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Erin L Olufs
- Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Philip R Fischer
- Mayo Clinic, Rochester, MN, USA
- Sheikh Shakhbout Medical City, Abu Dhabi, UAE
- Khalifa University College of Medicine and Health Sciences, Abu Dhabi, UAE
| | - Gisela Chelimsky
- Children's Hospital of Richmond, Richmond, VA, USA
- Virginia Commonwealth University Health, Richmond, VA, USA
| | | | | | | | | | | | - Ian J Butler
- University of Texas McGovern Medical School, Houston, TX, USA
| | | | | | - John E Fortunato
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Raewyn Gavin
- Starship Children's Hospital, Auckland, New Zealand
| | - Janice Gilden
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Renato Gonik
- University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Lauren Marsillio
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
- Stanley Manne Research Institute, Chicago, IL, USA
| | - Erin Marriott
- American Family Children's Hospital, Madison, WI, USA
| | | | - Paul Pianosi
- University of Minnesota Medical School, Minneapolis, MN, USA
| | | | | | | | - Debra E Weese-Mayer
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
- Stanley Manne Research Institute, Chicago, IL, USA
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Karrento K, Venkatesan T, Zhang L, Pawela L, Simpson P, Li BUK. Percutaneous Electrical Nerve Field Stimulation for Drug-Refractory Pediatric Cyclic Vomiting Syndrome. J Pediatr Gastroenterol Nutr 2023; 77:347-353. [PMID: 37364137 DOI: 10.1097/mpg.0000000000003876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
BACKGROUND Cyclic vomiting syndrome (CVS) is a disabling condition frequently refractory to pharmacologic therapy. The aim of this study was to evaluate the effects of noninvasive, auricular percutaneous electrical nerve field stimulation (PENFS) as prophylactic therapy for pediatric CVS. METHODS Children 8-18 years with drug-refractory CVS were prospectively enrolled from a tertiary care CVS clinic. Subjects received 6 consecutive weeks of PENFS. CVS severity was quantified by episode frequency and duration score (range 0-25) at baseline and at extended follow-up (4-6 months after end of therapy). Response was classified as ≥50% improvement in either frequency or duration of attacks at extended follow-up. Subjects also completed validated surveys of nausea, disability, and global response. RESULTS Thirty subjects completed the study. Median (interquartile range, IQR) age was 10.5 (8.5-15.5) years; 60% were female. At follow-up, 80% met criteria for treatment response with a median (IQR) response duration of 113 (61-182) days. The frequency-duration score improved from baseline median (IQR) 12.0 (9.0-16.0) to 3.0 (1.0-6.0) at follow-up, P < 0.0001. Median (IQR) nausea and disability scores decreased from baseline to week 6: 2.1 (1.3-2.7) to 0.9 (0-1.6), P = 0.003 and 47.5 (41.0-53.0) to 38.0 (16.0-51.0), P = 0.001, respectively. At end of therapy, 66% and 55% patients reported global response of at least "moderately better" and "a good deal better," respectively. There were no serious side effects. CONCLUSIONS This study suggests long-term benefits of PENFS for children with CVS. PENFS improves several disabling aspects of CVS, including episode frequency, duration, and functional disability.
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Affiliation(s)
- Katja Karrento
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Thangam Venkatesan
- the Division of Gastroenterology, The Ohio State University, Columbus, OH
| | - Liyun Zhang
- the Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Louis Pawela
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Pippa Simpson
- the Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - B U K Li
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
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Hughes BN, Wakai RT, Zhang J, Simpson P, Strasburger JF. Late-Coupled Premature Ventricular Contractions Predict Mortality in Fetuses Evaluated by Fetal Magnetocardiography. JACC Clin Electrophysiol 2023; 9:1601-1603. [PMID: 37354179 DOI: 10.1016/j.jacep.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/10/2023] [Accepted: 04/21/2023] [Indexed: 06/26/2023]
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Karrento K, Zhang L, Conley W, Qazi Z, Venkatesan T, Simpson P, Li BU. Percutaneous electrical nerve field stimulation improves comorbidities in children with cyclic vomiting syndrome. Front Pain Res (Lausanne) 2023; 4:1203541. [PMID: 37389229 PMCID: PMC10300638 DOI: 10.3389/fpain.2023.1203541] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/23/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction Children with cyclic vomiting syndrome (CVS) frequently suffer from disabling abdominal pain and comorbidities that impair quality of life. A noninvasive, auricular percutaneous electrical nerve field stimulation (PENFS) device is shown to be effective for abdominal pain in children with disorders of gut-brain interaction. We aimed to determine the effects of PENFS on pain, common comorbidities, and quality of life in pediatric CVS. Methods Children aged 8-18 years with drug-refractory CVS were enrolled in a prospective, open-label study receiving 6 consecutive weeks of PENFS. Subjects completed the following surveys at baseline, during/after therapy (week 6), and at extended follow-up approximately 4-6 months later: Abdominal Pain Index (API), State-Trait Anxiety Inventory for Children (STAI-C), Pittsburgh Sleep Quality Index (PSQI), and Patient Reported Outcome Measurement Information System (PROMIS) Pediatric Profile-37. Results Thirty subjects were included. Median (interquartile range, IQR) age was 10.5 (8.5-15.5) years; 60% were female. Median API scores decreased from baseline to week 6 (p = 0.003) and to extended follow-up (p < 0.0001). State anxiety scores decreased from baseline to week 6 (p < 0.0001) and to extended follow-up (p < 0.0001). There were short-term improvements in sleep at 6 weeks (p = 0.031) but not at extended follow-up (p = 0.22). Quality of life measures of physical function, anxiety, fatigue, and pain interference improved short-term, while there were long-term benefits for anxiety. No serious side effects were reported. Conclusions This is the first study to demonstrate the efficacy of auricular neurostimulation using PENFS for pain and several disabling comorbidities in pediatric CVS. PENFS improves anxiety, sleep, and several aspects of quality of life with long-term benefits for anxiety.Clinical trial registration: ClinicalTrials.gov, identifier NCT03434652.
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Affiliation(s)
- Katja Karrento
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Liyun Zhang
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - William Conley
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Zeeshan Qazi
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Thangam Venkatesan
- Division of Gastroenterology, The Ohio State University, Columbus, OH, United States
| | - Pippa Simpson
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - B U.K. Li
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
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Zembles TN, Dasgupta M, Kenkel TJ, Lehrer B, Simpson P, Havens PL, Huppler AR. Higher Weight-Based Doses Are Required to Achieve and Maintain Therapeutic Voriconazole Serum Trough Concentrations in Children. J Pediatr Pharmacol Ther 2023; 28:247-254. [PMID: 37303767 PMCID: PMC10249970 DOI: 10.5863/1551-6776-28.3.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/16/2022] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Children require weight-based voriconazole doses proportionately larger than adults to achieve therapeutic serum trough concentrations (1-6 mcg/mL). The objective of this quality improvement project was to determine the initial dose, proportion of patients achieving target concentrations with initial dosing, and subsequent therapeutic drug monitoring and dose modifications needed to achieve and maintain therapeutic voriconazole concentrations in children. METHODS This retrospective study evaluated children aged <18 years treated with voriconazole during the study period. Dosing and therapeutic drug monitoring (TDM) values were collected and compared by age. Data are presented as median (IQR), unless otherwise stated. RESULTS Fifty-nine patients, aged 10.4 (3.7-14.7) years and 49% female, met inclusion criteria; 42 had at least 1 steady-state voriconazole serum trough concentration measured. Twenty-one of 42 (50%) achieved the target concentration at the first steady-state measurement. An additional 13 of 42 (31%) achieved the target following 2 to 4 dose modifications. The dose required to first achieve a value in the target range was 22.3 (18.0-27.1) mg/kg/day in children aged <12 years and 12.0 (9.8-14.0) mg/kg/day in children aged ≥12 years. After reaching the target, 59% and 81% of repeated steady-state measurements were in the therapeutic range in patients aged <12 years and ≥12 years, respectively. CONCLUSIONS Reaching therapeutic voriconazole serum trough concentrations required doses larger than currently recommended by the American Academy of Pediatrics. Multiple dose adjustments and TDM measurements were required to achieve and maintain therapeutic voriconazole serum concentrations.
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Affiliation(s)
- Tracy N Zembles
- Department of Enterprise Safety (TNZ), Children's Wisconsin, Milwaukee, WI
| | - Mahua Dasgupta
- Department of Quantitative Health Sciences (MD, PS), Medical College of Wisconsin, Milwaukee, WI
| | - Troy J Kenkel
- Department of Pediatrics (TJK, PLH, ARH), Medical College of Wisconsin, Milwaukee, WI
| | - Brittany Lehrer
- Department of Pediatrics (BL), Vanderbilt University Medical Center, Nashville, TN
| | - Pippa Simpson
- Department of Quantitative Health Sciences (MD, PS), Medical College of Wisconsin, Milwaukee, WI
| | - Peter L Havens
- Department of Pediatrics (TJK, PLH, ARH), Medical College of Wisconsin, Milwaukee, WI
| | - Anna R Huppler
- Department of Pediatrics (TJK, PLH, ARH), Medical College of Wisconsin, Milwaukee, WI
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Gosalvez-Tejada A, Li BUK, Simpson P, Zhang L, Kovacic K. Natural History of Pediatric Cyclic Vomiting Syndrome: Progression to Dysautonomia. J Pediatr Gastroenterol Nutr 2023; 76:737-742. [PMID: 36800281 DOI: 10.1097/mpg.0000000000003738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND The clinical features of pediatric cyclic vomiting syndrome (CVS) often evolve over time. Many patients develop a constellation of chronic symptoms that suggest autonomic nervous system (ANS) dysfunction during adolescence. We aimed to determine the proportion of children with CVS who develop chronic rather than episodic symptoms consistent with ANS dysfunction. METHODS Retrospective chart review of children ages 0-18 years followed in an outpatient tertiary care CVS center. Patients completed standardized questionnaires at intake and follow-up visits, documenting clinical symptom pattern. Continuous variables are summarized as median [interquartile range (IQR)]. A Mann-Whitney test was used for group comparisons. RESULTS One hundred subjects were included. A total of 40% developed symptoms of ANS dysfunction (ANS+); 20% were confirmed by comprehensive ANS testing, 11% by orthostatic vital sign abnormalities, and 9% by clinical symptoms. The median (IQR) age at onset of chronic symptoms was 14 (10.02, 15) years. The presence of another disorder of gut-brain interaction ( P = 0.018) and a greater number of comorbidities ( P = 0.031) were more common in the ANS+ group. ANS+ subjects missed more school days ( P = 0.047) and were seen less frequently in the emergency department ( P = 0.023). CONCLUSIONS Many children with CVS (40%) develop symptoms consistent with clinical dysautonomia in adolescence. These patients experience more comorbid conditions and a greater impact on school attendance, possibly representing a worsened quality of life as their disease course transitions to daily symptoms. When symptoms of CVS change over time, therapeutic interventions may need to be adjusted and targeted accordingly.
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Affiliation(s)
- Andrea Gosalvez-Tejada
- From the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - B U K Li
- From the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Pippa Simpson
- the Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Liyun Zhang
- the Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Katja Kovacic
- From the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
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Boris JR, Abdallah H, Ahrens S, Chelimsky G, Chelimsky TC, Fischer PR, Fortunato JE, Gavin R, Gilden JL, Gonik R, Grubb BP, Klaas KM, Marriott E, Marsillio LE, Medow MS, Norcliffe-Kaufmann L, Numan MT, Olufs E, Pace LA, Pianosi PT, Simpson P, Stewart JM, Tarbell S, Van Waning NR, Weese-Mayer DE. Creating a data dictionary for pediatric autonomic disorders. Clin Auton Res 2023; 33:301-377. [PMID: 36800049 PMCID: PMC9936127 DOI: 10.1007/s10286-023-00923-3] [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] [Received: 12/06/2022] [Accepted: 01/06/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE Whether evaluating patients clinically, documenting care in the electronic health record, performing research, or communicating with administrative agencies, the use of a common set of terms and definitions is vital to ensure appropriate use of language. At a 2017 meeting of the Pediatric Section of the American Autonomic Society, it was determined that an autonomic data dictionary comprising aspects of evaluation and management of pediatric patients with autonomic disorders would be an important resource for multiple stakeholders. METHODS Our group created the list of terms for the dictionary. Definitions were prioritized to be obtained from established sources with which to harmonize. Some definitions needed mild modification from original sources. The next tier of sources included published consensus statements, followed by Internet sources. In the absence of appropriate sources, we created a definition. RESULTS A total of 589 terms were listed and defined in the dictionary. Terms were organized by Signs/Symptoms, Triggers, Co-morbid Disorders, Family History, Medications, Medical Devices, Physical Examination Findings, Testing, and Diagnoses. CONCLUSION Creation of this data dictionary becomes the foundation of future clinical care and investigative research in pediatric autonomic disorders, and can be used as a building block for a subsequent adult autonomic data dictionary.
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Affiliation(s)
- Jeffrey R Boris
- Jeffrey R. Boris, MD LLC, P.O. Box 16, Moylan, PA, 19065, USA.
| | | | | | - Gisela Chelimsky
- Children's Hospital of Richmond, Virginia Commonwealth University Health, Richmond, VA, USA
| | | | - Philip R Fischer
- Mayo Clinic, Rochester, MN, USA
- Sheikh Shakhbout Medical City, Abu Dhabi, UAE
- Khalifa University College of Medicine and Health Sciences, Abu Dhabi, UAE
| | | | | | - Janice L Gilden
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Renato Gonik
- University of Florida College of Medicine, Gainesville, FL, USA
| | | | | | - Erin Marriott
- American Family Children's Hospital, Madison, WI, USA
| | - Lauren E Marsillio
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Stanley Manne Children's Research Institute, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Mohammed T Numan
- University of Texas Houston McGovern Medical School, Houston, TX, USA
| | - Erin Olufs
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Paul T Pianosi
- University of Minnesota Medical School, Minneapolis, MN, USA
| | | | | | - Sally Tarbell
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | | | - Debra E Weese-Mayer
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Stanley Manne Children's Research Institute, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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11
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Gumm A, Ginde S, Hoffman G, Liegl M, Mack C, Simpson P, Vo N, Telega G, Vitola B, Chugh A. Does High-Intensity Exercise Cause Acute Liver Injury in Patients with Fontan Circulation? A Prospective Pilot Study. Pediatr Cardiol 2023:10.1007/s00246-023-03193-y. [PMID: 37219588 DOI: 10.1007/s00246-023-03193-y] [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] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023]
Abstract
The Fontan procedure results in chronic hepatic congestion and Fontan-associated liver disease (FALD) characterized by progressive liver fibrosis and cirrhosis. Exercise is recommended in this population, but may accelerate the progression of FALD from abrupt elevations in central venous pressure. The aim of this study was to assess if acute liver injury occurs after high-intensity exercise in patients with Fontan physiology. Ten patients were enrolled. Nine had normal systolic ventricular function and one had an ejection fraction < 40%. During cardiopulmonary exercise testing, patients had near-infrared spectroscopy (NIRS) to measure oxygen saturation of multiple organs, including the liver, and underwent pre- and post-exercise testing with liver elastography, laboratory markers, and cytokines to assess liver injury. The hepatic and renal NIRS showed a statistically significant decrease in oxygenation during exercise, and the hepatic NIRS had the slowest recovery compared to renal, cerebral, and peripheral muscle NIRS. A clinically significant increase in shear wave velocity occurred after exercise testing only in the one patient with systolic dysfunction. There was a statistically significant, albeit trivial, increase in ALT and GGT after exercise. Fibrogenic cytokines traditionally associated with FALD did not increase significantly in our cohort; however, pro-inflammatory cytokines that predispose to fibrogenesis did significantly rise during exercise. Although patients with Fontan circulation demonstrated a significant reduction in hepatic tissue oxygenation based on NIRS saturations during exercise, there was no clinical evidence of acute increase in liver congestion or acute liver injury following high-intensity exercise.
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Affiliation(s)
- Alexis Gumm
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
- Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Salil Ginde
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - George Hoffman
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Melodee Liegl
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Cara Mack
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nghia Vo
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Grzegorz Telega
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Bernadette Vitola
- Department of Pediatrics, MedStar Georgetown University Hospital, Georgetown, WA, USA
| | - Ankur Chugh
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
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12
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Sharma R, Flood V, Jobe S, Punzalan R, Simpson P, Conway C, Malec L. Utilization and optimization of an electronic self-administered bleeding assessment tool (E-Self BAT) for the screening of pediatric bleeding disorders in the hematology clinic. Haemophilia 2023; 29:685-688. [PMID: 36580378 DOI: 10.1111/hae.14717] [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: 04/22/2022] [Revised: 10/21/2022] [Accepted: 11/09/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Ruchika Sharma
- Versiti Blood Research Institute, Milwaukee, Wisconsin, USA.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Veronica Flood
- Versiti Blood Research Institute, Milwaukee, Wisconsin, USA.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shawn Jobe
- Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Rowena Punzalan
- Versiti Blood Research Institute, Milwaukee, Wisconsin, USA.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Lynn Malec
- Versiti Blood Research Institute, Milwaukee, Wisconsin, USA.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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13
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Richmond ME, Deshpande SR, Zangwill SD, Bichell DP, Kindel SJ, Mahle WT, Schroder JN, Wigger MA, Knecht KR, Pahl E, Gaglianello NA, Goetsch MA, Simpson P, Dasgupta M, Zhang L, North PE, Tomita-Mitchell A, Mitchell ME. Validation of donor fraction cell-free DNA with biopsy-proven cardiac allograft rejection in children and adults. J Thorac Cardiovasc Surg 2023; 165:460-468.e2. [PMID: 35643770 PMCID: PMC9617812 DOI: 10.1016/j.jtcvs.2022.04.027] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 04/04/2022] [Accepted: 04/19/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Donor-specific cell-free DNA shows promise as a noninvasive marker for allograft rejection, but as yet has not been validated in both adult and pediatric recipients. The study objective was to validate donor fraction cell-free DNA as a noninvasive test to assess for risk of acute cellular rejection and antibody-mediated rejection after heart transplantation in pediatric and adult recipients. METHODS Pediatric and adult heart transplant recipients were enrolled from 7 participating sites and followed for 12 months or more with plasma samples collected immediately before all endomyocardial biopsies. Donor fraction cell-free DNA was extracted, and quantitative genotyping was performed. Blinded donor fraction cell-free DNA and clinical data were analyzed and compared with a previously determined threshold of 0.14%. Sensitivity, specificity, negative predictive value, positive predictive value, and receiver operating characteristic curves were calculated. RESULTS A total of 987 samples from 144 subjects were collected. After applying predefined clinical and technical exclusions, 745 samples from 130 subjects produced 54 rejection samples associated with the composite outcome of acute cellular rejection grade 2R or greater and pathologic antibody-mediated rejection 2 or greater and 323 healthy samples. For all participants, donor fraction cell-free DNA at a threshold of 0.14% had a sensitivity of 67%, a specificity of 79%, a positive predictive value of 34%, and a negative predictive value of 94% with an area under the curve of 0.78 for detecting rejection. When analyzed independently, these results held true for both pediatric and adult cohorts at the same threshold of 0.14% (negative predictive value 92% and 95%, respectively). CONCLUSIONS Donor fraction cell-free DNA at a threshold of 0.14% can be used to assess for risk of rejection after heart transplantation in both pediatric and adult patients with excellent negative predictive value.
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Affiliation(s)
- Marc E Richmond
- Division of Pediatric Cardiology, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY.
| | - Shriprasad R Deshpande
- Division of Pediatric Cardiology, Children's National Heart Institute, Children's National Hospital, Washington, DC
| | | | - David P Bichell
- Division of Pediatric Cardiac Surgery, Department of Surgery, Vanderbilt University, Nashville, Tenn
| | - Steven J Kindel
- Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Herma Heart Institute, Children's Wisconsin, Milwaukee, Wis
| | - William T Mahle
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Jacob N Schroder
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University, Durham, NC
| | - Mark A Wigger
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Nashville, Tenn
| | - Kenneth R Knecht
- Department of Pediatrics, Arkansas Children's Hospital, Little Rock, Ark
| | | | | | - Mary A Goetsch
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wis
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis
| | - Mahua Dasgupta
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis
| | - Liyun Zhang
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis
| | - Paula E North
- Department of Pathology, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, Wis
| | - Aoy Tomita-Mitchell
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Herma Heart Institute, Milwaukee, Wis
| | - Michael E Mitchell
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Herma Heart Institute, Milwaukee, Wis
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14
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Magner K, Mikhailov T, Simpson P, Anderson L, Buchman B, Gedeit R, Margolis D, Meyer MT. Dexmedetomidine for sedation during hematopoietic stem cell harvest apheresis and leukapheresis in the PICU: Guideline development. Transfus Apher Sci 2023; 62:103525. [PMID: 36058778 DOI: 10.1016/j.transci.2022.103525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/02/2022] [Accepted: 08/17/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Hematopoietic stem cell (HSC) harvest apheresis and leukapheresis are performed in the pediatric intensive care unit (PICU) for high-risk pediatric patients who require procedural sedation. Patients need central access either with their own central lines, ports or require apheresis catheter (CVL) placement. Previously, patients were either awake or emerging from sedation on PICU admission. Uncertainty regarding procedural sedation plans caused delays initiating sedation and apheresis. A guideline was developed to standardize Dexmedetomidine (DEX) for procedural sedation. We investigated if guideline implementation would improve efficiency during PICU admission as demonstrated by shorter time intervals for initiation of sedation, apheresis, PICU length of stay and less alternative sedating medication. METHODS Data was collected retrospectively from electronic health records of preguideline and post-guideline patients who were admitted to the PICU for sedated apheresis. We compared demographic and clinical characteristics, time intervals for sedation, apheresis, PICU length of stay, and sedation agents between the two groups using Fisher Exact tests and Mann-Whitney tests, as appropriate. RESULTS The groups did not differ in age or weight at the time of apheresis. All intervals of time compared were shorter post-guideline. Time intervals from admission to start of sedation, admission to start of apheresis, and admission to end of apheresis were statistically significantly different. The type and number of alternative sedating medications administered did not differ between the two groups. CONCLUSION This guideline implementation improved efficiency during PICU admission. This study might have been too small to demonstrate statistically significant differences in other time intervals studied.
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Affiliation(s)
- Kristin Magner
- Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI, USA.
| | - Theresa Mikhailov
- Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI, USA
| | - Pippa Simpson
- Department of Pediatrics, Division of Quantitative Health Sciences. Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lynnette Anderson
- Pediatric Hematology/Oncology, Children's Wisconsin, Milwaukee, WI, USA
| | - Bo Buchman
- Pediatric Hematology/Oncology, Children's Wisconsin, Milwaukee, WI, USA
| | - Rainer Gedeit
- Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI, USA
| | - David Margolis
- Department of Pediatrics, Division of Hematology/Oncology, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI, USA
| | - Michael T Meyer
- Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI, USA
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15
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Cardinale B, Zembles TN, Ray K, Bushee G, Liegl M, Simpson P, Mitchell M. Retrospective Comparison of Cefdinir, Cephalexin, and Sulfamethoxazole-Trimethoprim in the Treatment of Outpatient Pediatric Urinary Tract Infections. Clin Pediatr (Phila) 2023; 62:47-54. [PMID: 35861216 DOI: 10.1177/00099228221112055] [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] [Indexed: 11/16/2022]
Abstract
This retrospective single-center study included children aged 2 months to 18 years who were prescribed an oral antibiotic for microbiologically confirmed urinary tract infection (UTI). The primary outcomes were re-encounter to the hospital, emergency department, or urgent care within 30 days and modification of the antibiotic regimen within 14 days. Development of Clostridioides difficile (C difficile) infection or new allergic reaction to the antibiotic prescribed was the secondary outcome. The sample included 2685 children. Rates of re-encounter were similar regardless of the initial antibiotic prescribed (P = .88), and patients who received cefdinir had a lower rate of medication changes (5%) compared with both cephalexin (14%) and sulfamethoxazole-trimethoprim (15%) (P ≤ .001). The most common reason for medication change was susceptibility interpretation. Given its low side-effect profile and narrow spectrum compared with the alternatives, cephalexin appears to be a reasonable choice as first-line therapy for the treatment of uncomplicated pediatric UTI.
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Affiliation(s)
| | - Tracy N Zembles
- Children's Wisconsin, Department of Enterprise Safety, Milwaukee, WI, USA
| | - Katie Ray
- Children's Wisconsin, Department of Enterprise Safety, Milwaukee, WI, USA
| | - Glenn Bushee
- Children's Wisconsin, Department of Enterprise Safety, Milwaukee, WI, USA
| | - Melodee Liegl
- Medical College of Wisconsin, Department of Quantitative Health Sciences, Milwaukee, WI, USA
| | - Pippa Simpson
- Medical College of Wisconsin, Department of Quantitative Health Sciences, Milwaukee, WI, USA
| | - Michelle Mitchell
- Medical College of Wisconsin, Department of Pediatrics, Milwaukee, WI, USA
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16
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Lerret SM, Schiffman R, White-Traut R, Medoff-Cooper B, Ahamed SI, Adib R, Liegl M, Alonso E, Mavis A, Jensen K, Peterson CG, Neighbors K, Riordan MK, Semp MC, Vo T, Stendahl G, Chapman S, Unteutsch R, Simpson P. Feasibility and Acceptability of a mHealth Self-Management Intervention for Pediatric Transplant Families. West J Nurs Res 2022; 44:955-965. [PMID: 34154460 PMCID: PMC8688578 DOI: 10.1177/01939459211024656] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Families of pediatric solid organ transplant recipients need ongoing education and support in the first 30 days following hospital discharge for the transplantation. The purpose of this report is to describe the feasibility, acceptability, and preliminary efficacy of a mHealth family-self management intervention, (myFAMI), designed to improve post-discharge outcomes of coping, family quality of life, self-efficacy, family self-management, and utilization of health care resources. We enrolled 46 primary family members. myFAMI was feasible and acceptable; 81% (n=17/21) of family members completed the app at least 24/30 days (goal 80% completion rate). Family members generated 134 trigger alerts and received a nurse response within the goal timeframe of < 2 h 99% of the time. Although there were no significant differences between groups, primary outcomes were in the expected direction. The intervention was well received and is feasible for future post-discharge interventions for families of children who receive an organ transplant.
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Affiliation(s)
- Stacee M Lerret
- Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel Schiffman
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Rosemary White-Traut
- Department of Nursing Research, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Barbara Medoff-Cooper
- College of Nursing, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sheikh Iqbal Ahamed
- Department of Mathematics, Statistics, and Computer Science, Marquette University, Milwaukee, WI, USA
| | - Riddhiman Adib
- Department of Mathematics, Statistics, and Computer Science, Marquette University, Milwaukee, WI, USA
| | - Melodee Liegl
- Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Estella Alonso
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Alisha Mavis
- Pediatric Gastroenterology, Hepatology and Nutrition, Duke University Medical Center, Durham, NC
| | - Kyle Jensen
- Pediatric Gastroenterology, Hepatology and Nutrition, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Caitlin G Peterson
- Pediatric Nephrology and Hypertension, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Katie Neighbors
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Mary K Riordan
- Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Melissa C Semp
- Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Truc Vo
- Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Gail Stendahl
- Pediatric Heart Transplant Program, Children's Wisconsin, Milwaukee, WI, USA
| | - Shelley Chapman
- Pediatric Nephrology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel Unteutsch
- Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Pippa Simpson
- Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
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17
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Bradley WH, Hayes MP, Taylor N, Rader JS, Bishop E, Hopp E, McAlarnen LA, Liegl M, Simpson P, Uyar D. An open label, nonrandomized, multisite phase II trial combining bevacizumab, atezolizumab, and rucaparib for the treatment of previously treated recurrent and progressive endometrial cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5510 Background: Patients with metastatic recurrent endometrial cancer have limited effective therapies. Single agent pembrolizumab is utilized in mismatch repair deficient (MMRd) patients, while the combination of lenvatinib and pembrolizumab is now more commonly used in MMR intact patients who have progressed after chemotherapy combinations. This trial investigated a novel three drug regimen. Methods: Patients with recurrent endometrial cancer not amenable to curative intent surgery or radiation after one or two lines of therapy were eligible regardless of histology. This study is a multicenter, open-label, nonrandomized phase II trial. All subjects initially received the three-drug combination of rucaparib, bevacizumab, and atezolizumab. The primary goal of this trial was to estimate the overall response rate in these patients, and secondarily to estimate the progression-free and overall survival of patients treated with this triplet combination. Total enrollment was 30, with the first six subjects participated in a safety lead-in. Treatments until progression, toxicity, or clinician choice. Subjects could continue past progression if, in the estimate of the treating clinician and subject, clinical benefit was being provided. Subjects were eligible for analysis if they received at least one cycle and had one post-dose tumor assessment. The ORR assumption was 27% with a lower bound of 14%. Results: 30 subjects were enrolled between 07/2019 and 06/2021. Of these 26 were evaluable. Median follow up at cut off was 14.9 months. 23 subjects had clinical benefit, with 1 (4%) with CR, 9 (39%) with PR, and 13 (57%) with stable disease as best response. Overall median event-free (progression or death) was 5.3 (95% CI 2.7-7.9) months and overall survival 13.3 (95% CI NA) months at cut off. Median duration of therapy was 4.4 months (IQR 1.7-7.3), with 4 subjects remaining on study directed therapy at data cut off. Histology distribution was 50% serous, 20% endometrioid, and 13% carcinosarcoma. 19 pts were White, 8 African American, 2 identified as Asian, 1 unknown. In the MMR deficient patients, event-free probability was 11.9 months. Grade 3 or 4 treatment related adverse events occurred in 50% patients. Conclusions: To our knowledge, this trial represents the first use of a non-chemotherapy-based triplet therapy for recurrent endometrial cancer. The combination of rucaparib, bevacizumab, and atezolizumab may safely be used to treat recurrent/persistent endometrial cancer. This combination demonstrates clinically meaningful improvement in response, with acceptable toxicity. Enhanced response to therapy was seen in MMR deficient subjects. Clinical trial information: NCT03694262.
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Affiliation(s)
| | - Monica Prasad Hayes
- Mount Sinai Medical Center, Department of Gynecologic Oncology, New York, NY
| | | | - Janet Sue Rader
- Froedtert and the Medical College of Wisconsin, Milwaukee, WI
| | - Erin Bishop
- Froedtert and the Medical College of Wisconsin, Milwaukee, WI
| | - Elizabeth Hopp
- Froedtert and the Medical College of Wisconsin, Milwaukee, WI
| | | | - Melodee Liegl
- Quantitative Health Sciences, Medical College of Wiscosin, Milwaukee, WI
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18
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White-Traut R, Gillette P, Simpson P, Zhang L, Nazarloo HP, Carter CS. Early Postpartum Maternal and Newborn Responses to Auditory, Tactile, Visual, Vestibular, and Olfactory Stimuli. J Obstet Gynecol Neonatal Nurs 2022; 51:402-417. [PMID: 35469779 DOI: 10.1016/j.jogn.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To compare maternal psychological well-being, newborn behavior, and maternal and newborn salivary oxytocin (OT) and cortisol before and after two maternally administered multisensory behavioral interventions or an attention control group. DESIGN Randomized prospective clinical trial. SETTING U.S. Midwest community hospital. PARTICIPANTS Newborns and their mothers (n = 102 dyads) participated. Mothers gave birth vaginally at term gestation and had no physical or mental health diagnoses. Newborns with low Apgar scores, receipt of oxygen, suspected infection, or congenital anomalies were excluded. METHODS Dyads were randomly assigned to the auditory, tactile, visual, and vestibular (ATVV) intervention, the ATVV with odor from a baby lotion (ATVVO), or the attention control (AC) Group. Maternal psychological well-being, newborn behavior, and endocrine responses (salivary cortisol and OT) were measured before and after the intervention. RESULTS Newborns in the ATVV and ATVVO groups exhibited increases in potent engagement behaviors (p < .0001 and p = .001, respectively). Newborns in the AC group exhibited a decrease in potent engagement (p = .013) and an increase in potent disengagement (p = .029). Mothers in the ATVVO group exhibited an increase in OT (p = .01) and the largest change in OT (p = .02) compared to mothers in the ATVV and AC groups. We noted no change in maternal psychological well-being or newborn endocrine responses. CONCLUSION Inclusion of an odor via lotion with a behavioral intervention (ATVV) influenced maternal OT more than the behavioral intervention alone. Newborns were behaviorally responsive to the interventions; however, endocrine measures were not associated with intervention changes.
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19
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Chelimsky G, Simpson P, Feng M, Willis E. Does Unconscious Bias Affect How Pediatricians Manage Their Patients? WMJ 2022; 121:18-25. [PMID: 35442574] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Both implicit bias-referred to as unconscious bias-and explicit bias affect how clinicians manage patients. The Implicit Association Test (IAT) has incremental predictive validity relative to self-reports of unconscious bias. Few studies have uniquely specified the impact of unconscious bias in pediatric practices. OBJECTIVE We aimed to assess the influence of unconscious bias on decision-making in the faculty in a pediatric academic center using the IAT, in addition to and separately applying clinical vignettes with racial and socioeconomic class associations in both tools as it relates to clinicians' race, gender, years in practice, education achieved by the clinician's parents, and language spoken. METHODS We conducted a prospective quality control evaluation of faculty in an academic center's pediatrics department. An anonymous online tool was used to gather IAT responses, clinical vignette responses, demographics, and explicit bias questions. RESULTS Of 295 faculty members (73% females), 230 completed the questionnaire, at least in part. Faculty reported on the explicit bias questions, neutral feelings when comparing the demands of educated vs noneducated patients, African American vs European American patients, and patients in the upper vs lower socioeconomic class. Of the approximately two-thirds who answered the IAT, faculty showed preference for European American and upper socioeconomic class. However, the clinical vignettes revealed no differences in how faculty responded to patients based on race or socioeconomic status when stratified by factors listed above, except physicians who favor upper socioeconomic class over lower socioeconomic class were more likely to give a detailed explanation of options if the patient's parent was upper socioeconomic class (P = 0.022). CONCLUSIONS Pediatricians exhibit racial and socioeconomic unconscious bias that minimally affects decision-making, at least based on vignette responses.
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Affiliation(s)
- Gisela Chelimsky
- Department of Pediatrics Virginia Commonwealth University, Richmond, Virginia,
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mingen Feng
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Earnestine Willis
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
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20
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Raff H, Phillips J, Simpson P, Weisman SJ, Hainsworth KR. Interaction of chronic pain, obesity and time of day on cortisol in female human adolescents. Stress 2022; 25:331-336. [PMID: 36330600 DOI: 10.1080/10253890.2022.2142778] [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: 11/06/2022] Open
Abstract
Adolescent obesity augments and impedes the treatment of chronic pain. This is associated with increased systemic inflammation and is more prominent in females. In addition, pain and obesity each independently affect the hypothalamic-pituitary-adrenal (HPA) axis. However, the interaction of pain and obesity on the HPA axis and the potential for sexual dimorphism in this phenomenon is not established. We hypothesized that dysregulation of the HPA axis occurs in female human adolescents with chronic pain, obesity, or the combination of the two and is associated with gonadal steroids. We measured serum cortisol, estradiol, and testosterone in 13-17-year-old adolescent females (N = 79) from venous blood drawn during the daytime (0830-1730 h) and analyzed the data in toto and partitioned by morning vs. afternoon sampling time. Subjects were categorized as healthy weight/no pain (controls; BMI = 56th percentile [37-71]), healthy weight with chronic pain, obese without pain (BMI = 97th percentile [95-99]), or the combination of obesity and chronic pain. Serum cortisol was lower with chronic pain and/or obesity compared to healthy controls and was lower with chronic pain and obesity compared to chronic pain alone (healthy weight). The lower serum cortisol in the pain alone group was more prominent in the morning compared to the afternoon. There was no relationship between serum estradiol and testosterone and study group. The decrease in the anti-inflammatory and other pain-ameliorating effects of cortisol may contribute to chronic pain and its resistance to treatment with concurrent obesity in female adolescents.
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Affiliation(s)
- Hershel Raff
- Department of Medicine (Endocrinology and Molecular Medicine), Surgery, and Physiology, Medical College of Wisconsin, Milwaukee, WI, USA
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Advocate Aurora Research Institute, Milwaukee, WI, USA
| | - Jonathan Phillips
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Advocate Aurora Research Institute, Milwaukee, WI, USA
| | - Pippa Simpson
- Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Biostatistics Core, Children's Wisconsin, Milwaukee, WI, USA
| | - Steven J Weisman
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Jane B. Pettit Pain and Headache Center, Children's Wisconsin, Milwaukee, WI, USA
| | - Keri R Hainsworth
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA
- Jane B. Pettit Pain and Headache Center, Children's Wisconsin, Milwaukee, WI, USA
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21
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Digiandomenico S, Conley SF, Johnson VP, Christopherson PA, Haberichter SL, Zhang J, Simpson P, Abshire TC, Montgomery RR, Flood VH. Screening for von Willebrand disease does not impact posttonsillectomy bleeding in a low-risk population. Pediatr Blood Cancer 2021; 68:e29371. [PMID: 34606172 PMCID: PMC8919995 DOI: 10.1002/pbc.29371] [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: 05/25/2021] [Revised: 08/23/2021] [Accepted: 09/05/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bleeding is an important complication in children following tonsillectomy. Screening with coagulation tests prior to procedure is common to assess bleeding risk in the perioperative period, although ASH/ASPHO Choosing Wisely guidelines recommend against routine PT/PTT testing. Our aim was to compare von Willebrand factor antigen (VWF:Ag) and activity levels among patients with postoperative bleeding following tonsillectomy to evaluate for potential risk for bleeding. PROCEDURE Eligible subjects were aged 0-18 without significant personal or family history of major bleeding. Postoperative bleeding diaries were collected and symptoms measured using a postoperative bleeding score. Plasma VWF levels were drawn at time of anesthesia administration. RESULTS Postoperative bleeding occurred in 248 cases out of 1399 total subjects. Median VWF:Ag was 86 in patients with postoperative bleeding scores of 1-2, 86 for scores 3-4, 84 for scores 5-6, and 83 for scores >6, with no significant difference among groups (p = .98). Additionally, no difference was observed for subjects with multiple days of postoperative bleeding as compared to those with only 1 day of postoperative bleeding. Finally, no difference in VWF:Ag was observed for subjects whose first reported bleed occurred early in the postoperative course compared to those whose first reported bleed occurred later. VWF:Ag does not correlate with severity of bleeding, time of onset of first bleeding event, or recurrence of bleeding in healthy children with no personal or family history of bleeding who have postoperative bleeding following tonsillectomy. CONCLUSIONS This data does not support routine von Willebrand disease screening prior to tonsillectomy.
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Affiliation(s)
- Stefanie Digiandomenico
- Department of Pediatrics, Division of Hematology/Oncology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226
| | - Stephen F. Conley
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226
| | - Victoria P. Johnson
- Versiti Blood Research Institute, 8727 Watertown Plank Rd, Milwaukee, WI 53226
| | | | - Sandra L. Haberichter
- Department of Pediatrics, Division of Hematology/Oncology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226,Versiti Blood Research Institute, 8727 Watertown Plank Rd, Milwaukee, WI 53226,Children’s Research Institute, Children’s Hospital of Wisconsin, Milwaukee, WI 53226
| | - Jian Zhang
- Department of Pediatrics, Division of Quantitative Health Sciences, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226
| | - Pippa Simpson
- Department of Pediatrics, Division of Quantitative Health Sciences, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226
| | - Thomas C. Abshire
- Department of Pediatrics, Division of Hematology/Oncology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226,Versiti Blood Research Institute, 8727 Watertown Plank Rd, Milwaukee, WI 53226,Children’s Research Institute, Children’s Hospital of Wisconsin, Milwaukee, WI 53226
| | - Robert R. Montgomery
- Department of Pediatrics, Division of Hematology/Oncology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226,Versiti Blood Research Institute, 8727 Watertown Plank Rd, Milwaukee, WI 53226,Children’s Research Institute, Children’s Hospital of Wisconsin, Milwaukee, WI 53226
| | - Veronica H. Flood
- Department of Pediatrics, Division of Hematology/Oncology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226,Versiti Blood Research Institute, 8727 Watertown Plank Rd, Milwaukee, WI 53226,Children’s Research Institute, Children’s Hospital of Wisconsin, Milwaukee, WI 53226
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22
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Vu C, Farez R, Simpson P, Kaljo K. Gendered Differences in Teaching Performance Evaluations of Obstetrics and Gynecology Residents. J Surg Educ 2021; 78:2038-2045. [PMID: 34045159 DOI: 10.1016/j.jsurg.2021.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Teaching performance evaluations are commonly used for career development and advancement. Due to possible gendered expectations, implicit or explicit bias may emerge in evaluations completed by learners. This study investigated how third-year medical students evaluated teaching performance of obstetrics and gynecology resident physicians based on resident gender. SETTING This study was conducted at the Medical College of Wisconsin in Milwaukee, Wisconsin. DESIGN This retrospective mixed methods study examined teaching performance evaluations of obstetrics and gynecology resident physicians from 2010 to 2018, completed by third-year medical students. A two-sample, two-sided t-test was used to compare numerical scores. Deductive content analysis of written comments focused on specific categories: positive or negative agentic or communal demeanors and characteristics, teaching skills, character and professionalism, leadership abilities, clinical skills and knowledge, and frequency of words and phrases used to describe residents. SETTING This study was conducted at the Medical College of Wisconsin in Milwaukee, Wisconsin. RESULTS Of 83 residents (71 females, 12 males), there was no statistical significance in the teaching performance evaluation scores between male and female residents (n = 10,753 total completed evaluations). Female residents had lower scores than male residents; males tended not to score below 4 (5-point response scale; 5 = outstanding). Of 3,813 written comments, male residents had more positive comments, with statistical significance in communal characteristics (71.4% male, 53.9% female, p = 0.01). Female residents received more negative comments, with statistical significance in communal characteristics (7.5% female, 2.8% male, p = 0.01). Frequency of words presented that male residents had more "standout" traits ("outstanding," "excellent," "exemplary"), "ability" terms ("intelligent," "bright," "talented," "smart"), and were often considered "fun," "funny," and "humorous." Female residents were described by "compassion" terms ("kind," "compassionate"). CONCLUSION Student-completed teaching performance evaluations are a valuable assessment of teaching skills and influence department recognition, award distribution, fellowship and employment opportunities. This study found that medical students did evaluate female residents differently than male residents. Understanding gendered expectations may assist in findings ways to address discrepancies between male and female physician evaluations.
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Affiliation(s)
- Cindy Vu
- Medical College of Wisconsin, Milwaukee, Wisconsin
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23
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Wright B, Hargate R, Garside M, Carr G, Wakefield T, Swanwick R, Noon I, Simpson P. A systematic scoping review of early interventions for parents of deaf infants. BMC Pediatr 2021; 21:467. [PMID: 34686176 PMCID: PMC8532316 DOI: 10.1186/s12887-021-02893-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/03/2021] [Indexed: 02/14/2023] Open
Abstract
Background Over 90% of the 50,000 deaf children in the UK have hearing parents, many of whom were not expecting a deaf child and may require specialist support. Deaf children can experience poorer long-term outcomes than hearing children across a range of domains. After early detection by the Universal Newborn Hearing Screening Programme, parents in the UK receive support from Qualified Teachers of the Deaf and audiologists but resources are tight and intervention support can vary by locality. There are challenges faced due to a lack of clarity around what specific parenting support interventions are most helpful. Methods The aim of this research was to complete a systematic scoping review of the evidence to identify early support interventions for parents of deaf infants. From 5577 identified records, 54 met inclusion criteria. Two reviewers screened papers through three rounds before completing data extraction and quality assessment. Results Identified parent support interventions included both group and individual sessions in various settings (including online). They were led by a range of professionals and targeted various outcomes. Internationally there were only five randomised controlled trials. Other designs included non-randomised comparison groups, pre / post and other designs e.g. longitudinal, qualitative and case studies. Quality assessment showed few high quality studies with most having some concerns over risk of bias. Conclusion Interventions commonly focused on infant language and communication followed by parental knowledge and skills; parent wellbeing and empowerment; and parent/child relationship. There were no interventions that focused specifically on parent support to understand or nurture child socio-emotional development despite this being a well-established area of poor outcome for deaf children. There were few UK studies and research generally was not of high quality. Many studies were not recent and so not in the context of recent healthcare advances. Further research in this area is urgently needed to help develop evidence based early interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02893-9.
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Affiliation(s)
- B Wright
- Leeds and York Partnership NHS Foundation Trust, COMIC Research, IT Centre, Science Park, University of York, Innovation Way, Heslington, York, YO10 5NP, UK
| | - R Hargate
- Leeds and York Partnership NHS Foundation Trust, COMIC Research, IT Centre, Science Park, University of York, Innovation Way, Heslington, York, YO10 5NP, UK
| | - M Garside
- Leeds and York Partnership NHS Foundation Trust, COMIC Research, IT Centre, Science Park, University of York, Innovation Way, Heslington, York, YO10 5NP, UK.
| | - G Carr
- The University College London Ear Institute, 332 Grays Inn Rd, London, WC1X 8EE, UK
| | - T Wakefield
- National Deaf Children's Society and NatSIP, Ground Floor South, Castle House 37-45 Paul Street, London, EC2A 4LS, UK
| | - R Swanwick
- University of Leeds, School of Education, Hillary Place, Woodhouse, Leeds, LS2 9JT, UK
| | - I Noon
- National Deaf Children's Society and NatSIP, Ground Floor South, Castle House 37-45 Paul Street, London, EC2A 4LS, UK
| | - P Simpson
- British Association of Teachers of the Deaf, 21, Keating Close, Rochester, ME1 1EQ, UK
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24
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Lewis ME, Simpson P, Mori J, Jubb B, Sullivan J, McFadyen L, van der Ryst E, Craig C, Robertson DL, Westby M. V3-Loop genotypes do not predict maraviroc susceptibility of CCR5-tropic virus or clinical response through week 48 in HIV-1-infected, treatment-experienced persons receiving optimized background regimens. Antivir Chem Chemother 2021; 29:20402066211030380. [PMID: 34343443 PMCID: PMC8369958 DOI: 10.1177/20402066211030380] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Viruses from 15 of 35 maraviroc-treated participants with virologic failure and CCR5-tropic (R5) virus in the MOTIVATE studies at Week 24 had reduced maraviroc susceptibility. On-treatment amino acid changes were observed in the viral envelope glycoprotein 120 third variable (V3)-loop stems and tips and differed between viruses. No amino acid change reliably predicted reduced susceptibility, indicating that resistance was genetic context-dependent. Through Week 24, poor adherence was associated with maraviroc-susceptible virologic failure, whereas reduced maraviroc susceptibility was associated with suboptimal background regimen activity, highlighting the importance of overall regimen activity and good adherence. Predictive values of pretreatment V3-loop sequences containing these Week 24 mutations or other variants present at >3% in pretreatment viruses of participants with virologic failure at Week 48 were retrospectively assessed. Week 48 clinical outcomes were evaluated for correlates with pretreatment V3-loop CCR5-tropic sequences from 704 participants (366 responders; 338 virologic failures [83 with R5 virus with maraviroc susceptibility assessment]). Seventy-five amino acid variants with >3% prevalence were identified among 23 V3-loop residues. Previously identified variants associated with resistance in individual isolates were represented, but none were associated reliably with virologic failure alone or in combination. Univariate analysis showed virologic-failure associations with variants 4L, 11R, and 19S (P < 0.05). However, 11R is a marker for CXCR4 tropism, whereas neither 4L nor 19S was reliably associated with reduced maraviroc susceptibility in R5 failure. These findings from a large study of V3-loop sequences confirm lack of correlation between V3-loop genotype and clinical outcome in participants treated with maraviroc.Clinical trial registration numbers (ClinicalTrials.gov): NCT00098306 and NCT00098722.
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Affiliation(s)
- M E Lewis
- Pfizer Global Research and Development, Sandwich Labs, Sandwich, Kent, UK.,The Research Network Ltd, Sandwich, Kent, UK
| | - P Simpson
- Pfizer Global Research and Development, Sandwich Labs, Sandwich, Kent, UK.,AstraZeneca, Cambridge, UK
| | - J Mori
- Pfizer Global Research and Development, Sandwich Labs, Sandwich, Kent, UK.,hVIVO, Queen Mary BioEnterprise Innovation Centre, London, UK
| | - B Jubb
- Pfizer Global Research and Development, Sandwich Labs, Sandwich, Kent, UK
| | - J Sullivan
- Pfizer Global Research and Development, Sandwich Labs, Sandwich, Kent, UK.,Cytel, London, UK
| | - L McFadyen
- Pfizer Inc, Pharmacometrics, Sandwich, UK
| | - E van der Ryst
- Pfizer Global Research and Development, Sandwich Labs, Sandwich, Kent, UK.,The Research Network Ltd, Sandwich, Kent, UK
| | - C Craig
- Pfizer Global Research and Development, Sandwich Labs, Sandwich, Kent, UK.,The Research Network Ltd, Sandwich, Kent, UK
| | - D L Robertson
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - M Westby
- Pfizer Global Research and Development, Sandwich Labs, Sandwich, Kent, UK.,Centauri Therapeutics Limited, Discovery Park, Kent, UK
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25
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Kovacic K, Zhang L, Nugent Liegl M, Pawela L, Simpson P, Sood MR. Gastric emptying in healthy children using the Spirulina breath test: The impact of gender, body size, and pubertal development. Neurogastroenterol Motil 2021; 33:e14063. [PMID: 33300658 DOI: 10.1111/nmo.14063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/10/2020] [Accepted: 11/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are no pediatric norms for gastric emptying (GE) measured by nuclear scintigraphy. The 13 C-labeled, stable isotope GE breath test (GEBT) is a non-radioactive alternative. We aimed to determine normative GEBT ranges in a cohort of healthy children and examine the influence of age, gender, puberty, and body surface area (BSA). METHODS Healthy children ages 8-18 years completed the [13 C]-Spirulina platensis GEBT after an overnight fast. Breath samples were collected at baseline, every 15 min × 1 h, then every 30 min for 4 h total. The 13 CO2 excretion rate was determined by the change in 13 CO2 /12 CO2 over time in each breath sample, expressed as kPCD (Percent 13 C Dose excreted/min). A mixed model with random time was used for multivariable analysis and outcome fit into a quadratic model. KEY RESULTS The 100 subjects completed the test meal within allotted time. Median (IQR) age was 13.5 (11.3-15.5) years; 51% were female. Females had lower 13 CO2 excretion rates (slower GE) than males across time (p < 0.001) while decreased excretion rates correlated with higher BSA (p = 0.015). Gender differences were also noted within pubertal stages with females showing slower GE. Multivariable analysis suggested that pre-pubertal children have faster GE than both peri- and post-pubertal groups (p < 0.0001). CONCLUSIONS & INFERENCES Gender, puberty, and BSA influence GE rates in healthy children more than age. Although further data are needed, pubertal stage and hormonal influences may be unique factors to consider when assessing GE in children.
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Affiliation(s)
- Katja Kovacic
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Liyun Zhang
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Melodee Nugent Liegl
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Louis Pawela
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Pippa Simpson
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Manu R Sood
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
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26
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Karafin MS, Schumacher C, Zhang J, Simpson P, Johnson ST, Pierce KL. Human leukocyte antigen (HLA)-incompatible mean fluorescence intensity-selected platelet products have corrected count increments similar to HLA antigen-matched platelets. Transfusion 2021; 61:2307-2316. [PMID: 34075590 DOI: 10.1111/trf.16430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Donor specific antibody sum mean fluorescence intensity (MFI) values have been successfully used in transplant medicine to assess risk for organ rejection. However, little is known regarding whether MFI values could be similarly used to aid in platelet product selection. We have developed a novel protocol where MFI values are used to offer human leukocyte antigen (HLA)-incompatible platelet products when HLA antigen-matched products are not available. We aimed to evaluate the efficacy of this protocol. METHODS We performed a 4-year retrospective chart review for all patients who received at least one MFI-selected platelet product. A corrected count increment (CCI) was calculated for each transfusion event. A mixed effects model was used to investigate the association between CCIs for MFI-selected, HLA antigen matched, and random donor platelet transfusions. A random effects expectation-maximization regression tree was used to define the extent to which other patient variables, such as age, sex, and diagnosis impacted the CCI for each platelet transfusion. RESULTS Twenty highly HLA alloimmunized patients received a total of 591 platelets. MFI-selected platelet (low MFI) transfusions had a significantly higher median CCI 0-6 hour post-transfusion (13,559, interquartile range [IQR]: 8275-18,736) compared to random donor platelets (2121, IQR: 0-10,368, p < 0.0001). There was no significant difference in median CCI between HLA antigen matched and MFI selected platelet transfusions (p = 0.2). Mixed effects and regression modeling revealed that MFI-selected platelet products had a significantly higher CCI than non-matched platelets, even when accounting for other significant patient variables. CONCLUSION MFI-selected HLA-incompatible platelet products could provide a comparable alternative to traditional HLA antigen-matched platelet products.
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Affiliation(s)
- Matthew S Karafin
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Jian Zhang
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Section of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pippa Simpson
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Section of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Susan T Johnson
- Diagnostic Laboratories, Versiti Wisconsin, Milwaukee, Wisconsin, USA
| | - Karen L Pierce
- Diagnostic Laboratories, Versiti Wisconsin, Milwaukee, Wisconsin, USA
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27
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Baumann Kreuziger L, Gaddh M, Onadeko O, George G, Wang TF, Oo TH, Jaglal M, Houghton DE, Streiff MB, Gali R, Feng M, Simpson P, Billett HH. Treatment of catheter-related thrombosis in patients with hematologic malignancies: A Venous thromboEmbolism Network U.S. retrospective cohort study. Thromb Res 2021; 202:155-161. [PMID: 33862470 DOI: 10.1016/j.thromres.2021.03.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Optimal treatment of catheter-related thrombosis (CRT) is uncertain in patients with hematologic malignancy. We aimed to evaluate the treatment strategies, outcomes, and predictors of recurrent venous thromboembolism (VTE) associated with catheter-related thrombosis (CRT) in patients with hematologic malignancy. METHODS We performed a multicenter retrospective cohort study of eight institutions through the Venous thromboEmbolism Network US. Patients with hematologic malignancies with documented CRT were identified using ICD-9 and ICD-10 diagnostic codes. Semi-competing risks proportional hazard regression models were created. RESULTS AND CONCLUSIONS Of the 663 patients in the cohort, 124 (19%) were treated with anticoagulation alone, 388 (58%) were treated with anticoagulation and catheter removal, 119 (18%) treated with catheter removal only, and 32 (5%) had neither catheter removal nor anticoagulation. 100 (15%) patients experienced a recurrent VTE event. In the 579 patients who had catheter removal, the most common reason for catheter removal was the CRT [392 (68%)]. For subjects who received any anticoagulation (n = 512), total anticoagulation duration was not associated with VTE recurrence [1.000 (0.999-1.002)]. After adjustment patients treated with catheter removal only had an increased risk of VTE recurrence [2.50 (1.24-5.07)] and death [4.96 (2.47-9.97)]. Patients with no treatment had increased risk of death [16.81 (6.22-45.38)] and death after VTE recurrence [27.29 (3.13-238.13)]. In this large, multicenter retrospective cohort, we found significant variability in the treatment of CRT in patients with hematologic malignancy. Treatment without anticoagulation was associated with recurrent VTE.
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Affiliation(s)
| | - Manila Gaddh
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | | | - Gemlyn George
- Medical College of Wisconsin, Department of Medicine/Hematology and Oncology, Milwaukee, WI, USA
| | - Tzu-Fei Wang
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Thein H Oo
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Jaglal
- Division of Hematology and Oncology, Department of Hematology and Oncology, Morsani College of Medicine, Moffitt Cancer Center, Tampa, FL, USA
| | - Damon E Houghton
- Department of Cardiovascular Diseases, Division of Vascular Medicine & Department of Medicine, Division of Hematology/Oncology, Mayo Clinic, Rochester, MN, USA
| | - Michael B Streiff
- Division of Hematology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Radhika Gali
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mingen Feng
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Pippa Simpson
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Henny H Billett
- Albert Einstein College of Medicine, Bronx, NY, USA; Montefiore Medical Center, New York City, NY, USA
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28
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Cain MT, Smith NJ, Barash M, Simpson P, Durham LA, Makker H, Roberts C, Falcucci O, Wang D, Walker R, Ahmed G, Brown SA, Nanchal RS, Joyce DL. Extracorporeal Membrane Oxygenation with Right Ventricular Assist Device for COVID-19 ARDS. J Surg Res 2021; 264:81-89. [PMID: 33789179 PMCID: PMC7969863 DOI: 10.1016/j.jss.2021.03.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 01/08/2023]
Abstract
Background: Right ventricular failure is an underrecognized consequence of COVID-19 pneumonia. Those with severe disease are treated with extracorporeal membrane oxygenation (ECMO) but with poor outcomes. Concomitant right ventricular assist device (RVAD) may be beneficial. Methods: A retrospective analysis of intensive care unit patients admitted with COVID-19 ARDS (Acute Respiratory Distress Syndrome) was performed. Nonintubated patients, those with acute kidney injury, and age > 75 were excluded. Patients who underwent RVAD/ECMO support were compared with those managed via invasive mechanical ventilation (IMV) alone. The primary outcome was in-hospital mortality. Secondary outcomes included 30-d mortality, acute kidney injury, length of ICU stay, and duration of mechanical ventilation. Results: A total of 145 patients were admitted to the ICU with COVID-19. Thirty-nine patients met inclusion criteria. Of these, 21 received IMV, and 18 received RVAD/ECMO. In-hospital (52.4 versus 11.1%, P = 0.008) and 30-d mortality (42.9 versus 5.6%, P= 0.011) were significantly lower in patients treated with RVAD/ECMO. Acute kidney injury occurred in 15 (71.4%) patients in the IMV group and zero RVAD/ECMO patients (P< 0.001). ICU (11.5 versus 21 d, P= 0.067) and hospital (14 versus 25.5 d, P = 0.054) length of stay were not significantly different. There were no RVAD/ECMO device complications. The duration of mechanical ventilation was not significantly different (10 versus 5 d, P = 0.44). Conclusions: RVAD support at the time of ECMO initiation resulted in the no secondary end-organ damage and higher in-hospital and 30-d survival versus IMV in specially selected patients with severe COVID-19 ARDS. Management of severe COVID-19 ARDS should prioritize right ventricular support.
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Affiliation(s)
- Michael T Cain
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nathan J Smith
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Mark Barash
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pippa Simpson
- Department of Pediatrics, Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lucian A Durham
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Hemanckur Makker
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christopher Roberts
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Octavio Falcucci
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dong Wang
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rebekah Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gulrayz Ahmed
- Department of Medicine, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sherry-Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rahul S Nanchal
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David L Joyce
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Lewis ME, Jubb B, Simpson P, Lopatukhin A, Kireev D, Bobkova M, Craig C, van der Ryst E, Westby M, Butler SL. Highly prevalent Russian HIV-1 V3-loop sequence variants are susceptible to maraviroc. Antivir Chem Chemother 2021; 29:20402066211025156. [PMID: 34160290 PMCID: PMC8236768 DOI: 10.1177/20402066211025156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/26/2021] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Maraviroc inhibits CCR5-tropic HIV-1 across different subtypes in vitro and has demonstrated efficacy in clinical trials. V3-loop amino acid variants observed in individual maraviroc-resistant viruses have not been found to be predictive of reduced susceptibility. Sequence-database searches have demonstrated that approximately 7.3% of viruses naturally encode these variants, raising concerns regarding potential pre-existing resistance. A study from Russia reported that combinations of these same amino acids are present in the V3 loops of the Russian variant subtype A (IDU-A, now A6) with a much greater prevalence (range: 74.4%-92.3%) depending on the combination. However, these studies and database searches did not include phenotypic evaluation. METHODS Sixteen Russian HIV-1 isolates (including sub-subtype A6 viruses) were assessed for V3 loop sequence and phenotypic susceptibility to maraviroc. RESULTS All 12 of the A6 viruses and 2/4 subtype B isolates encoded V3-loop variants that have previously been identified in individual virus isolates with reduced susceptibility to maraviroc. However, despite the prevalence of these V3-loop amino acid variants among the tested viruses, phenotypic sensitivity to maraviroc was observed in all instances. Similarly, reduced susceptibility to maraviroc was not found in virus from participants who experienced virologic failure in a clinical study of maraviroc in Russia (A4001101, [NCT01275625]). DISCUSSION Altogether, these data confirm that the presence of individual or combinations of V3-loop amino acid residues in sub-subtype A6 viruses alone does not predict natural resistance to maraviroc and that V3-loop genotype analysis of R5 virus prior to treatment is not helpful in predicting clinical outcome.
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Affiliation(s)
- ME Lewis
- Pfizer Global Research and Development, Sandwich Labs, Sandwich, UK
- The Research Network Ltd, Sandwich, UK
| | - B Jubb
- Pfizer Global Research and Development, Sandwich Labs, Sandwich, UK
| | - P Simpson
- Pfizer Global Research and Development, Sandwich Labs, Sandwich, UK
| | - A Lopatukhin
- HIV Research Group, Central Research Institute of Epidemiology, Moscow, Russia
| | - D Kireev
- HIV Research Group, Central Research Institute of Epidemiology, Moscow, Russia
| | - M Bobkova
- Laboratory of Virus Leucosis, Ivanovsky Institute of Virology, Moscow, Russia
| | - C Craig
- Pfizer Global Research and Development, Sandwich Labs, Sandwich, UK
- The Research Network Ltd, Sandwich, UK
| | - E van der Ryst
- Pfizer Global Research and Development, Sandwich Labs, Sandwich, UK
- The Research Network Ltd, Sandwich, UK
| | - M Westby
- Pfizer Global Research and Development, Sandwich Labs, Sandwich, UK
| | - SL Butler
- Pfizer Global Research and Development, Sandwich Labs, Sandwich, UK
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Wolfgram P, Zhang L, Simpson P, Fiallo-Scharer R. Clinical associations of quarterly Patient Health Questionnaire-9 depression screening results in adolescents with type 1 diabetes. Pediatr Diabetes 2020; 21:871-877. [PMID: 32277561 DOI: 10.1111/pedi.13017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 10/18/2019] [Revised: 03/06/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Awareness of comorbid depression in type 1 diabetes (T1D) patients is necessary to optimize health and diabetes care. Depression can occur or recur requiring regular review for depression symptoms. A validated tool to screen adolescents for symptoms of depression is the Patient Health Questionnaire (PHQ)-9 Modified for Teens (PHQ91-9 ). METHODS PHQ91-9 depression screen results, depression-related ICD-codes, demographic data, and information on complications and comorbidities of adolescents ≥11 years old with T1D were obtained. Longitudinal and single observation multivariable analyses identified associations of covariates with positive PHQ91-9 depression screens. RESULTS 5032 PHQ91-9 surveys were completed by 1225 unique participants. Overall, 6% (286/5032) of the PHQ91-9 depression screens were positive, and 60% (171/286) of the positive screens occurred in 107 unique patients without documented depression. In the longitudinal analysis, positive PHQ91-9 screens were associated (P < .05) with a diagnosis of depression listed in the medical record (OR 9.8), diabetic retinopathy (OR 4.3), female sex (OR 1.9), and use of an insulin pump (OR 0.5), while the single observation analysis at the time of a positive PHQ91-9 indicated presence of depression in the medical record (odds ratio 12.1), female sex (OR 1.9), and obesity (OR 1.8) were significantly (P < .05) associated with positive PHQ91-9 results. CONCLUSION Quarterly PHQ91-9 depression screening of adolescents with T1D during routine clinic visits can immediately inform care, and previous diagnosis of depression is the most strongly associated covariate, highlighting the importance of documenting depression in the medical record. Additionally, awareness for higher odds of positive PHQ91-9 depression screens in females, obese adolescent, and patients on insulin injections is important.
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Affiliation(s)
- Peter Wolfgram
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Liyun Zhang
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Krasaelap A, Sood MR, Li BUK, Unteutsch R, Yan K, Nugent M, Simpson P, Kovacic K. Efficacy of Auricular Neurostimulation in Adolescents With Irritable Bowel Syndrome in a Randomized, Double-Blind Trial. Clin Gastroenterol Hepatol 2020; 18:1987-1994.e2. [PMID: 31622740 DOI: 10.1016/j.cgh.2019.10.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/25/2019] [Accepted: 10/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Auricular neurostimulation therapy, in which a noninvasive device delivers percutaneous electrical nerve field stimulation (PENFS) to the external ear, is effective in pediatric patients with functional abdominal pain disorders. Preclinical studies showed that PENFS modulates central pain pathways and attenuates visceral hyperalgesia. We evaluated the efficacy of PENFS in adolescents with irritable bowel syndrome (IBS). METHODS We analyzed data from pediatric patients with IBS who participated in a double-blind trial at a tertiary care gastroenterology clinic from June 2015 through November 2016. Patients were randomly assigned to groups that received PENFS (n = 27; median age, 15.3 y; 24 female) or a sham stimulation (n = 23; median age, 15.6 y; 21 female), 5 days/week for 4 weeks. The primary endpoint was number of patients with a reduction of 30% or more in worst abdominal pain severity after 3 weeks. Secondary endpoints were reduction in composite abdominal pain severity score, reduction in usual abdominal pain severity, and improvement in global symptom based on a symptom response scale (-7 to +7; 0 = no change) after 3 weeks. RESULTS Reductions of 30% or more in worst abdominal pain were observed in 59% of patients who received PENFS vs 26% of patients who received the sham stimulation (P = .024). The patients who received PENFS had a composite pain median score of 7.5 (interquartile range [IQR], 3.6-14.4) vs 14.4 for the sham group (IQR, 4.5-39.2) (P = .026) and a usual pain median score of 3.0 (IQR, 3.0-5.0) vs 5.0 in the sham group (IQR, 3.0-7.0) (P = .029). A symptom response scale score of 2 or more was observed in 82% of patients who received PENFS vs 26% of patients in the sham group (P ≤ .001). No significant side effects were reported. CONCLUSIONS Auricular neurostimulation reduces abdominal pain scores and improves overall wellbeing in adolescents with IBS. PENFS is a noninvasive treatment option for pediatric patients with functional bowel disorders. ClinicalTrials.gov no: NCT02367729.
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Affiliation(s)
- Amornluck Krasaelap
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Manu R Sood
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - B U K Li
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rachel Unteutsch
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ke Yan
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Melodee Nugent
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pippa Simpson
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Katja Kovacic
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Clement ND, Bell A, Simpson P, Macpherson G, Patton JT, Hamilton DF. Robotic-assisted unicompartmental knee arthroplasty has a greater early functional outcome when compared to manual total knee arthroplasty for isolated medial compartment arthritis. Bone Joint Res 2020; 9:15-22. [PMID: 32435451 PMCID: PMC7229306 DOI: 10.1302/2046-3758.91.bjr-2019-0147.r1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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] [Indexed: 12/03/2022] Open
Abstract
Aims The primary aim of the study was to compare the knee-specific functional outcome of robotic unicompartmental knee arthroplasty (rUKA) with manual total knee arthroplasty (mTKA) for the management of isolated medial compartment osteoarthritis. Secondary aims were to compare length of hospital stay, general health improvement, and satisfaction between rUKA and mTKA. Methods A powered (1:3 ratio) cohort study was performed. A total of 30 patients undergoing rUKA were propensity score matched to 90 patients undergoing mTKA for isolated medial compartment arthritis. Patients were matched for age, sex, body mass index (BMI), and preoperative function. The Oxford Knee Score (OKS) and EuroQol five-dimension questionnaire (EQ-5D) were collected preoperatively and six months postoperatively. The Forgotten Joint Score (FJS) and patient satisfaction were collected six months postoperatively. Length of hospital stay was also recorded. Results There were no significant differences in the preoperative demographics (p ⩾ 0.150) or function (p ⩾ 0.230) between the groups. The six-month OKS was significantly greater in the rUKA group when compared with the mTKA group (difference 7.7, p < 0.001). There was also a greater six-month postoperative EQ-5D (difference 0.148, p = 0.002) and FJS (difference 24.2, p < 0.001) for the rUKA when compared to the mTKA. No patient was dissatisfied in the rUKA group and five (6%) were dissatisfied in the mTKA, but this was not significant (p = 0.210). Length of stay was significantly (p < 0.001) shorter in the rUKA group (median two days, interquartile range (IQR) 1 to 3) compared to the mTKA (median four days, IQR 3 to 5). Conclusion Patients with isolated medial compartment arthritis had a greater knee-specific functional outcome and generic health with a shorter length of hospital stay after rUKA when compared to mTKA. Cite this article: Bone Joint Res 2019;9(1):15–22.
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Affiliation(s)
- N D Clement
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Bell
- Spire Murrayfield Hospital, Edinburgh, UK
| | - P Simpson
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK. Spire Murrayfield Hospital, Edinburgh, UK
| | - G Macpherson
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK. Spire Murrayfield Hospital, Edinburgh, UK
| | - J T Patton
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK. Spire Murrayfield Hospital, Edinburgh, UK
| | - D F Hamilton
- Department of Orthopaedics, University of Edinburgh, University of Edinburgh, Edinburgh, UK
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Karafin MS, Simpson P, Field JJ. Chronic Pain Does Not Impact Baseline Circulating Cytokine Levels in Adults with Sickle Cell Disease. Acta Haematol 2020; 144:111-116. [PMID: 32403100 DOI: 10.1159/000507563] [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] [Received: 01/10/2020] [Accepted: 03/29/2020] [Indexed: 11/19/2022]
Abstract
Chronic pain affects 50% of adults with sickle cell disease (SCD). Although inflammation is thought to contribute to the pathogenesis of chronic pain, no studies have examined the differences in circulating cytokines between patients with SCD with and without chronic pain. We performed an observational cohort study using blood and urine samples from adults with SCD with and without chronic pain at their usual state of health. We tested the hypothesis that, compared to those without chronic pain, those with chronic pain would have significantly higher baseline circulating proinflammatory cytokines. A total of 61 adults with SCD, 40 with chronic pain and 21 without chronic pain were tested. When SCD patients with chronic pain were compared to those without chronic pain, no significant differences in cytokine levels were noted. The variables most associated with the diagnosis of chronic pain in this population were opioid dose and subject age.
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Affiliation(s)
- Matthew S Karafin
- Medical Sciences Institute, Versiti, Milwaukee, Wisconsin, USA,
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA,
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joshua J Field
- Medical Sciences Institute, Versiti, Milwaukee, Wisconsin, USA
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Simpson P, McCart Reed A, Kutasovic J, Coorey C, Kuo L, Nguyen H, Pei W, Ong J, Sokolova A, Evans E, Porter A, Lakhani S. 52P Characterising clinicopathological and biological parameters predictive of outcome for patients diagnosed with invasive lobular carcinoma. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.186] [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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Becktell K, Simpson P, Phelan R, Schmidt D, Anderson L, Nichols J, Bingen K. Developmental differences in health-related quality of life in adolescent and young adult cancer survivors. Qual Life Res 2020; 29:2435-2444. [PMID: 32323061 DOI: 10.1007/s11136-020-02507-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Adolescents and young adults (AYAs) experience developmental transitions. AYA survivors of cancer are at risk for chronic health conditions due to treatment. This study examined developmental differences in AYA survivors' health-related quality of life (HRQOL) between age groups and compared to population norms. METHODS HRQOL was assessed in AYA survivors of cancer (diagnosed before age 30) in long-term follow-up. Cancer survivors who were 12-39 years old at survey completion and completed therapy ≥ 2 years ago were included. HRQOL was assessed using the PedsQL™ and FACT. RESULTS Sample size was 155 survivors. PedsQL™ school functioning was worse in 15-17 year olds compared to 12-14 year olds (66.35 vs 77.60, p = 0.012). Compared to population norms, PedsQL™ outcomes were only worse in survivors' school functioning. Survivors' 18-39 years old had FACT scores that were better than population norms for overall HRQOL (91.33 vs 80.1, p < 0.001), and in physical (24.22 vs 22.7, p < 0.001), social (23.46 vs 19.1, p < 0.001), and functional well-being (22.94 vs 18.5, p < 0.001). Regression analysis identified that survivors who were < 15 years old and had not relapsed, and survivors who were 15-18 years old and had ≥ 2 late effects are at highest risk of lower HRQOL. For older survivors the highest risk group for lower HRQOL were < 21 years old at survey completion, > 7 years old at diagnosis and > 6 years post therapy. CONCLUSION A trend in school functioning issues in older adolescent survivors emerged. Older survivors show improved HRQOL when compared to the general population. Those further off therapy are at risk of poor HRQOL.
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Affiliation(s)
- Kerri Becktell
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd, MFRC3018, Milwaukee, WI, 53226, USA.
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd, MFRC3018, Milwaukee, WI, 53226, USA
| | - Rachel Phelan
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd, MFRC3018, Milwaukee, WI, 53226, USA
| | - Deb Schmidt
- Children's Hospital of Wisconsin, MFRC3018, PO Box 1997, Milwaukee, WI, 53201, USA
| | - Lynnette Anderson
- Children's Hospital of Wisconsin, MFRC3018, PO Box 1997, Milwaukee, WI, 53201, USA
| | - Julie Nichols
- Children's Hospital of Wisconsin, MFRC3018, PO Box 1997, Milwaukee, WI, 53201, USA
| | - Kristin Bingen
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd, MFRC3018, Milwaukee, WI, 53226, USA
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Field JJ, Kassim A, Brandow A, Embury SH, Matsui N, Wilkerson K, Bryant V, Zhang L, Simpson P, DeBaun MR. Phase 2 trial of montelukast for prevention of pain in sickle cell disease. Blood Adv 2020; 4:1159-1165. [PMID: 32208487 PMCID: PMC7094028 DOI: 10.1182/bloodadvances.2019001165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/28/2020] [Indexed: 12/23/2022] Open
Abstract
Cysteinyl leukotrienes (CysLTs) are lipid mediators of inflammation. In patients with sickle cell disease (SCD), levels of CysLTs are increased compared with controls and associated with a higher rate of hospitalization for pain. We tested the hypothesis that administration of the CysLT receptor antagonist montelukast would improve SCD-related comorbidities, including pain, in adolescents and adults with SCD. In a phase 2 randomized trial, we administered montelukast or placebo for 8 weeks. The primary outcome measure was a >30% reduction in soluble vascular cell adhesion molecule 1 (sVCAM), a marker of vascular injury. Secondary outcome measures were reduction in daily pain, improvement in pulmonary function, and improvement in microvascular blood flow, as measured by laser Doppler velocimetry. Forty-two participants with SCD were randomized to receive montelukast or placebo for 8 weeks. We found no difference between the montelukast and placebo groups with regard to the levels of sVCAM, reported pain, pulmonary function, or microvascular blood flow. Although montelukast is an effective treatment for asthma, we did not find benefit for SCD-related outcomes. This clinical trial was registered at www.clinicaltrials.gov as #NCT01960413.
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Affiliation(s)
- Joshua J Field
- Medical Sciences Institute, Versiti Wisconsin, Milwaukee, WI
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Adetola Kassim
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Amanda Brandow
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | | | - Neil Matsui
- Vanguard Therapeutics, Inc., Half Moon Bay, CA; and
| | - Karina Wilkerson
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Valencia Bryant
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Liyun Zhang
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Michael R DeBaun
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
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Lerret SM, White-Traut R, Medoff-Cooper B, Simpson P, Adib R, Ahamed SI, Schiffman R. Pilot study protocol of a mHealth self-management intervention for family members of pediatric transplant recipients. Res Nurs Health 2020; 43:145-154. [PMID: 31985067 DOI: 10.1002/nur.22010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/30/2019] [Indexed: 01/19/2023]
Abstract
Solid-organ transplantation is the treatment of choice for end-stage organ failure. Parents of pediatric transplant recipients who reported a lack of readiness for discharge had more difficulty coping and managing their child's medically complex care at home. In this paper, we describe the protocol for the pilot study of a mHealth intervention (myFAMI). The myFAMI intervention is based on the Individual and Family Self-Management Theory and focuses on family self-management of pediatric transplant recipients at home. The purpose of the pilot study is to test the feasibility of the myFAMI intervention with family members of pediatric transplant recipients and to test the preliminary efficacy on postdischarge coping through a randomized controlled trial. The sample will include 40 family units, 20 in each arm of the study, from three pediatric transplant centers in the United States. Results from this study may advance nursing science by providing insight for the use of mHealth to facilitate patient/family-nurse communication and family self-management behaviors for family members of pediatric transplant recipients.
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Affiliation(s)
- Stacee M Lerret
- Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rosemary White-Traut
- Department of Nursing Research, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | - Pippa Simpson
- Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Riddhiman Adib
- Department of Mathematics, Statistics, and Computer Science, Marquette University, Milwaukee, Wisconsin
| | - Sheikh Iqbal Ahamed
- Department of Mathematics, Statistics, and Computer Science, Marquette University, Milwaukee, Wisconsin
| | - Rachel Schiffman
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
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Curiale MS, Gangar V, D’onorio A, Gambrel-Lenarz S, Mcallister JS, Bailey B, Bednar AM, Bowen B, Brown D, Bulthaus M, Cash J, Cirigliano M, Cox M, D’onorio A, David OE, Fraser J, Frye K, Gangar V, Gambrel-Lenarz S, Hanlin J, Helbig T, Johnson J, Jost-Keating K, Kora L, Koeritzer R, Kozlowski S, Kraemer M, Lally S, Lambeth B, Lawlor K, Lewandowski V, Lopez S, McDonald S, Mclntyre S, Naq M, Pierson M, Reinhard J, Richter D, Saunders L, Simpson P, Smoot L, Tong MS, Warburton D, Williams H, Wilson-Perry A, Yuan J. High-Sensitivity Dry Rehydratable Film Method for Enumeration of Coliforms in Dairy Products: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/80.3.505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
A dry-film coliform count plate that is inoculated with 5 mL sample was compared with the Violet Red Bile Agar plate method in a collaborative study by 18 laboratories. Products analyzed were 2% milk, chocolate milk, cream, vanilla ice cream, cottage cheese, and cheese. Collaborators tested blind duplicate uninoculated samples and samples inoculated at low, medium, and high level. Significantly (P< 0.05) higher numbers of coliforms were recovered by the dry-film method from 2% milk samples at the 3 inoculum levels, the chocolate milk at the low- and high-inoculum levels, and the cream at the high-inoculum level. Significantly higher counts were obtained by the agar method for cottage cheese samples at the low-inoculum level. The repeatability standard deviation for the dry-film method was significantly higher for the high-inoculum level chocolate milk sample and the medium-inoculum level cottage cheese. The same statistic was significantly higher for the agar method at all 3 inoculum levels in the 2% milk and the medium-inoculum level cream. The high-sensitivity dry rehydratable film method for enumeration of coliforms in dairy products has been adopted first action by AOAC INTERNATIONAL.
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Affiliation(s)
- Michael S Curiale
- Silliker Laboratories Group, Inc., Corporate Research Center, 160 Armory Dr, South Holland, IL 60473
| | - Vidhya Gangar
- Silliker Laboratories Group, Inc., Corporate Research Center, 160 Armory Dr, South Holland, IL 60473
| | - Armando D’onorio
- Silliker Laboratories Group, Inc., Corporate Research Center, 160 Armory Dr, South Holland, IL 60473
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Abstract
OBJECTIVES To identify whether advanced maternal age (AMA), defined as age ≥35 years old, is independently associated with small for gestational age (SGA). STUDY DESIGN This was a retrospective cohort of births from the National Vital Statistics System in the United States from 2009 to 2013. Women were categorized based on four age groups at the time of delivery: 20 to 29, 30 to 34, 35 to 39, and ≥40 years old. The primary outcome of SGA < 10th and SGA < 5th percentiles was compared between the four groups using both univariable and multivariable analyses to determine whether maternal age was associated with SGA independent of parity. RESULTS A total of 17,031,005 births were eligible for analysis, with 2,705,501 births to AMA women. In multivariable analyses, maternal age of 30 to 34, compared with 20 to 29, was associated with lower rates of SGA < 10th and <5th percentiles (adjusted odds ratio [aOR] = 0.95; 95% confidence interval [CI]: 0.95-0.96 and aOR = 0.97; 95% CI: 0.96-0.98, respectively). The AMA of 35 to 39, compared with 20 to 29, was associated with lower rates of SGA < 10th percentile and unchanged rates of SGA < 5th percentile (aOR = 0.97; 95% CI: 0.96-0.98 and aOR = 1; 95% CI: 0.99-1.01, respectively). In contrast, AMA of ≥40, compared with age 20 to 29, was associated with higher rates of both SGA < 10th and <5th percentiles (aOR = 1.06; 95% CI: 1.04-1.07 and aOR = 1.14; 95% CI: 1.12-1.16, respectively). A significant association was found between maternal age and parity toward the risk of SGA (p < 0.001). Nulliparous women ≥30 years old but not multiparous women had higher rates of SGA < 10th and SGA < 5th percentiles compared with nulliparous women in the age group of 20 to 29. In contrast, both nulliparous and multiparous women age ≥40 years old had an increased risk for SGA < 5th percentile compared with all women in the age group of 20 to 29. CONCLUSION Nulliparous women aged 30 years and older have higher risk of SGA < 10th and SGA < 5th percentiles compared with nulliparous women age 20 to 29. In contrast, both nulliparous and multiparous women age 40 years and older have an increased risk of SGA < 5th percentile compared with all women in the age group of 20 to 29.
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Affiliation(s)
- Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI
| | - Sarah De Cicco
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI
| | - Liyun Zhang
- Department of Pediatrics, Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI
| | - Pippa Simpson
- Department of Pediatrics, Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI
| | - Judith Hibbard
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI
| | - Leonard E Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
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Tinklenberg JA, Siebers EM, Beatka MJ, Fickau BA, Ayres S, Meng H, Yang L, Simpson P, Granzier HL, Lawlor MW. Myostatin Inhibition Using ActRIIB-mFc Does Not Produce Weight Gain or Strength in the Nebulin Conditional KO Mouse. J Neuropathol Exp Neurol 2019; 78:130-139. [PMID: 30597051 DOI: 10.1093/jnen/nly120] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Mutations in at least 12 genes are responsible for a group of congenital skeletal muscle diseases known as nemaline myopathies (NMs). NMs are associated with a range of clinical symptoms and pathological changes often including the presence of cytoplasmic rod-like structures (nemaline bodies) and myofiber hypotrophy. Our recent work has identified a variable degree of behavioral benefit when treating 2 NM mouse models due to mutations in Acta1 with myostatin inhibition. This study is focused on the effects of delivering ActRIIB-mFc (Acceleron; a myostatin inhibitor) to the nebulin conditional knockout KO (Neb cKO) mouse model of NM. Treatment of Neb cKO mice with ActRIIB-mFc did not produce increases in weight gain, strength, myofiber size, or hypertrophic pathway signaling. Overall, our studies demonstrate a lack of response in Neb cKO mice to myostatin inhibition, which differs from the response observed when treating other NM models.
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Affiliation(s)
- Jennifer A Tinklenberg
- Division of Pediatric Pathology, Department of Pathology and Laboratory Medicine.,Neuroscience Research Center Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Emily M Siebers
- Division of Pediatric Pathology, Department of Pathology and Laboratory Medicine.,Neuroscience Research Center Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Margaret J Beatka
- Division of Pediatric Pathology, Department of Pathology and Laboratory Medicine.,Neuroscience Research Center Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brittany A Fickau
- Division of Pediatric Pathology, Department of Pathology and Laboratory Medicine.,Neuroscience Research Center Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Samuel Ayres
- Division of Pediatric Pathology, Department of Pathology and Laboratory Medicine.,Neuroscience Research Center Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Hui Meng
- Division of Pediatric Pathology, Department of Pathology and Laboratory Medicine
| | - Lin Yang
- Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Pippa Simpson
- Division of Pediatric Pathology, Department of Pathology and Laboratory Medicine
| | - Henk L Granzier
- Division of Quantitative Health Sciences, Department of Pediatrics Medical College of Wisconsin, Milwaukee, Wisconsin (PS); and College of Medicine, University of Arizona, Tucson, Arizona
| | - Michael W Lawlor
- Division of Pediatric Pathology, Department of Pathology and Laboratory Medicine.,Neuroscience Research Center Medical College of Wisconsin, Milwaukee, Wisconsin
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Vepraskas SH, O'Day P, Zhang L, Simpson P, Gage S. Parents Support Teach-back, Demonstration, and a Postdischarge Phone Call to Augment Discharge Education. Hosp Pediatr 2019; 8:778-784. [PMID: 30464003 DOI: 10.1542/hpeds.2018-0119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To identify caregiver preferences for discharge education components, content, and techniques. METHODS Before discharge education, a 9-question structured interview was performed with caregivers of children from 2 populations admitted to the hospital medicine service: patients with asthma (age 2-17 years) or children who were not dependent on technology (age <2 years). McNemar's tests were used to evaluate for significant differences between response options. Open coding was used for theme development to interpret qualitative responses about information caregivers wished to receive before leaving the hospital. RESULTS The interview was administered to 100 caregivers. More than 90% of caregivers believed that instruction regarding follow-up appointments, medications, and reasons to call the pediatrician or return to the emergency department were important aspects of discharge education. Caregivers also identified a desire for education on their child's condition, care at home, and illness prevention. Most caregivers reported that teach-back, early discharge education, and a postdischarge phone call would be beneficial. Caregivers varied in their preferences for written, verbal, and video instruction, whereas live demonstration was rated almost universally as an effective method by 97% of caregivers (P < .0001). CONCLUSIONS In our study, we provide insight into caregivers' perspectives on the content, timing, and style of education needed to promote a safe transition of care from the hospital to the home. These findings add caregiver support to the expert consensus in Project Improving Pediatric Patient-Centered Care Transitions and elucidate additional themes to aid in further study and optimization of discharge education.
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Affiliation(s)
- Sarah H Vepraskas
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Peter O'Day
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Liyun Zhang
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Sandra Gage
- Phoenix Children's Hospital, Phoenix, Arizona
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Liberio N, Robinson H, Nugent M, Simpson P, Margolis DA, Malarkannan S, Keever-Taylor C, Thakar MS. Single-center experience suggests donor lymphocyte infusion may promote long-term survival in children with high-risk acute lymphoblastic leukemia. Pediatr Blood Cancer 2019; 66:e27950. [PMID: 31368194 PMCID: PMC6754268 DOI: 10.1002/pbc.27950] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 04/10/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Donor lymphocyte infusion (DLI) is often used to treat leukemic relapse after hematopoietic cell transplantation (HCT). However, the relationship between outcomes and distinct DLI cellular composition has not been previously reported. Additionally, there are limited published data on efficacy in pediatrics. We evaluated whether DLI cellular content and development of graft-versus-host disease (GVHD) impacted disease and influenced overall survival (OS) in children receiving DLI for recurrent leukemia. METHODS We performed an Institutional Review Board-approved, retrospective study investigating all consecutive DLIs given to patients at the Children's Hospital of Wisconsin between 1980 and 2018. Analyses were conducted using Mann-Whitney, Fisher exact, and chi-square tests. RESULTS Thirty patients ≤20 years old with hematologic malignancies (myeloid [AML/MDS/CML/JMML], n = 23; lymphoid [ALL], n = 7) received DLI to treat post-transplant relapse. We found no significant difference in OS or development of GVHD based on CD3, CD4, CD8, CD56, or CD19 DLI cellular composition. With a median follow-up of 0.69 (range, 0.04-16.61) years, OS at five years was 32% ± 9%. The lymphoid group had a five-year survival rate at 71% ± 17% compared with the myeloid group at 22% ± 9%, although not statistically significant (P = 0.11). The development of GVHD did not affect OS (P = 0.62). CONCLUSION Here, we report a single-center, long-term experience of pediatric DLIs. Surprisingly, many children with ALL were able to achieve durable remissions. Although cellular composition did not have a significant effect on GVHD or OS in our small study, engineering DLI products to maximize specific effector cell populations could be one strategy to improve efficacy.
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Affiliation(s)
- Nicole Liberio
- Department of Pediatrics, Medical College of Wisconsin, Blood Research Institute, Blood Center of Wisconsin, Milwaukee
| | - Haley Robinson
- Department of Pediatrics, Medical College of Wisconsin, Blood Research Institute, Blood Center of Wisconsin, Milwaukee
| | - Melodee Nugent
- Department of Pediatrics, Medical College of Wisconsin, Blood Research Institute, Blood Center of Wisconsin, Milwaukee
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, Blood Research Institute, Blood Center of Wisconsin, Milwaukee
| | - David A. Margolis
- Department of Pediatrics, Medical College of Wisconsin, Blood Research Institute, Blood Center of Wisconsin, Milwaukee
| | - Subramaniam Malarkannan
- Department of Pediatrics, Medical College of Wisconsin, Blood Research Institute, Blood Center of Wisconsin, Milwaukee,Department of Medicine, and Medical College of Wisconsin, Blood Research Institute, Blood Center of Wisconsin, Milwaukee,Department of Microbiology and Immunology, Medical College of Wisconsin and Blood Research Institute, Blood Center of Wisconsin, Milwaukee,Laboratory of Molecular Immunology and Immunotherapy, Blood Research Institute, Blood Center of Wisconsin, Milwaukee
| | - Carolyn Keever-Taylor
- Department of Medicine, and Medical College of Wisconsin, Blood Research Institute, Blood Center of Wisconsin, Milwaukee
| | - Monica S. Thakar
- Department of Pediatrics, Medical College of Wisconsin, Blood Research Institute, Blood Center of Wisconsin, Milwaukee,Laboratory of Molecular Immunology and Immunotherapy, Blood Research Institute, Blood Center of Wisconsin, Milwaukee
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Aminzadeh Z, Simpson P, Athan E. Central venous catheter associated blood stream infections (CVC-BSIs) in the non-intensive care settings: Epidemiology, microbiology and outcomes. Infect Dis Health 2019; 24:222-228. [DOI: 10.1016/j.idh.2019.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/04/2019] [Accepted: 07/07/2019] [Indexed: 12/23/2022]
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McAndrew S, Acharya K, Westerdahl J, Brousseau DC, Panepinto JA, Simpson P, Leuthner J, Lagatta JM. A Prospective Study of Parent Health-Related Quality of Life before and after Discharge from the Neonatal Intensive Care Unit. J Pediatr 2019; 213:38-45.e3. [PMID: 31256914 PMCID: PMC6765405 DOI: 10.1016/j.jpeds.2019.05.067] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/28/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine how infant illness and parent demographics are associated with parent health-related quality of life (HRQL) during and 3 months after hospitalization in the neonatal intensive care unit (NICU). We hypothesized that parents of extremely preterm infants would report lower NICU HRQL than other parents, and that all parents would report improved HRQL after discharge. STUDY DESIGN This prospective study of parent-infant dyads admitted to a level IV NICU for ≥14 days from 2016 to 2017 measured parent HRQL before and 3 months after discharge using the Pediatric Quality of Life Inventory Family Impact Module. Multivariable regression was used to identify risk factors associated with HRQL differences during hospitalization and after discharge. RESULTS Of the 194 dyads, 167 (86%) completed the study (24% extremely preterm; 53% moderate to late preterm; 22% term). During the NICU hospitalization, parents of extremely preterm infants reported lower adjusted HRQL (-7 points; P = .013) than other parents. After discharge, parents of extremely preterm infants reported higher HRQL compared with their NICU score (+10 points; P = .001). Tracheostomy (-13; P = .006), home oxygen (-6; P = .022), and readmission (-5; P = .037) were associated with lower parent HRQL 3 months after discharge, adjusted for NICU HRQL score. CONCLUSIONS Parents of extremely preterm infants experienced a greater negative impact on HRQL during the NICU hospitalization and more improvement after discharge than parents of other infants hospitalized in the NICU. Complex home care was associated with lower parent HRQL after discharge. The potential benefit of home discharge should be balanced against the potential negative impact of complex home care.
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Affiliation(s)
- Sarah McAndrew
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee WI
| | - Krishna Acharya
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee WI
| | | | | | | | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee WI
| | - Jonathan Leuthner
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee WI
| | - Joanne M. Lagatta
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee WI
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Rader JS, Pan A, Corbin B, Iden M, Lu Y, Vellano CP, Akbani R, Mills GB, Simpson P. Identification and validation of a prognostic proteomic signature for cervical cancer. Gynecol Oncol 2019; 155:324-330. [PMID: 31477280 DOI: 10.1016/j.ygyno.2019.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To date, The Cancer Genome Atlas (TCGA) has provided the most extensive molecular characterization of invasive cervical cancer (ICC). Analysis of reverse phase protein array (RPPA) data from TCGA samples showed that cervical cancers could be stratified into 3 clusters exhibiting significant differences in survival outcome: hormone, EMT, and PI3K/AKT. The goals of the current study were to: 1) validate the TCGA RPPA results in an independent cohort of ICC patients and 2) to develop and validate an algorithm encompassing a small antibody set for clinical utility. METHODS Subjects consisted of 2 ICC patient cohorts with accompanying RPPA and clinical-pathologic data: 155 samples from TCGA (TCGA-155) and 61 additional, unique samples (MCW-61). Using data from 173 common RPPA antibodies, we replicated Silhouette clustering analysis in both ICC cohorts. Further, an index score for each patient was calculated from the survival-associated antibodies (SAAs) identified using Random survival forests (RSF) and the Cox proportional hazard regression model. Kaplan-Meier survival analysis and the log-rank test were performed to assess and compare cluster or risk group survival outcome. RESULTS In addition to validating the prognostic ability of the proteomic clusters reported by TCGA, we developed an algorithm based on 22 unique antibodies (SAAs) that stratified women with ICC into low-, medium-, or high-risk survival groups. CONCLUSIONS We provide a signature of 22 antibodies which accurately predicted survival outcome in 2 separate groups of ICC patients. Future studies examining these candidate biomarkers in additional ICC cohorts is warranted to fully determine their clinical potential.
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Affiliation(s)
- Janet S Rader
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, United States of America.
| | - Amy Pan
- Department of Pediatrics, Medical College of Wisconsin, United States of America
| | - Bradley Corbin
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, United States of America
| | - Marissa Iden
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, United States of America
| | - Yiling Lu
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, United States of America
| | - Christopher P Vellano
- Translational Research to Advance Therapeutics and Innovation in Oncology Platform, The University of Texas MD Anderson Cancer Center, United States of America
| | - Rehan Akbani
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, United States of America
| | - Gordon B Mills
- Cell, Development and Cancer Biology, Knight Cancer Institute, Oregon Health & Science University, United States of America
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, United States of America
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Hirsch SA, Simpson P, Flynn KE, Nugent M, Kruper A. Optimizing utilization of emotional support during infertility treatment. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.661] [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: 11/28/2022]
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Kovacic K, Kapavarapu PK, Sood MR, Li BUK, Nugent M, Simpson P, Miranda A. Nausea exacerbates symptom burden, quality of life, and functioning in adolescents with functional abdominal pain disorders. Neurogastroenterol Motil 2019; 31:e13595. [PMID: 30957319 DOI: 10.1111/nmo.13595] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/22/2019] [Revised: 03/05/2019] [Accepted: 03/22/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Nausea frequently co-exists with functional abdominal pain disorders (FAPDs) and may be linked to a higher disease burden. This study aimed to prospectively compare multisystem symptoms, quality of life, and functioning in FAPDs with and without nausea. METHODS Adolescents ages 11-18 years fulfilling Rome III criteria for a FAPD were grouped by the presence or absence of chronic nausea. Subjects completed validated instruments assessing nausea (Nausea Profile Questionnaire = NPQ), quality of life (Patient-Reported Outcome Measurement Information System), functioning (Functional Disability Inventory), and anxiety (State-Trait Anxiety Inventory for Children). Group comparisons were performed for instruments, multisystem symptoms, school absences, and clinical diagnoses. KEY RESULTS A total of 112 subjects were included; 71% reported chronic nausea. Patients with Nausea compared to No Nausea had higher NPQ scores (P ≤ 0.001), worse quality of life (P = 0.004), and greater disability (P = 0.02). State and trait anxiety scores were similar (P = 0.57, P = 0.25). A higher NPQ score correlated with poorer quality of life, more disability, and higher anxiety. Specific comorbidities were more common in Nausea vs No Nausea group: dizziness (81% vs 41%; P ≤ 0.001), concentrating difficulties (68% vs 27%; P ≤ 0.001), chronic fatigue (58% vs 20%; P = 0.01), and sleep disturbances (73% vs 48%; P = 0.02). The Nausea group reported more school absences (P = 0.001) and more commonly met criteria for functional dyspepsia (P = 0.034). CONCLUSION AND INFERENCES Nausea co-existing with FAPDs is associated with a higher extra-intestinal symptom burden, worse quality of life, and impaired functioning in children. Assessing and targeting nausea therapeutically is essential to improve outcomes in FAPDs.
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Affiliation(s)
- Katja Kovacic
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Prasanna K Kapavarapu
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Manu R Sood
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - B U K Li
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Melodee Nugent
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pippa Simpson
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Adrian Miranda
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
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Karafin MS, Chen G, Wandersee NJ, Brandow AM, Hurley RW, Simpson P, Ward D, Li SJ, Field JJ. Chronic pain in adults with sickle cell disease is associated with alterations in functional connectivity of the brain. PLoS One 2019; 14:e0216994. [PMID: 31107926 PMCID: PMC6527293 DOI: 10.1371/journal.pone.0216994] [Citation(s) in RCA: 15] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 05/02/2019] [Indexed: 12/21/2022] Open
Abstract
Chronic pain affects 50% of adults with sickle cell disease (SCD). Although central sensitization is thought to contribute to the pathogenesis of this chronic pain, no studies have examined differences in functional connectivity of the brain between patients with SCD with and without chronic pain. We performed an observational cohort study using resting-state functional MRI (rsfMRI) of the brain on adults with SCD with and without chronic pain. We tested the hypothesis that, compared to those without chronic pain, those with chronic pain would have differences in functional connectivity between the periaqueductal grey (PAG) and other regions of the brain. Twenty-two adults with SCD, 15 with chronic pain and 7 without chronic pain, as well as 10 African-American controls, underwent rsfMRI of the brain. When SCD patients with chronic pain were compared to those without chronic pain, significant differences in connectivity were noted between the PAG and 9 regions of the brain, including several in the default mode network, a network involved in introspection that has been implicated in other chronic pain syndromes. Changes in functional connectivity between patients with SCD with and without chronic pain suggest a mechanism for chronic pain that involves neuro-plastic changes to the brain.
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Affiliation(s)
- Matthew S. Karafin
- Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, Wisconsin, United States of America
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- * E-mail:
| | - Guangyu Chen
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Nancy J. Wandersee
- Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Amanda M. Brandow
- Department of Hematology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Robert W. Hurley
- Department of Anesthesia, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Doug Ward
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Shi-Jiang Li
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Joshua J. Field
- Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, Wisconsin, United States of America
- Department of Hematology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
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Becktell K, Phelan R, Schmidt D, Anderson L, Nichols J, Simpson P, Bingen K. Developmental differences in health-related quality of life (HRQL) in adolescent and young adult (AYA) survivors of childhood cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e21524] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21524 Background: AYAs experience many distinct periods of developmental transition within this life stage. AYA survivors of childhood cancer are at risk for chronic physical and psychosocial health conditions due to treatment-related exposures. Few studies have evaluated HRQL differences that may exist among developmental subgroups of AYA cancer survivors. This study examined HRQL differences across AYA developmental subgroups (early teens 12-14 years; late teens 15-17; emerging adults 18-24; young adults 25-39) of long term childhood cancer survivors. Methods: Cancer survivors ages 12-39 years who were seen in a long term follow up clinic at time of survey completion (as part of larger HRQL study) and completed therapy ≥2 years ago were included. HRQL was assessed using PedsQL (< 18) and FACT-G (> 18) measures. Demographic and treatment data were obtained from EMR. Analyses compared HRQL measure scores among AYA age subgroups and investigated predictors of HRQL outcomes. Results: A total of 155 patients were included in analysis. Mean age at survey completion was 17.9 [range 12-33] years. PedsQL school functioning was significantly lower for 15-17 year-old compared to 12-14 year-old survivors (M = 77.60, p = 0.01). There were no differences between 18-24 and 25-39 year-old survivors on the FACT-G. PedsQL school functioning was significantly lower for survivors (< 18) compared to normative data (p = 0.004). FACT-G scores for survivors were significantly higher compared to population norms in all domains (p≤0.001) except emotional well-being. Regression CART analysis indicated survivors who were ≤15 years-old and had not relapsed and survivors who were > 15 years old and had ≥2 late effects had lower PedsQL scores. Survivors who were ≥21 years-old had lower FACT-G scores compared to < 21 years. Survivors who were < 21 years-old, > 7 years-old at diagnosis, and > 6 years from end of treatment had lower FACT-G scores. Conclusions: Adolescent survivors may be at risk for school problems years after cancer treatment. Young adult survivors may be at greater risk of poor HRQL. This study highlights potential developmental differences in HRQL predictors and outcomes in long term AYA cancer survivors.
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Chelimsky G, Rausch S, Bierer D, Feng M, Simpson P, Awe E, Chelimsky T. Cardiovagal modulation in pediatric functional gastrointestinal disorders. Neurogastroenterol Motil 2019; 31:e13564. [PMID: 30916860 DOI: 10.1111/nmo.13564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/21/2018] [Accepted: 01/11/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Though reduced cardiovagal modulation accompanies adult IBS, adolescents with functional gastrointestinal disorders (FGID) have not been studied. We aim to investigate whether adolescents with FGID have reduced cardiovagal modulation. METHODS After 10-minute supine rest, we recorded ECG for 5-minute supine and 5-minute standing without support in healthy and FGID-affected adolescents. After analysis with Kubios 2.2 for high-frequency (hf) and low-frequency (lf) heart rate variability (HRV), Wilcoxon signed-ranks test compared individual paired supine and standing HRV data, while Kruskal-Wallis and Mann-Whitney U tests compared HRV across groups. RESULTS A total of 50 FGID subjects (90% females; median age 17 years [range 11-21]) and 22 healthy comparison group (HC) (59% females; median age 14 years [range 10-18]) participated. Both absolute and relative supine hfHRV exceeded standing in both groups. Absolute supine lfHRV was higher than standing in FGID patients and not in HCs, while relative supine lfHRV power was actually lower in both groups. Compared to HC, FGID group showed significantly lower absolute HRV, while relative HRV did not differ between groups. CONCLUSIONS Cardiovagal modulation is lower in adolescents with FGID. This difference impacts these subjects significantly. Whether this finding reflects a cause or a consequence of FGID is unknown.
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Affiliation(s)
- Gisela Chelimsky
- Division of Gastroenterology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sydnee Rausch
- Division of Gastroenterology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Douglas Bierer
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mingen Feng
- Division of Quanitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pippa Simpson
- Division of Quanitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Elizabeth Awe
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Thomas Chelimsky
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
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