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Gupta R, Khalaf RT, Morrison J, Amankwah E, Ruan W, Fishman DS, Barth BA, Liu QY, Giefer M, Kim KM, Martinez M, Dall'oglio L, Torroni F, De Angelis P, Faraci S, Bitton S, Dua K, Werlin S, Gugig R, Huang C, Mamula P, Quiros JA, Zheng Y, Piester T, Grover A, Fox VL, Wilsey M, Troendle DM. Impact of Trainee Involvement on Pediatric ERCP Procedures: Results From the Pediatric ERCP Initiative. J Pediatr Gastroenterol Nutr 2023; 77:126-130. [PMID: 36976177 DOI: 10.1097/mpg.0000000000003782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
This study examines the role of trainee involvement with pediatric endoscopic retrograde cholangiopancreatography (ERCP) and whether it affects the procedure's success, post-procedural adverse outcomes, and duration. A secondary analysis of the Pediatric ERCP Database Initiative, an international database, was performed. Consecutive ERCPs on children <19 years of age from 18 centers were entered prospectively into the database. In total 1124 ERCPs were entered into the database, of which 320 (28%) were performed by trainees. The results showed that the presence of trainees did not impact technical success ( P = 0.65) or adverse events rates ( P = 0.43). Rates of post-ERCP pancreatitis, pain, and bleeding were similar between groups ( P > 0.05). Fewer cases involving trainees were in the top quartile (>58 minutes) of procedural time (19% vs 26%; P = 0.02). Overall, our findings indicate trainee involvement in pediatric ERCP is safe.
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Affiliation(s)
- Rekha Gupta
- From the Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Racha T Khalaf
- the Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of South Florida Morsani College of Medicine, Tampa, FL
| | - John Morrison
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | | | - Wenly Ruan
- Baylor College of Medicine Texas Children's Hospital, Houston, TX
| | - Douglas S Fishman
- From the Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Bradley A Barth
- the UT Southwestern Medical Center; Children's Health, Children's Medical Center, Dallas, TX
| | - Quin Y Liu
- the Cedars-Sinai Medical Center, Los Angeles, CA
| | - Matthew Giefer
- The University of Queensland, AU-Oschsner Health, New Orleans, LA
| | - Kyung Mo Kim
- University of Ulsan College of Medicine; Asan Medical Center Children's Hospital, Seoul, Republic of Korea
| | - Mercedes Martinez
- Columbia University New York Presbyterian Morgan Stanley Children's Hospital of New York, New York, NY
| | | | | | | | | | - Sam Bitton
- From the Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Kulwinder Dua
- Medical College of Wisconsin; Children's Wisconsin, Milwaukee, WI
| | - Steven Werlin
- Medical College of Wisconsin; Children's Wisconsin, Milwaukee, WI
| | - Roberto Gugig
- Stanford Children's Health; Lucile Packard Children's Hospital Stanford, Palo Alto, CA
| | | | - Petar Mamula
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Yuhua Zheng
- University of Southern California; Children's Hospital of Los Angeles, Los Angeles, CA
| | - Travis Piester
- University of Southern California; Children's Hospital of Los Angeles, Los Angeles, CA
| | - Amit Grover
- From the Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Victor L Fox
- From the Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Michael Wilsey
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - David M Troendle
- the UT Southwestern Medical Center; Children's Health, Children's Medical Center, Dallas, TX
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Trocchia C, Khalaf R, Amankwah E, Ruan W, Fishman DS, Barth BA, Liu QY, Giefer M, Kim KM, Martinez M, Dall'oglio L, Torroni F, De Angelis P, Faraci S, Bitton S, Werlin SL, Dua K, Gugig R, Huang C, Mamula P, Quiros JA, Zheng Y, Piester T, Grover A, Fox VL, Wilsey M, Troendle DM. Pediatric ERCP in the Setting of Acute Pancreatitis: A Secondary Analysis of an International Multicenter Cohort Study. J Pediatr Gastroenterol Nutr 2023; 76:817-821. [PMID: 36913706 PMCID: PMC10198832 DOI: 10.1097/mpg.0000000000003762] [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] [Indexed: 03/15/2023]
Abstract
Previous studies have demonstrated the safety of performing endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric population; however, few have addressed the outcomes of children undergoing ERCP during acute pancreatitis (AP). We hypothesize that ERCP performed in the setting of AP can be executed with similar technical success and adverse event profiles to those in pediatric patients without pancreatitis. Using the Pediatric ERCP Database Initiative, a multi-national and multi-institutional prospectively collected dataset, we analyzed 1124 ERCPs. One hundred and ninety-four (17%) of these procedures were performed in the setting of AP. There were no difference in the procedure success rate, procedure time, cannulation time, fluoroscopy time, or American Society of Anesthesiology class despite patients with AP having higher American Society of Gastrointestinal Endoscopy grading difficulty scores. This study suggests that ERCP can be safely and efficiently performed in pediatric patients with AP when appropriately indicated.
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Affiliation(s)
| | - Racha Khalaf
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - Ernest Amankwah
- From Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Wenly Ruan
- Baylor College of Medicine; Texas Children's Hospital, Houston, TX
| | | | - Bradley A Barth
- the UT Southwestern Medical Center; Children's Health Children's Medical Center, Dallas, TX
| | - Quin Y Liu
- the Cedars-Sinai Medical Center, Los Angeles, CA
| | - Matthew Giefer
- The University of Queensland, AU-Oschsner Health, New Orleans, LA
| | - Kyung Mo Kim
- University of Ulsan College of Medicine; Asan Medical Center Children's Hospital, Seoul, The Republic of Korea
| | - Mercedes Martinez
- Columbia University; New York Presbyterian Morgan Stanley Children's Hospital of New York, New York, NY
| | | | | | | | | | - Sam Bitton
- Zucker School of Medicine at Hofstra/Northwell; Cohen Children's Medical Center, Lake Success, NY
| | - Steven L Werlin
- Medical College of Wisconsin; Children's Wisconsin, Milwaukee, WI
| | - Kulwinder Dua
- Medical College of Wisconsin; Children's Wisconsin, Milwaukee, WI
| | - Roberto Gugig
- Stanford Children's Health, Lucile Packard Children's Hospital Stanford, Palo Alto, CA
| | | | - Petar Mamula
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Yuhua Zheng
- University of Southern California; Children's Hospital of Los Angeles, Los Angeles, CA
| | - Travis Piester
- University of Southern California; Children's Hospital of Los Angeles, Los Angeles, CA
| | - Amit Grover
- Harvard Medical School; Boston Children's Hospital, Boston, MA
| | - Victor L Fox
- Harvard Medical School; Boston Children's Hospital, Boston, MA
| | - Michael Wilsey
- From Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - David M Troendle
- the UT Southwestern Medical Center; Children's Health Children's Medical Center, Dallas, TX
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Piester T, Frymoyer A, Christofferson M, Yu H, Bass D, Park KT. A Mobile Infliximab Dosing Calculator for Therapy Optimization in Inflammatory Bowel Disease. Inflamm Bowel Dis 2018; 24:227-234. [PMID: 29361094 PMCID: PMC6048868 DOI: 10.1093/ibd/izx037] [Citation(s) in RCA: 4] [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: 06/15/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Inadequate infliximab (IFX) drug exposure remains a clinical challenge and leads to high loss of response rates and therapy failure in inflammatory bowel disease (IBD). We aimed to determine the feasibility and pilot effectiveness of a novel, web-based, mobile IFX dosing calculator (mIDC) for therapy optimization. METHODS We developed an mIDC leveraging the known clinical variables of C-reative protein (CRP), albumin, patient's weight, disease activity indices, calprotectin, drug trough levels, and antibodies to IFX that significantly affect pharmacokinetics and/or outcomes. A prospective observational cohort study in pediatric and young adult IBD patients receiving maintenance IFX was performed. System-wide practice adoption of mIDC was achieved through a quality improvement (QI) initiative within a hospital-based infusion unit. RESULTS Forty-nine patients (median age: 16.0 years; 55% female; 65% Crohn's disease) were followed over 9 months. mIDC recommendations for dose optimization were followed by the treating physicians in 198 (89%) out of 222 infusions. Twenty-eight (13%) of 222 mIDC recommendations were to escalate IFX dosing; 15 (54%) of 28 escalation recommendations were declined, and these patients were more likely to already be receiving IFX dose intensification compared with those in whom escalation recommendations were followed (P < 0.05). From mIDC initiation to end of follow-up, mean albumin levels remained unchanged at 3.8 g/dL. Median CRP remained unchanged at 2 g/L. Median calprotectin levels showed a downward trend from 30 to 27 μg/g (n = 9, P < 0.05). The percentage of patients undergoing therapeutic drug monitoring in clinical care increased from 34% to 86% with the QI initiative. The target median IFX trough goal of >5 μg/mL was achieved with 81% probability throughout the QI initiative, an increase of 12% compared with pre-QI values. CONCLUSIONS The use of a novel mIDC is feasible and potentially effective, facilitating both standardization and individualization of therapy in clinical care. mIDC appears to be a practical IFX dosing tool for point-of-care use, leveraging individual pharmacokinetic considerations.
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Affiliation(s)
- Travis Piester
- Stanford Children’s Inflammatory Bowel Disease Center, Division of
Gastroenterology, Stanford University School of Medicine, Stanford, California
| | - Adam Frymoyer
- Division of Neonatal and Developmental Medicine, Department of Pediatrics,
Stanford University School of Medicine, Stanford, California
| | - Megan Christofferson
- Stanford Children’s Inflammatory Bowel Disease Center, Division of
Gastroenterology, Stanford University School of Medicine, Stanford, California
| | - Helen Yu
- Stanford Children’s Inflammatory Bowel Disease Center, Division of
Gastroenterology, Stanford University School of Medicine, Stanford, California
| | - Dorsey Bass
- Stanford Children’s Inflammatory Bowel Disease Center, Division of
Gastroenterology, Stanford University School of Medicine, Stanford, California
| | - K T Park
- Stanford Children’s Inflammatory Bowel Disease Center, Division of
Gastroenterology, Stanford University School of Medicine, Stanford, California,Address correspondence to: K. T. Park, MD, MS, Pediatric Gastroenterology,
Hepatology, and Nutrition, 750 Welch Road, Ste 116, Palo Alto, CA 94304 ()
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Mann PC, Cooper ME, Ryckman KK, Comas B, Gili J, Crumley S, Bream EN, Byers HM, Piester T, Schaefer A, Christine PJ, Lawrence A, Schaa KL, Kelsey KJ, Berends SK, Gadow E, Cosentino V, Castilla EE, Camelo JL, Saleme C, Day LJ, England SK, Marazita ML, Dagle JM, Murray JC, Murray JC. Polymorphisms in the fetal progesterone receptor and a calcium-activated potassium channel isoform are associated with preterm birth in an Argentinian population. J Perinatol 2013; 33:336-40. [PMID: 23018797 PMCID: PMC3719965 DOI: 10.1038/jp.2012.118] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To investigate genetic etiologies of preterm birth (PTB) in Argentina through evaluation of single-nucleotide polymorphisms (SNPs) in candidate genes and population genetic admixture. STUDY DESIGN Genotyping was performed in 389 families. Maternal, paternal and fetal effects were studied separately. Mitochondrial DNA (mtDNA) was sequenced in 50 males and 50 females. Y-chromosome anthropological markers were evaluated in 50 males. RESULT Fetal association with PTB was found in the progesterone receptor (PGR, rs1942836; P=0.004). Maternal association with PTB was found in small conductance calcium activated potassium channel isoform 3 (KCNN3, rs883319; P=0.01). Gestational age associated with PTB in PGR rs1942836 at 32-36 weeks (P=0.0004). MtDNA sequencing determined 88 individuals had Amerindian consistent haplogroups. Two individuals had Amerindian Y-chromosome consistent haplotypes. CONCLUSION This study replicates single locus fetal associations with PTB in PGR, maternal association in KCNN3, and demonstrates possible effects for divergent racial admixture on PTB.
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Affiliation(s)
- Paul C. Mann
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, 52242
| | - Margaret E. Cooper
- Department of Oral Biology and Center for Craniofacial and Dental Genetics, Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, 15219
| | - Kelli K. Ryckman
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, 52242
| | - Belén Comas
- Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Capital Federal, Argentina,Instituto Nacional de Genética Médica Populacional and Estudio Colaborativo Latino Americano de Malformaciones Congénitas at Laboratório de Epidemiologia de Malformações Congênitas Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Juan Gili
- Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Capital Federal, Argentina,Instituto Nacional de Genética Médica Populacional and Estudio Colaborativo Latino Americano de Malformaciones Congénitas at Laboratório de Epidemiologia de Malformações Congênitas Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Suzanne Crumley
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, 52242
| | - Elise N.A. Bream
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, 52242
| | - Heather M. Byers
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, 52242
| | - Travis Piester
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, 52242
| | - Amanda Schaefer
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, 52242
| | - Paul J. Christine
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, 52242
| | - Amy Lawrence
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, 52242
| | - Kendra L. Schaa
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, 52242
| | | | - Susan K. Berends
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, 52242
| | - Enrique Gadow
- Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Capital Federal, Argentina
| | - Viviana Cosentino
- Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Capital Federal, Argentina
| | - Eduardo E. Castilla
- Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Capital Federal, Argentina,Instituto Nacional de Genética Médica Populacional and Estudio Colaborativo Latino Americano de Malformaciones Congénitas at Laboratório de Epidemiologia de Malformações Congênitas Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jorge López Camelo
- Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Capital Federal, Argentina,Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Capital Federal, Argentina,Instituto Multidisciplinario de Biología Celular, La Plata, Buenos Aires, Argentina
| | - Cesar Saleme
- Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Tucumán, Argentina
| | - Lori J. Day
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, 52242
| | - Sarah K. England
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, 52242,Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, Iowa, 52242
| | - Mary L. Marazita
- Department of Oral Biology and Center for Craniofacial and Dental Genetics, Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, 15219
| | - John M. Dagle
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, 52242
| | - Jeffrey C. Murray
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, 52242,Corresponding Author: Jeffrey C. Murray, MD Professor, Departments of Pediatrics, Epidemiology, and Biological Sciences University of Iowa Carver College of Medicine 500 Newton Road, 2182 ML, Iowa City, IA 52242-1181 319-335-6897 phone; 319-335-6970 fax
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