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Rucker A, Watson A, Badolato G, Jarvis L, Patel SJ, Goyal MK. Social Navigation for Adolescent Emergency Department Patients: A Randomized Clinical Trial. J Adolesc Health 2024; 74:292-300. [PMID: 37804303 DOI: 10.1016/j.jadohealth.2023.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Adolescent emergency department (ED) patients have unmet social needs that contribute to ED use. This study aimed to evaluate the effect of social needs navigation for adolescents on subsequent ED visits and community resource use and to identify characteristics associated with elevated social risk. METHODS Between July 2017 and August 2019, we used a random date generator to establish intervention and control group enrollment dates. All adolescents completed a social needs survey. Adolescents enrolled on intervention dates received in-person, risk-tailored social needs navigation. Those enrolled on control dates received a preprinted resource guide. We used chart review and follow-up calls to assess 12-month ED revisits and community resource use. Logistic regression was used to compare these outcomes between groups. We measured the association between ≥3 reported unmet needs and characteristics hypothesized a priori to be associated with elevated social risk (nonurgent visits, obesity, or any of nine "socially sensitive" chief complaints) using logistic regression. RESULTS A total of 399 adolescents were randomized. There was no difference between groups in the number of ED revisits. There was increased community resource use in the intervention group (adjusted odds ratio [aOR]: 3.5 [95% confidence interval {CI}: 1.5, 8.2]). Adolescents with a socially sensitive chief complaint had increased odds of ≥3 unmet needs (aOR: 2.2 [95% CI: 1.3, 3.6]), as did those with food insecurity in a post hoc analysis (aOR: 9.9 [95% CI: 4.0, 24.6]). DISCUSSION Social needs navigation increased community resource use but not subsequent ED visits. Adolescents with socially sensitive chief complaints or food insecurity reported increased unmet needs.
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Affiliation(s)
- Alexandra Rucker
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C; School of Medicine and Health Sciences, The George Washington University, Washington, D.C.
| | - Ar'Reon Watson
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C
| | - Gia Badolato
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C
| | - Lenore Jarvis
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C; School of Medicine and Health Sciences, The George Washington University, Washington, D.C
| | - Shilpa J Patel
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C; School of Medicine and Health Sciences, The George Washington University, Washington, D.C
| | - Monika K Goyal
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C; School of Medicine and Health Sciences, The George Washington University, Washington, D.C
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Khan A, Patel SJ, Anderson M, Baird JD, Johnson TM, Liss I, Graham DA, Calaman S, Fegley AE, Goldstein J, O'Toole JK, Rosenbluth G, Alminde C, Bass EJ, Bismilla Z, Caruth M, Coghlan-McDonald S, Cray S, Destino LA, Dreyer BP, Everhart JL, Good BP, Guiot AB, Haskell H, Hepps JH, Knighton AJ, Kocolas I, Kuzma NC, Lewis K, Litterer KP, Kruvand E, Markle P, Micalizzi DA, Patel A, Rogers JE, Subramony A, Vara T, Yin HS, Sectish TC, Srivastava R, Starmer AJ, West DC, Spector ND, Landrigan CP. Implementing a Family-Centered Rounds Intervention Using Novel Mentor-Trios. Pediatrics 2024; 153:e2023062666. [PMID: 38164122 DOI: 10.1542/peds.2023-062666] [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] [Accepted: 10/16/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Patient and Family Centered I-PASS (PFC I-PASS) emphasizes family and nurse engagement, health literacy, and structured communication on family-centered rounds organized around the I-PASS framework (Illness severity-Patient summary-Action items-Situational awareness-Synthesis by receiver). We assessed adherence, safety, and experience after implementing PFC I-PASS using a novel "Mentor-Trio" implementation approach with multidisciplinary parent-nurse-physician teams coaching sites. METHODS Hybrid Type II effectiveness-implementation study from 2/29/19-3/13/22 with ≥3 months of baseline and 12 months of postimplementation data collection/site across 21 US community and tertiary pediatric teaching hospitals. We conducted rounds observations and surveyed nurses, physicians, and Arabic/Chinese/English/Spanish-speaking patients/parents. RESULTS We conducted 4557 rounds observations and received 2285 patient/family, 1240 resident, 819 nurse, and 378 attending surveys. Adherence to all I-PASS components, bedside rounding, written rounds summaries, family and nurse engagement, and plain language improved post-implementation (13.0%-60.8% absolute increase by item), all P < .05. Except for written summary, improvements sustained 12 months post-implementation. Resident-reported harms/1000-resident-days were unchanged overall but decreased in larger hospitals (116.9 to 86.3 to 72.3 pre versus early- versus late-implementation, P = .006), hospitals with greater nurse engagement on rounds (110.6 to 73.3 to 65.3, P < .001), and greater adherence to I-PASS structure (95.3 to 73.6 to 72.3, P < .05). Twelve of 12 measures of staff safety climate improved (eg, "excellent"/"very good" safety grade improved from 80.4% to 86.3% to 88.0%), all P < .05. Patient/family experience and teaching were unchanged. CONCLUSIONS Hospitals successfully used Mentor-Trios to implement PFC I-PASS. Family/nurse engagement, safety climate, and harms improved in larger hospitals and hospitals with better nurse engagement and intervention adherence. Patient/family experience and teaching were not affected.
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Affiliation(s)
- Alisa Khan
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Shilpa J Patel
- Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
- Kapi'olani Medical Center for Women and Children, Hawaii Pacific Health, Honolulu, Hawaii
| | - Michele Anderson
- Family Centered Care Department, Lucile Packard Children's Hospital Stanford, Palo Alto, California
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
| | - Jennifer D Baird
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California
| | - Tyler M Johnson
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Isabella Liss
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Dionne A Graham
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Program for Patient Safety and Quality, Boston Children's Hospital, Boston, Massachusetts
| | - Sharon Calaman
- Division of Pediatric Critical Care, NYU Langone Health/Hassenfeld Children's Hospital, NYU Grossman School of Medicine; New York City, New York
| | - April E Fegley
- Center for Quality Improvement, Society of Hospital Medicine, Philadelphia, Pennsylvania
| | - Jenna Goldstein
- Center for Quality Improvement, Society of Hospital Medicine, Philadelphia, Pennsylvania
| | - Jennifer K O'Toole
- Departments of Pediatrics and Internal Medicine, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Glenn Rosenbluth
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, California
- Benioff Children's Hospital, San Francisco, University of California San Francisco School of Medicine, San Francisco, California
| | - Claire Alminde
- Department of Nursing, St Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Ellen J Bass
- Department of Information Science in the College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania
| | - Zia Bismilla
- Departments of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Monique Caruth
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
| | - Sally Coghlan-McDonald
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
- Benioff Children's Hospital, San Francisco, University of California San Francisco School of Medicine, San Francisco, California
| | - Sharon Cray
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
- Patient Safety and Quality Improvement Committee, St Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Lauren A Destino
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
- Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Benard P Dreyer
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York
| | - Jennifer L Everhart
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
- Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Brian P Good
- Department of Pediatrics, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - Amy B Guiot
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Helen Haskell
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
- Mothers Against Medical Error, Columbia, South Carolina
| | - Jennifer H Hepps
- Department of Pediatrics, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Irene Kocolas
- Department of Pediatrics, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - Nicholas C Kuzma
- Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, Pennsylvania
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Kheyandra Lewis
- Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, Pennsylvania
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Katherine P Litterer
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
- Office of Experience, Boston Children's Hospital, Boston, Massachusetts
| | - Elizabeth Kruvand
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
- SSM Health Cardinal Glennon Children's Hospital, St Louis, Missouri
| | - Peggy Markle
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Dale A Micalizzi
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
| | - Aarti Patel
- Department of Pediatrics, University of California San Diego, Rady Children's Hospital, San Diego, California
| | - Jayne E Rogers
- Department of Nursing, Boston Children's Hospital, Boston, Massachusetts
| | - Anupama Subramony
- Department of Pediatrics, Cohen Children's Medical Center, Hofstra Northwell School of Medicine, New Hyde Park, New York
| | - Tiffany Vara
- Kapi'olani Medical Center for Women and Children, Hawaii Pacific Health, Honolulu, Hawaii
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
| | - H Shonna Yin
- Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, New York
| | - Theodore C Sectish
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Rajendu Srivastava
- Department of Pediatrics, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
- Healthcare Delivery Institute, Intermountain Health, Murray, Utah
| | - Amy J Starmer
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Daniel C West
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nancy D Spector
- Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, Pennsylvania
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
- The Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) Program, Philadelphia, Pennsylvania
| | - Christopher P Landrigan
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
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3
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Margolis RHF, Patel SJ, Brewer T, Lawless C, Krueger J, Fox E, Kachroo N, Stringfield S, Teach SJ. Implementation of caregiver depression screening in an urban, community-based asthma clinic: a quality improvement project. J Asthma 2023; 60:1677-1686. [PMID: 36755521 DOI: 10.1080/02770903.2023.2178935] [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: 12/16/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE Caregiver depressive symptoms are prevalent among children with asthma and associated with greater asthma morbidity. Identifying caregivers with depression and connecting them to appropriate treatment may reduce child asthma morbidity. The goal of this project was to implement a workflow for caregiver depression screening and treatment referral in an urban, community-based, asthma clinic serving under-resourced children. METHODS The Model for Improvement with weekly Plan-Do-Study-Act cycles was utilized. A two-item depression screening tool (Patient Health Questionnaire-2; PHQ-2) and an acceptability question using a 5-point Likert scale were added to an existing social needs screening checklist administered to all caregivers during the child's clinic visit. Caregivers with a positive PHQ-2 score (≥3) received the PHQ-9. Positive screens on the PHQ-9 (≥5) received information and referrals by level of risk. PHQ-9 positive caregivers received a follow-up phone call two weeks post-visit to assess connection to support, improvement in depressive symptoms, and satisfaction with resources provided. RESULTS The PHQ-2 was completed by 84.4% of caregivers (233/276). Caregivers had a mean age of 33.8 years (SD = 8.3; Range: 18-68) and were predominately female (86.4%), Black (80.4%), and non-Hispanic (78.4%). The majority (72.3%) found the screening acceptable (agree/strongly agree). Nearly one in six caregivers (37/233, 15.9%) reported depressive symptoms (PHQ-2 ≥ 3); 11.6% (27/233) had clinically significant symptoms (PHQ-9 score ≥ 10); and 2.1% (5/233) reported suicidal thoughts. Of those with depressive symptoms, 70.3% (26/37) participated in the follow-up phone call. While 50% (13/26) reported the resources given in clinic were "extremely helpful," no caregivers contacted or used them. CONCLUSIONS Caregiver depression screening was successfully integrated into a pediatric asthma clinic serving under-resourced children. While caregivers found screening to be acceptable, it did not facilitate short-term connection to treatment among those with depressive symptoms.
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Affiliation(s)
- Rachel H F Margolis
- Center for Translational Research, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
| | - Shilpa J Patel
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Taylor Brewer
- Center for Translational Research, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Casey Lawless
- Children's Mercy Kansas City Hospital, Kansas City, MO, USA
- UMKC School of Medicine, Kansas City, MO, USA
| | - Julie Krueger
- Division of General and Community Pediatrics, Children's National Hospital, Washington, DC, USA
| | - Eduardo Fox
- Division of General and Community Pediatrics, Children's National Hospital, Washington, DC, USA
| | - Nikita Kachroo
- Center for Translational Research, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
| | - Shayla Stringfield
- Center for Translational Research, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
| | - Stephen J Teach
- Center for Translational Research, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
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4
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O'Toole JK, Calaman S, Anderson M, Baird J, Fegley A, Goldstein J, Johnson T, Khan A, Patel SJ, Rosenbluth G, Sectish TC, West DC, Landrigan CP, Spector ND. Utilizing co-production to improve patient-centeredness and engagement in healthcare delivery: Lessons from the Patient and Family-Centered I-PASS studies. J Hosp Med 2023; 18:848-852. [PMID: 36717094 DOI: 10.1002/jhm.13055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/23/2022] [Accepted: 01/14/2023] [Indexed: 02/01/2023]
Affiliation(s)
- Jennifer K O'Toole
- Departments of Pediatrics, Division of Hospital Medicine, Department of Internal Medicine, Division of General Internal Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sharon Calaman
- Department of Pediatrics, Division of Pediatric Critical Care, NYU Grossman School of Medicine and NYU Langone Health, New York City, New York, USA
| | - Michelle Anderson
- Family Centered Care Department, Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA
| | - Jennifer Baird
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - April Fegley
- Center for Quality Improvement with the Society of Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Jenna Goldstein
- Center for Quality Improvement with the Society of Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Tyler Johnson
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alisa Khan
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shilpa J Patel
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Division of Pediatric Hospital Medicine, Kapiolani Medical Center for Women & Children, Hawaii Pacific Health, Honolulu, Hawaii, USA
| | - Glenn Rosenbluth
- Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, California, USA
| | - Theodore C Sectish
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel C West
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher P Landrigan
- Department of Pediatrics, Division of General Pediatrics, Departments of Medicine and Neurology, Division of Sleep and Circadian Disorders, Harvard Medical School, Boston Children's Hospital, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nancy D Spector
- Department of Pediatrics, Drexel University College of Medicine, The Hedwig van Amerigen Executive Leadership in Academic Medicine (ELAM) Program, Philadelphia, Pennsylvania, USA
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Bochkov YA, Devries M, Tetreault K, Gangnon R, Lee S, Bacharier LB, Busse WW, Camargo CA, Choi T, Cohen R, De R, DeMuri GP, Fitzpatrick AM, Gergen PJ, Grindle K, Gruchalla R, Hartert T, Hasegawa K, Khurana Hershey GK, Holt P, Homil K, Jartti T, Kattan M, Kercsmar C, Kim H, Laing IA, Le Souëf PN, Liu AH, Mauger DT, Pappas T, Patel SJ, Phipatanakul W, Pongracic J, Seroogy C, Sly PD, Tisler C, Wald ER, Wood R, Lemanske RF, Jackson DJ, Gern JE. Rhinoviruses A and C elicit long-lasting antibody responses with limited cross-neutralization. J Med Virol 2023; 95:e29058. [PMID: 37638498 PMCID: PMC10484091 DOI: 10.1002/jmv.29058] [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] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
Rhinoviruses (RVs) can cause severe wheezing illnesses in young children and patients with asthma. Vaccine development has been hampered by the multitude of RV types with little information about cross-neutralization. We previously showed that neutralizing antibody (nAb) responses to RV-C are detected twofold to threefold more often than those to RV-A throughout childhood. Based on those findings, we hypothesized that RV-C infections are more likely to induce either cross-neutralizing or longer-lasting antibody responses compared with RV-A infections. We pooled RV diagnostic data from multiple studies of children with respiratory illnesses and compared the expected versus observed frequencies of sequential infections with RV-A or RV-C types using log-linear regression models. We tested longitudinally collected plasma samples from children to compare the duration of RV-A versus RV-C nAb responses. Our models identified limited reciprocal cross-neutralizing relationships for RV-A (A12-A75, A12-A78, A20-A78, and A75-A78) and only one for RV-C (C2-C40). Serologic analysis using reference mouse sera and banked human plasma samples confirmed that C40 infections induced nAb responses with modest heterotypic activity against RV-C2. Mixed-effects regression modeling of longitudinal human plasma samples collected from ages 2 to 18 years demonstrated that RV-A and RV-C illnesses induced nAb responses of similar duration. These results indicate that both RV-A and RV-C nAb responses have only modest cross-reactivity that is limited to genetically similar types. Contrary to our initial hypothesis, RV-C species may include even fewer cross-neutralizing types than RV-A, whereas the duration of nAb responses during childhood is similar between the two species. The modest heterotypic responses suggest that RV vaccines must have a broad representation of prevalent types.
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Affiliation(s)
| | - Mark Devries
- University of Wisconsin-Madison, Madison, WI, United States
| | | | - Ronald Gangnon
- University of Wisconsin-Madison, Madison, WI, United States
| | - Sujin Lee
- Department of Pediatrics, Center for ViroScience and Cure, Emory University School of Medicine, Atlanta, GA, United States
| | | | | | - Carlos A. Camargo
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Timothy Choi
- University of Wisconsin-Madison, Madison, WI, United States
| | - Robyn Cohen
- Boston University, Boston, MA, United States
| | - Ramyani De
- Department of Pediatrics, Center for ViroScience and Cure, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Anne M. Fitzpatrick
- Department of Pediatrics, Emory University and Children’s Healthcare of Atlanta, Atlanta, GA, United States
| | - Peter J. Gergen
- National Institute of Allergy and Infectious Disease, National Institutes of Health, Rockville, MD, United States
| | | | | | - Tina Hartert
- Vanderbilt University, Nashville, TN, United States
| | - Kohei Hasegawa
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | | | - Patrick Holt
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Kiara Homil
- University of Turku and Turku University Hospital, Turku, Finland
| | - Tuomas Jartti
- University of Turku and Turku University Hospital, Turku, Finland
- PEDEGO Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Meyer Kattan
- Columbia University, New York, NY, United States
| | | | - Haejin Kim
- Henry Ford Health Systems, Detroit, MI, United States
| | | | | | - Andrew H. Liu
- Children’s Hospital Colorado, University of Colorado, Aurora, CO, United States
| | | | - Tressa Pappas
- University of Wisconsin-Madison, Madison, WI, United States
| | | | | | | | | | - Peter D. Sly
- Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | | | - Ellen R. Wald
- University of Wisconsin-Madison, Madison, WI, United States
| | - Robert Wood
- Johns Hopkins University, Baltimore, MD, United States
| | | | | | - James E. Gern
- University of Wisconsin-Madison, Madison, WI, United States
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Arjoune Y, Nguyen TN, Salvador T, Telluri A, Schroeder JC, Geggel RL, May JW, Pillai DK, Teach SJ, Patel SJ, Doroshow RW, Shekhar R. StethAid: A Digital Auscultation Platform for Pediatrics. Sensors (Basel) 2023; 23:5750. [PMID: 37420914 PMCID: PMC10304273 DOI: 10.3390/s23125750] [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] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/18/2023] [Accepted: 06/15/2023] [Indexed: 07/09/2023]
Abstract
(1) Background: Mastery of auscultation can be challenging for many healthcare providers. Artificial intelligence (AI)-powered digital support is emerging as an aid to assist with the interpretation of auscultated sounds. A few AI-augmented digital stethoscopes exist but none are dedicated to pediatrics. Our goal was to develop a digital auscultation platform for pediatric medicine. (2) Methods: We developed StethAid-a digital platform for artificial intelligence-assisted auscultation and telehealth in pediatrics-that consists of a wireless digital stethoscope, mobile applications, customized patient-provider portals, and deep learning algorithms. To validate the StethAid platform, we characterized our stethoscope and used the platform in two clinical applications: (1) Still's murmur identification and (2) wheeze detection. The platform has been deployed in four children's medical centers to build the first and largest pediatric cardiopulmonary datasets, to our knowledge. We have trained and tested deep-learning models using these datasets. (3) Results: The frequency response of the StethAid stethoscope was comparable to those of the commercially available Eko Core, Thinklabs One, and Littman 3200 stethoscopes. The labels provided by our expert physician offline were in concordance with the labels of providers at the bedside using their acoustic stethoscopes for 79.3% of lungs cases and 98.3% of heart cases. Our deep learning algorithms achieved high sensitivity and specificity for both Still's murmur identification (sensitivity of 91.9% and specificity of 92.6%) and wheeze detection (sensitivity of 83.7% and specificity of 84.4%). (4) Conclusions: Our team has created a technically and clinically validated pediatric digital AI-enabled auscultation platform. Use of our platform could improve efficacy and efficiency of clinical care for pediatric patients, reduce parental anxiety, and result in cost savings.
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Affiliation(s)
- Youness Arjoune
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC 20010, USA
| | - Trong N. Nguyen
- AusculTech Dx, 2601 University Blvd West #301, Silver Spring, MD 20902, USA
| | - Tyler Salvador
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC 20010, USA
| | - Anha Telluri
- School of Medicine and Health Sciences, George Washington University, Washington, DC 20052, USA
| | - Jonathan C. Schroeder
- Division of Pulmonary and Sleep Medicine, Children’s National Hospital, Washington, DC 20010, USA
| | - Robert L. Geggel
- Department of Cardiology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Joseph W. May
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Dinesh K. Pillai
- Division of Pulmonary and Sleep Medicine, Children’s National Hospital, Washington, DC 20010, USA
| | - Stephen J. Teach
- Department of Pediatrics, Children’s National Hospital, Washington, DC 20010, USA
| | - Shilpa J. Patel
- Division of Emergency Medicine, Children’s National Hospital, Washington, DC 20010, USA
| | - Robin W. Doroshow
- AusculTech Dx, 2601 University Blvd West #301, Silver Spring, MD 20902, USA
- Department of Cardiology, Children’s National Hospital, Washington, DC 20010, USA
| | - Raj Shekhar
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC 20010, USA
- AusculTech Dx, 2601 University Blvd West #301, Silver Spring, MD 20902, USA
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Margolis RHF, Patel SJ, Krueger J, Brewer T, Williams A, Stringfield S, Teach SJ, Parikh K. Association between social needs and asthma control among children evaluated at a single-center high-risk asthma clinic. J Allergy Clin Immunol Pract 2023; 11:1947-1949.e1. [PMID: 36921799 DOI: 10.1016/j.jaip.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/14/2023]
Affiliation(s)
- Rachel H F Margolis
- Center for Translational Research, Children's National Research Institute, Washington, DC.
| | - Shilpa J Patel
- Center for Translational Research, Children's National Research Institute, Washington, DC; Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Julie Krueger
- Division of General and Community Pediatrics, Children's National Hospital, Washington, DC
| | - Taylor Brewer
- Center for Translational Research, Children's National Research Institute, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Andrea Williams
- Center for Translational Research, Children's National Research Institute, Washington, DC
| | - Shayla Stringfield
- Center for Translational Research, Children's National Research Institute, Washington, DC
| | - Stephen J Teach
- Center for Translational Research, Children's National Research Institute, Washington, DC; Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Kavita Parikh
- Center for Translational Research, Children's National Research Institute, Washington, DC; Division of Hospital Medicine, Children's National Hospital, Washington, DC
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Brent DA, Horowitz LM, Grupp-Phelan J, Bridge JA, Gibbons R, Chernick LS, Rea M, Cwik MF, Shenoi RP, Fein JA, Mahabee-Gittens EM, Patel SJ, Mistry RD, Duffy S, Melzer-Lange MD, Rogers A, Cohen DM, Keller A, Hickey RW, Page K, Casper TC, King CA. Prediction of Suicide Attempts and Suicide-Related Events Among Adolescents Seen in Emergency Departments. JAMA Netw Open 2023; 6:e2255986. [PMID: 36790810 PMCID: PMC9932829 DOI: 10.1001/jamanetworkopen.2022.55986] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
IMPORTANCE Screening adolescents in emergency departments (EDs) for suicidal risk is a recommended strategy for suicide prevention. Comparing screening measures on predictive validity could guide ED clinicians in choosing a screening tool. OBJECTIVE To compare the Ask Suicide-Screening Questions (ASQ) instrument with the Computerized Adaptive Screen for Suicidal Youth (CASSY) instrument for the prediction of suicidal behavior among adolescents seen in EDs, across demographic and clinical strata. DESIGN, SETTING, AND PARTICIPANTS The Emergency Department Study for Teens at Risk for Suicide is a prospective, random-series, multicenter cohort study that recruited adolescents, oversampled for those with psychiatric symptoms, who presented to the ED from July 24, 2017, through October 29, 2018, with a 3-month follow-up to assess the occurrence of suicidal behavior. The study included 14 pediatric ED members of the Pediatric Emergency Care Applied Research Network and 1 Indian Health Service ED. Statistical analysis was performed from May 2021 through January 2023. MAIN OUTCOMES AND MEASURES This study used a prediction model to assess outcomes. The primary outcome was suicide attempt (SA), and the secondary outcome was suicide-related visits to the ED or hospital within 3 months of baseline; both were assessed by an interviewer blinded to baseline information. The ASQ is a 4-item questionnaire that surveys suicidal ideation and lifetime SAs. A positive response or nonresponse on any item indicates suicidal risk. The CASSY is a computerized adaptive screening tool that always includes 3 ASQ items and a mean of 8 additional items. The CASSY's continuous outcome is the predicted probability of an SA. RESULTS Of 6513 adolescents available, 4050 were enrolled, 3965 completed baseline assessments, and 2740 (1705 girls [62.2%]; mean [SD] age at enrollment, 15.0 [1.7] years; 469 Black participants [17.1%], 678 Hispanic participants [24.7%], and 1618 White participants [59.1%]) completed both screenings and follow-ups. The ASQ and the CASSY showed a similar sensitivity (0.951 [95% CI, 0.918-0.984] vs 0.945 [95% CI, 0.910-0.980]), specificity (0.588 [95% CI, 0.569-0.607] vs 0.643 [95% CI, 0.625-0.662]), positive predictive value (0.127 [95% CI, 0.109-0.146] vs 0.144 [95% CI, 0.123-0.165]), and negative predictive value (both 0.995 [95% CI, 0.991-0.998], respectively). Area under the receiver operating characteristic curve findings were similar among patients with physical symptoms (ASQ, 0.88 [95% CI, 0.81-0.95] vs CASSY, 0.94 [95% CI, 0.91-0.96]). Among patients with psychiatric symptoms, the CASSY performed better than the ASQ (0.72 [95% CI, 0.68-0.77] vs 0.57 [95% CI, 0.55-0.59], respectively). CONCLUSIONS AND RELEVANCE This study suggests that both the ASQ and the CASSY are appropriate for universal screening of patients in pediatric EDs. For the small subset of patients with psychiatric symptoms, the CASSY shows greater predictive validity.
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Affiliation(s)
- David A. Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania
| | - Lisa M. Horowitz
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | | | - Jeffrey A. Bridge
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - Robert Gibbons
- Department of Medicine, The University of Chicago, Chicago, Illinois
- Department of Public Health Sciences (Biostatistics), The University of Chicago, Chicago, Illinois
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
- Department of Comparative Human Development, The University of Chicago, Chicago, Illinois
| | - Lauren S. Chernick
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York
| | - Margaret Rea
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California
| | - Mary F. Cwik
- Department of International Health, Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rohit P. Shenoi
- Division of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Joel A. Fein
- Center for Violence Prevention, Children’s Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia
| | - E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Shilpa J. Patel
- Division of Pediatric Emergency Medicine, Children’s National Hospital, Washington, DC
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Rakesh D. Mistry
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Susan Duffy
- Hasbro Children’s Hospital, Department of Pediatrics, Alpert Medical School at Brown University, Providence, Rhode Island
| | | | - Alexander Rogers
- Department of Emergency Medicine, University of Michigan, Ann Arbor
- Department of Pediatrics, University of Michigan, Ann Arbor
| | - Daniel M. Cohen
- Division of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Allison Keller
- Department of Pediatric Emergency Medicine, University of Utah and Primary Children’s Hospital, Salt Lake City
| | - Robert W. Hickey
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kent Page
- Department of Pediatrics, University of Utah, Salt Lake City
| | | | - Cheryl A. King
- Department of Psychiatry, Michigan Medicine, Ann Arbor
- Injury Prevention Center, The University of Michigan, Ann Arbor
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Berg JS, Payne AS, Wavra T, Morrison S, Patel SJ. Implementation of a Medical Clearance Algorithm for Psychiatric Emergency Patients. Hosp Pediatr 2023; 13:66-71. [PMID: 36575918 DOI: 10.1542/hpeds.2022-006672] [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: 12/29/2022]
Abstract
BACKGROUND Despite evidence demonstrating limited benefit, many clinicians continue to perform routine laboratory testing of well-appearing children to medically clear them before psychiatric admission. METHODS We conducted a quality improvement project to reduce routine laboratory testing among pediatric patients requiring admission to our psychiatric unit. We convened key stakeholders whose input informed the modification of an existing pathway and the development of a medical clearance algorithm. Our outcome was a reduction in routine laboratory testing for children requiring psychiatric admission. Our balancing measure was the number of patients requiring transfer from the inpatient psychiatry unit to a medical service. We used run charts to evaluate nonrandom variation and demonstrate sustained change. RESULTS Before the introduction of the new medical clearance algorithm, 93% (n = 547/589) of children with psychiatric emergencies received laboratory testing. After implementing the medical clearance algorithm, 19.6% (n = 158/807) of children with psychiatric emergencies received laboratory testing. Despite a decreased rate of routine testing, there were no transfers to the medical service. CONCLUSIONS Implementing a medical clearance algorithm can decrease routine laboratory testing without increasing transfers to the medical service among children requiring psychiatric admission.
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Affiliation(s)
- Julie S Berg
- Children's National Hospital, Washington, District of Columbia.,The George Washington School of Medicine & Health Sciences, Washington, District of Columbia
| | - Asha S Payne
- Children's National Hospital, Washington, District of Columbia.,The George Washington School of Medicine & Health Sciences, Washington, District of Columbia
| | - Theresa Wavra
- Children's National Hospital, Washington, District of Columbia
| | - Sephora Morrison
- Children's National Hospital, Washington, District of Columbia.,The George Washington School of Medicine & Health Sciences, Washington, District of Columbia
| | - Shilpa J Patel
- Children's National Hospital, Washington, District of Columbia.,The George Washington School of Medicine & Health Sciences, Washington, District of Columbia
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Starmer AJ, Spector ND, O’Toole JK, Bismilla Z, Calaman S, Campos ML, Coffey M, Destino LA, Everhart JL, Goldstein J, Graham DA, Hepps JH, Howell EE, Kuzma N, Maynard G, Melvin P, Patel SJ, Popa A, Rosenbluth G, Schnipper JL, Sectish TC, Srivastava R, West DC, Yu CE, Landrigan CP. Implementation of the I-PASS handoff program in diverse clinical environments: A multicenter prospective effectiveness implementation study. J Hosp Med 2023; 18:5-14. [PMID: 36326255 PMCID: PMC10964397 DOI: 10.1002/jhm.12979] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Handoff miscommunications are a leading source of medical errors. Harmful medical errors decreased in pediatric academic hospitals following implementation of the I-PASS handoff improvement program. However, implementation across specialties has not been assessed. OBJECTIVE To determine if I-PASS implementation across diverse settings would be associated with improvements in patient safety and communication. DESIGN Prospective Type 2 Hybrid effectiveness implementation study. SETTINGS AND PARTICIPANTS Residents from diverse specialties across 32 hospitals (12 community, 20 academic). INTERVENTION External teams provided longitudinal coaching over 18 months to facilitate implementation of an enhanced I-PASS program and monthly metric reviews. MAIN OUTCOME AND MEASURES Systematic surveillance surveys assessed rates of resident-reported adverse events. Validated direct observation tools measured verbal and written handoff quality. RESULTS 2735 resident physicians and 760 faculty champions from multiple specialties (16 internal medicine, 13 pediatric, 3 other) participated. 1942 error surveillance reports were collected. Major and minor handoff-related reported adverse events decreased 47% following implementation, from 1.7 to 0.9 major events/person-year (p < .05) and 17.5 to 9.3 minor events/person-year (p < .001). Implementation was associated with increased inclusion of all five key handoff data elements in verbal (20% vs. 66%, p < .001, n = 4812) and written (10% vs. 74%, p < .001, n = 1787) handoffs, as well as increased frequency of handoffs with high quality verbal (39% vs. 81% p < .001) and written (29% vs. 78%, p < .001) patient summaries, verbal (29% vs. 78%, p < .001) and written (24% vs. 73%, p < .001) contingency plans, and verbal receiver syntheses (31% vs. 83%, p < .001). Improvement was similar across provider types (adult vs. pediatric) and settings (community vs. academic).
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Affiliation(s)
- Amy J. Starmer
- Department of Pediatrics, Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy D. Spector
- Section of General Pediatrics, Department of Pediatrics, St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
- Department of Pediatrics and Executive Leadership in Academic Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Jennifer K. O’Toole
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Zia Bismilla
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Calaman
- Section of General Pediatrics, Department of Pediatrics, St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Maria-Lucia Campos
- Department of Pediatrics, Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maitreya Coffey
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Lauren A. Destino
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Stanford University School of Medicine, Lucile Packard Children’s Hospital Stanford, Palo Alto, California, USA
| | - Jennifer L. Everhart
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Stanford University School of Medicine, Lucile Packard Children’s Hospital Stanford, Palo Alto, California, USA
| | - Jenna Goldstein
- Society for Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Dionne A. Graham
- Program for Patient Safety and Quality, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Jennifer H. Hepps
- Department of Pediatrics, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Eric E. Howell
- Society for Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Nicholas Kuzma
- Section of General Pediatrics, Department of Pediatrics, St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Greg Maynard
- Society for Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Patrice Melvin
- Program for Patient Safety and Quality, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Shilpa J. Patel
- Department of Pediatrics, Kapi’olani Medical Center for Women and Children/University of Hawai’i John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Alina Popa
- Department of Medicine, University of California Riverside, Riverside, California, USA
- Division of Hospital Medicine, University of California San Diego, San Diego, California, USA
| | - Glenn Rosenbluth
- Department of Pediatrics, Benioff Children’s Hospital, University of California, San Francisco, California, USA
| | - Jeffrey L. Schnipper
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Theodore C. Sectish
- Department of Pediatrics, Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rajendu Srivastava
- Department of Pediatrics, Primary Children’s Hospital, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Healthcare Delivery Institute, Intermountain Healthcare, Murray, Utah, USA
| | - Daniel C. West
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Clifton E. Yu
- Department of Pediatrics, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Christopher P. Landrigan
- Department of Pediatrics, Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Departments of Medicine and Neurology, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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11
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Knighton AJ, Bass EJ, McLaurin EJ, Anderson M, Baird JD, Cray S, Destino L, Khan A, Liss I, Markle P, O’Toole JK, Patel A, Srivastava R, Landrigan CP, Spector ND, Patel SJ. Intervention, individual, and contextual determinants to high adherence to structured family-centered rounds: a national multi-site mixed methods study. Implement Sci Commun 2022; 3:74. [PMID: 35842692 PMCID: PMC9287702 DOI: 10.1186/s43058-022-00322-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Effective communication in transitions between healthcare team members is associated with improved patient safety and experience through a clinically meaningful reduction in serious safety events. Family-centered rounds (FCR) can serve a critical role in interprofessional and patient-family communication. Despite widespread support, FCRs are not utilized consistently in many institutions. Structured FCR approaches may prove beneficial in increasing FCR use but should address organizational challenges. The purpose of this study was to identify intervention, individual, and contextual determinants of high adherence to common elements of structured FCR in pediatric inpatient units during the implementation phase of a large multi-site study implementing a structured FCR approach.
Methods
We performed an explanatory sequential mixed methods study from September 2019 to October 2020 to evaluate the variation in structured FCR adherence across 21 pediatric inpatient units. We analyzed 24 key informant interviews of supervising physician faculty, physician learners, nurses, site administrators, and project leaders at 3 sites using a qualitative content analysis paradigm to investigate site variation in FCR use. We classified implementation determinants based on the Consolidated Framework for Implementation Research.
Results
Provisional measurements of adherence demonstrated considerable variation in structured FCR use across sites at a median time of 5 months into the implementation. Consistent findings across all three sites included generally positive clinician beliefs regarding the use of FCR and structured rounding approaches, benefits to learner self-efficacy, and potential efficiency gains derived through greater rounds standardization, as well as persistent challenges with nurse engagement and interaction on rounds and coordination and use of resources for families with limited English proficiency.
Conclusions
Studies during implementation to identify determinants to high adherence can provide generalizable knowledge regarding implementation determinants that may be difficult to predict prior to implementation, guide adaptation during the implementation, and inform sustainment strategies.
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12
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Patel SJ, Khan A, Bass EJ, Graham D, Baird J, Anderson M, Calaman S, Cray S, Destino L, Fegley A, Goldstein J, Johnson T, Kocolas I, Lewis KD, Liss I, Markle P, O'Toole JK, Rosenbluth G, Srivastava R, Vara T, Landrigan CP, Spector ND, Knighton AJ. Family, nurse, and physician beliefs on family-centered rounds: A 21-site study. J Hosp Med 2022; 17:945-955. [PMID: 36131598 PMCID: PMC10087029 DOI: 10.1002/jhm.12962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/11/2022] [Accepted: 08/30/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Variation exists in family-centered rounds (FCR). OBJECTIVE We sought to understand patient/family and clinician FCR beliefs/attitudes and practices to support implementation efforts. DESIGNS, SETTINGS AND PARTICIPANTS Patients/families and clinicians at 21 geographically diverse US community/academic pediatric teaching hospitals participated in a prospective cohort dissemination and implementation study. INTERVENTION We inquired about rounding beliefs/attitudes, practices, and demographics using a 26-question survey coproduced with family/nurse/attending-physician collaborators, informed by prior research and the Consolidated Framework for Implementation Research. MAIN OUTCOME AND MEASURES Out of 2578 individuals, 1647 (64%) responded to the survey; of these, 1313 respondents participated in FCR and were included in analyses (616 patients/families, 243 nurses, 285 resident physicians, and 169 attending physicians). Beliefs/attitudes regarding the importance of FCR elements varied by role, with resident physicians rating the importance of several FCR elements lower than others. For example, on adjusted multivariable analysis, attending physicians (odds ratio [OR] 3.0, 95% confidence interval [95% CI] 1.2-7.8) and nurses (OR 3.1, 95% CI 1.3-7.4) were much more likely than resident physicians to report family participation on rounds as very/extremely important. Clinician support for key FCR elements was higher than self-reported practice (e.g., 88% believed family participation was important on rounds; 68% reported it often/always occurred). In practice, key elements of FCR were reported to often/always occur only 23%-70% of the time. RESULT Support for nurse and family participation in FCR is high among clinicians but varies by role. Physicians, particularly resident physicians, endorse several FCR elements as less important than nurses and patients/families. The gap between attitudes and practice and between clinician types suggests that attitudinal, structural, and cultural barriers impede FCR.
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Affiliation(s)
- Shilpa J Patel
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
- Division of Pediatric Hospital Medicine, Kapiolani Medical Center for Women & Children, Hawaii Pacific Health, Honolulu, Hawaii, USA
| | - Alisa Khan
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of General Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Ellen J Bass
- Department of Information Science in the College of Computing and Informatics, Department of Health Systems and Sciences Research in the College of Nursing & Health Professions, School of Biomedical Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Dionne Graham
- Department of General Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Program for Patient Safety and Quality, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jennifer Baird
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Michele Anderson
- Family-Centered Care Department, Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA
| | - Sharon Calaman
- Division of Pediatric Critical Care, Department of Pediatrics, NYU Grossman School of Medicine, NYU Langone Health/Hassenfeld Children's Hospital, New York City, New York, USA
| | - Sharon Cray
- Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
- Patient and Family-Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts, USA
| | - Lauren Destino
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford/Stanford School of Medicine, Palo Alto, California, USA
| | - April Fegley
- Society of Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Jenna Goldstein
- Society of Hospital Medicine, Philadelphia, Pennsylvania, USA
| | - Tyler Johnson
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Irene Kocolas
- Department of Pediatrics, Primary Children's Hospital, Salt Lake City, University of Utah, Utah, USA
| | - Kheyandra D Lewis
- Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Isabella Liss
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Peggy Markle
- Patient and Family-Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts, USA
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jennifer K O'Toole
- Departments of Pediatrics and Internal Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Glenn Rosenbluth
- Department of Pediatrics, San Francisco School of Medicine, University of California, San Francisco, California, USA
- Department of Pediatrics, Benioff Children's Hospital, San Francisco, California, USA
| | - Raj Srivastava
- Department of Pediatrics, Primary Children's Hospital, Salt Lake City, University of Utah, Utah, USA
- Healthcare Delivery Institute, Intermountain Healthcare, Murray, Utah, USA
| | - Tiffany Vara
- Division of Pediatric Hospital Medicine, Kapiolani Medical Center for Women & Children, Hawaii Pacific Health, Honolulu, Hawaii, USA
- Patient and Family-Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts, USA
| | - Christopher P Landrigan
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of General Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Departments of Medicine and Neurology, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nancy D Spector
- Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
- The Hedwig van Amerigen Executive Leadership in Academic Medicine (ELAM) Program, Philadelphia, Pennsylvania, USA
| | - Andrew J Knighton
- Healthcare Delivery Institute, Intermountain Healthcare, Murray, Utah, USA
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Khan A, Parente V, Baird JD, Patel SJ, Cray S, Graham DA, Halley M, Johnson T, Knoebel E, Lewis KD, Liss I, Romano EM, Trivedi S, Spector ND, Landrigan CP, Bass EJ, Calaman S, Fegley AE, Knighton AJ, O'Toole JK, Sectish TC, Srivastava R, Starmer AJ, West DC. Association of Patient and Family Reports of Hospital Safety Climate With Language Proficiency in the US. JAMA Pediatr 2022; 176:776-786. [PMID: 35696195 PMCID: PMC9194750 DOI: 10.1001/jamapediatrics.2022.1831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Patients with language barriers have a higher risk of experiencing hospital safety events. This study hypothesized that language barriers would be associated with poorer perceptions of hospital safety climate relating to communication openness. OBJECTIVE To examine disparities in reported hospital safety climate by language proficiency in a cohort of hospitalized children and their families. DESIGN, SETTING, AND PARTICIPANTS This cohort study conducted from April 29, 2019, through March 1, 2020, included pediatric patients and parents or caregivers of hospitalized children at general and subspecialty units at 21 US hospitals. Randomly selected Arabic-, Chinese-, English-, and Spanish-speaking hospitalized patients and families were approached before hospital discharge and were included in the analysis if they provided both language proficiency and health literacy data. Participants self-rated language proficiency via surveys. Limited English proficiency was defined as an answer of anything other than "very well" to the question "how well do you speak English?" MAIN OUTCOMES AND MEASURES Primary outcomes were top-box (top most; eg, strongly agree) 5-point Likert scale ratings for 3 Children's Hospital Safety Climate Questionnaire communication openness items: (1) freely speaking up if you see something that may negatively affect care (top-box response: strongly agree), (2) questioning decisions or actions of health care providers (top-box response: strongly agree), and (3) being afraid to ask questions when something does not seem right (top-box response: strongly disagree [reverse-coded item]). Covariates included health literacy and sociodemographic characteristics. Logistic regression was used with generalized estimating equations to control for clustering by site to model associations between openness items and language proficiency, adjusting for health literacy and sociodemographic characteristics. RESULTS Of 813 patients, parents, and caregivers who were approached to participate in the study, 608 completed surveys (74.8% response rate). A total of 87.7% (533 of 608) of participants (434 [82.0%] female individuals) completed language proficiency and health literacy items and were included in the analyses; of these, 14.1% (75) had limited English proficiency. Participants with limited English proficiency had lower odds of freely speaking up if they see something that may negatively affect care (adjusted odds ratio [aOR], 0.26; 95% CI, 0.15-0.43), questioning decisions or actions of health care providers (aOR, 0.19; 95% CI, 0.09-0.41), and being unafraid to ask questions when something does not seem right (aOR, 0.44; 95% CI, 0.27-0.71). Individuals with limited health literacy (aOR, 0.66; 95% CI, 0.48-0.91) and a lower level of educational attainment (aOR, 0.59; 95% CI, 0.36-0.95) were also less likely to question decisions or actions. CONCLUSIONS AND RELEVANCE This cohort study found that limited English proficiency was associated with lower odds of speaking up, questioning decisions or actions of providers, and being unafraid to ask questions when something does not seem right. This disparity may contribute to higher hospital safety risk for patients with limited English proficiency. Dedicated efforts to improve communication with patients and families with limited English proficiency are necessary to improve hospital safety and reduce disparities.
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Affiliation(s)
- Alisa Khan
- Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Victoria Parente
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Jennifer D. Baird
- Institute for Nursing and Interprofessional Research, Children’s Hospital Los Angeles, Los Angeles, California
| | - Shilpa J. Patel
- Department of Pediatrics, Hawaii Pacific Health, Honolulu,Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu
| | - Sharon Cray
- Department of Pediatrics, St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania,Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
| | - Dionne A. Graham
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts,Program for Patient Safety and Quality, Boston Children’s Hospital, Boston, Massachusetts
| | - Monique Halley
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
| | - Tyler Johnson
- Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Erin Knoebel
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Kheyandra D. Lewis
- Department of Pediatrics, St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania,Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Isabella Liss
- Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Eileen M. Romano
- Department of Nursing, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Shrunjal Trivedi
- Program for Patient Safety and Quality, Boston Children’s Hospital, Boston, Massachusetts
| | - Nancy D. Spector
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania,The Hedwig van Ameringen Executive Leadership in Academic Medicine Program, Philadelphia, Pennsylvania
| | - Christopher P. Landrigan
- Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts,Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Ellen J Bass
- Department of Information Science, College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania.,Department of Health Systems and Science Research, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
| | - Sharon Calaman
- Department of Pediatrics, New York University Grossman School of Medicine, New York.,New York University Langone Health/Hassenfeld Children's Hospital, New York
| | - April E Fegley
- Society of Hospital Medicine, Philadelphia, Pennsylvania
| | - Andrew J Knighton
- Healthcare Delivery Institute, Intermountain Healthcare, Salt Lake City, Utah
| | - Jennifer K O'Toole
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Theodore C Sectish
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Rajendu Srivastava
- Healthcare Delivery Institute, Intermountain Healthcare, Salt Lake City, Utah.,Department of Pediatrics, University of Utah School of Medicine, Salt Lake City.,Primary Children's Medical Center, Salt Lake City, Utah
| | - Amy J Starmer
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Daniel C West
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.,Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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14
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Rucker AC, Watson A, Badolato G, Boyle M, Hendrix C, Jarvis L, Patel SJ, Goyal MK. Predictors of Elevated Social Risk in Pediatric Emergency Department Patients and Families. Pediatr Emerg Care 2022; 38:e910-e917. [PMID: 34225329 DOI: 10.1097/pec.0000000000002489] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to identify predictors of high unmet social needs among pediatric emergency department (ED) patients. We hypothesized that obesity, frequent nonurgent visits, reported food insecurity, or an at-risk chief complaint (CC) would predict elevated social risk. METHODS We administered a tablet-based survey assessing unmet social needs in 13 domains to caregivers of patients aged 0 to 17 years presenting to an urban pediatric ED. Responses were used to tabulate a social risk score (SRS). We performed multivariable logistic regression to measure associations between a high SRS (≥3) and obesity, frequent nonurgent visits, food insecurity, or an at-risk CC (physical abuse, sexual abuse, assault, mammalian bites, reproductive/sexual health complaints, intoxication, ingestion/poisoning, psychiatric/behavioral complaints, or any complaint triaged as "least urgent"). RESULTS Five hundred seventy caregivers completed the survey. Eighty-one percent reported at least one unmet social need, and 33% identified ≥3 social needs. Caregivers of patients with an at-risk CC had twice the odds of a high SRS (adjusted odds ratio [aOR], 1.8; 95% confidence interval [CI], 1.0-3.3). Caregivers of patients reporting food insecurity had 4 times the odds of a high SRS (aOR, 4.3; 95% CI, 2.5-7.3). Neither obesity (aOR, 1.5; 95% CI, 0.9-2.6) nor frequent nonurgent visits (aOR, 0.9; 95% CI, 0.4-1.9) were predictive of a high SRS. CONCLUSIONS Unmet social needs are prevalent among caregivers of pediatric ED patients, supporting universal screening in this population. Patients with an at-risk CC or reported food insecurity might benefit from proactive intervention. Future studies should examine optimal methods for ED-based interventions that address social determinants of health.
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Affiliation(s)
| | - Ar'Reon Watson
- Department of Psychiatry, Center for Child and Human Development, Georgetown University, Washington, DC
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15
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McKinley KW, Rickard KNZ, Latif F, Wavra T, Berg J, Morrison S, Chamberlain JM, Patel SJ. Impact of Universal Suicide Risk Screening in a Pediatric Emergency Department: A Discrete Event Simulation Approach. Healthc Inform Res 2022; 28:25-34. [PMID: 35172088 PMCID: PMC8850173 DOI: 10.4258/hir.2022.28.1.25] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/09/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives The aim of this study was to use discrete event simulation (DES) to model the impact of two universal suicide risk screening scenarios (emergency department [ED] and hospital-wide) on mean length of stay (LOS), wait times, and overflow of our secure patient care unit for patients being evaluated for a behavioral health complaint (BHC) in the ED of a large, academic children’s hospital. Methods We developed a conceptual model of BHC patient flow through the ED, incorporating anticipated system changes with both universal suicide risk screening scenarios. Retrospective site-specific patient tracking data from 2017 were used to generate model parameters and validate model output metrics with a random 50/50 split for derivation and validation data. Results The model predicted small increases (less than 1 hour) in LOS and wait times for our BHC patients in both universal screening scenarios. However, the days per year in which the ED experienced secure unit overflow increased (existing system: 52.9 days; 95% CI, 51.5–54.3 days; ED: 94.4 days; 95% CI, 92.6–96.2 days; and hospital-wide: 276.9 days; 95% CI, 274.8–279.0 days). Conclusions The DES model predicted that implementation of either universal suicide risk screening scenario would not severely impact LOS or wait times for BHC patients in our ED. However, universal screening would greatly stress our existing ED capacity to care for BHC patients in secure, dedicated patient areas by creating more overflow.
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Affiliation(s)
- Kenneth W. McKinley
- Emergency Medicine Section of Data Analytics, Children’s National Hospital, Washington, DC, USA
| | - Kelly N. Z. Rickard
- Department of Engineering Management and Systems Engineering, The George Washington University, Washington, DC, USA
| | - Finza Latif
- Division of Psychiatry and Behavioral Sciences, Children’s National Hospital, Washington, DC, USA
- Division of Child and Adolescent Psychiatry, Sidra Medicina, Al Gharafa, Doha, Qatar
| | - Theresa Wavra
- Emergency Medicine and Trauma Center, Children’s National Hospital, Washington, DC, USA
| | - Julie Berg
- Emergency Medicine and Trauma Center, Children’s National Hospital, Washington, DC, USA
| | - Sephora Morrison
- Emergency Medicine and Trauma Center, Children’s National Hospital, Washington, DC, USA
| | - James M. Chamberlain
- Emergency Medicine Section of Data Analytics, Children’s National Hospital, Washington, DC, USA
| | - Shilpa J. Patel
- Emergency Medicine Section of Data Analytics, Children’s National Hospital, Washington, DC, USA
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16
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Agbim C, Patel SJ, Brown K, Kline J. Practicing What We Teach: Increasing Inhaler Use for Mild Asthma in the Pediatric Emergency Department. J Healthc Qual 2022; 44:40-49. [PMID: 34507346 DOI: 10.1097/jhq.0000000000000326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Asthma is a leading cause of pediatric emergency department (ED) visits. A metered-dose inhaler and spacer (MDI-S) device is equivalent to and more cost effective than delivery by nebulization in the ED management of mild asthma exacerbations. We aimed to increase the use of albuterol MDI-S among patients with mild asthma exacerbations using a quality improvement framework. METHODS We evaluated albuterol use for mild asthma exacerbations between January 2019 and March 2020 in our pediatric EDs. RESULTS Our primary outcome was the proportion of albuterol delivered through an MDI-S. Our process measure was the use of a new electronic order set. Balancing measures included ED length of stay, admission rates, and the use of intravenous magnesium. Interventions included forging multidisciplinary partnerships, revising clinical practice guidelines, establishing an electronic order set, and leading educational initiatives for clinicians. We demonstrated a center line shift of MDI-S use from 34.4% to 47.7%. The average length of stay, hospital admissions, and magnesium use were not affected by our interventions. CONCLUSION Forging multidisciplinary partnerships, creating an electronic order set prioritizing albuterol MDI-S use, and educational initiatives led to a sustained increase in albuterol MDI-S use for mild asthma in our pediatric EDs.
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17
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Patel SJ, Badolato GM, Parikh K, Iqbal SF, Goyal MK. Regional Differences in Pediatric Firearm-Related Emergency Department Visits and the Association With Firearm Legislation. Pediatr Emerg Care 2021; 37:e692-e695. [PMID: 30807509 DOI: 10.1097/pec.0000000000001779] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to describe regional and temporal trends in pediatric firearm-related emergency department (ED) visits and investigate association with regional firearm legislation. METHODS We conducted a cross-sectional analysis using the Nationwide Emergency Department Sample from 2009 to 2013 for children aged 21 years or younger. We calculated national estimates of firearm-related visits using annual census data and measured trends. We used state-level gun law scores to derive regional scores to measure strictness of firearm legislation. We used multivariable logistic and linear regression to measure regional differences in visits and their association with regional gun law scores, respectively. RESULTS There were 111,839 (95% confidence interval, 101,248-122,431) ED visits for pediatric firearm-related injuries. Rates of visits varied by region, with the lowest rate in the Northeast and highest rate in the South (40.0 [34-45]; 70.8 [63.7-76.9] per 100,000 ED visits, respectively). Compared with the Northeast, odds of firearm-related ED visits were higher in the Midwest (adjusted odds ratio [aOR], 1.8; 1.4-2.3), West (aOR, 2.5; 2.0-3.2), and South (aOR, 1.9; 1.5-2.4). Firearm-related visits remained consistent over time. A higher (stricter) regional median Brady gun law score was associated with a lower rate of firearm-related visits (β = -0.8; R2 = 0.9; P = 0.03). CONCLUSIONS Rates of pediatric firearm-related ED visits vary by region. Stricter regional gun laws were associated with lower rates of ED visits for pediatric firearm-related injuries. Further study of the social and cultural regional differences in gun ownership and the role of legislation in the prevention of pediatric firearm-related morbidity and mortality is warranted.
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18
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Margolis RHF, Patel SJ, Sheehan WJ, Simpson JN, Kachroo N, Bahar B, Teach SJ. Association between pediatric asthma and positive tests for SARS-CoV-2 in the District of Columbia. J Allergy Clin Immunol Pract 2021; 9:3490-3493. [PMID: 34265448 PMCID: PMC8274272 DOI: 10.1016/j.jaip.2021.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/06/2021] [Accepted: 06/16/2021] [Indexed: 11/02/2022]
Affiliation(s)
- Rachel H F Margolis
- Center for Translational Research, Children's National Research Institute, Washington, DC
| | - Shilpa J Patel
- Center for Translational Research, Children's National Research Institute, Washington, DC; Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - William J Sheehan
- Center for Translational Research, Children's National Research Institute, Washington, DC; Division of Allergy and Immunology, Children's National Hospital, Washington, DC
| | - Joelle N Simpson
- Center for Translational Research, Children's National Research Institute, Washington, DC; Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Nikita Kachroo
- Center for Translational Research, Children's National Research Institute, Washington, DC
| | - Burak Bahar
- Division of Pathology and Laboratory Medicine, Children's National Hospital, Washington, DC
| | - Stephen J Teach
- Center for Translational Research, Children's National Research Institute, Washington, DC; Division of Emergency Medicine, Children's National Hospital, Washington, DC.
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19
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Cohen JS, Donnelly K, Patel SJ, Badolato GM, Boyle MD, McCarter R, Goyal MK. Firearms Injuries Involving Young Children in the United States During the COVID-19 Pandemic. Pediatrics 2021; 148:peds.2020-042697. [PMID: 33850026 DOI: 10.1542/peds.2020-042697] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Increased rates of firearm ownership, school closures, and a suspected decrease in supervision during the coronavirus disease 2019 (COVID-19) pandemic place young children at increased risk of firearm injuries. We measured trends in firearm injuries in children and inflicted by children discharging a firearm during the pandemic and correlated these changes with a rise in firearm acquisition. METHODS In this cross-sectional study with an interrupted time series analysis, we used multiyear data from the Gun Violence Archive. We compared trends in (1) firearm injuries in children younger than 12 years old and (2) firearm injuries inflicted by children younger than 12 years old during the pre-COVID-19 period (March to August in the years 2016-2019) and during the first 6 months of the COVID-19 pandemic (March 2020 to August 2020). Linear regression models were developed to evaluate the relationship between firearm injuries and new firearm acquisitions. RESULTS There was an increased risk of (1) firearm injuries in young children (relative risk = 1.90; 95% confidence interval 1.58 to 2.29) and (2) firearm injuries inflicted by young children (relative risk = 1.43; 95% confidence interval 1.14 to 1.80) during the first 6 months of the COVID-19 pandemic as compared to the pre-COVID-19 study period. These increased incidents correlate with an increase in new firearm ownership (P < .03). CONCLUSIONS There has been a surge in firearm injuries in young children and inflicted by young children during the first 6 months of the COVID-19 pandemic. There is an urgent and critical need for enactment of interventions aimed at preventing firearm injuries and deaths involving children.
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Affiliation(s)
- Joanna S Cohen
- Division of Emergency Medicine, Children's National Health System, Washington, District of Columbia.,Departments of Pediatrics.,Emergency Medicine, School of Medicine and Health Sciences
| | - Katie Donnelly
- Division of Emergency Medicine, Children's National Health System, Washington, District of Columbia.,Departments of Pediatrics.,Emergency Medicine, School of Medicine and Health Sciences
| | - Shilpa J Patel
- Division of Emergency Medicine, Children's National Health System, Washington, District of Columbia.,Departments of Pediatrics.,Emergency Medicine, School of Medicine and Health Sciences
| | - Gia M Badolato
- Division of Emergency Medicine, Children's National Health System, Washington, District of Columbia
| | - Meleah D Boyle
- Division of Emergency Medicine, Children's National Health System, Washington, District of Columbia
| | - Robert McCarter
- Departments of Pediatrics.,Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Monika K Goyal
- Division of Emergency Medicine, Children's National Health System, Washington, District of Columbia .,Departments of Pediatrics.,Emergency Medicine, School of Medicine and Health Sciences
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20
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King CA, Brent D, Grupp-Phelan J, Casper TC, Dean JM, Chernick LS, Fein JA, Mahabee-Gittens EM, Patel SJ, Mistry RD, Duffy S, Melzer-Lange M, Rogers A, Cohen DM, Keller A, Shenoi R, Hickey RW, Rea M, Cwik M, Page K, McGuire TC, Wang J, Gibbons R. Prospective Development and Validation of the Computerized Adaptive Screen for Suicidal Youth. JAMA Psychiatry 2021; 78:540-549. [PMID: 33533908 PMCID: PMC7859874 DOI: 10.1001/jamapsychiatry.2020.4576] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The rate of suicide among adolescents is rising in the US, yet many adolescents at risk are unidentified and receive no mental health services. OBJECTIVE To develop and independently validate a novel computerized adaptive screen for suicidal youth (CASSY) for use as a universal screen for suicide risk in medical emergency departments (EDs). DESIGN, SETTING, AND PARTICIPANTS Study 1 of this prognostic study prospectively enrolled adolescent patients at 13 geographically diverse US EDs in the Pediatric Emergency Care Applied Research Network. They completed a baseline suicide risk survey and participated in 3-month telephone follow-ups. Using 3 fixed Ask Suicide-Screening Questions items as anchors and additional items that varied in number and content across individuals, we derived algorithms for the CASSY. In study 2, data were collected from patients at 14 Pediatric Emergency Care Applied Research Network EDs and 1 Indian Health Service hospital. Algorithms were independently validated in a prospective cohort of adolescent patients who also participated in 3-month telephone follow-ups. Adolescents aged 12 to 17 years were consecutively approached during randomly assigned shifts. EXPOSURES Presentation at an ED. MAIN OUTCOME AND MEASURE A suicide attempt between ED visit and 3-month follow-up, measured via patient and/or parent report. RESULTS The study 1 CASSY derivation sample included 2075 adolescents (1307 female adolescents [63.0%]; mean [SD] age, 15.1 [1.61] years) with 3-month follow-ups (72.9% retention [2075 adolescents]). The study 2 validation sample included 2754 adolescents (1711 female adolescents [62.1%]; mean [SD] age, 15.0 [1.65] years), with 3-month follow-ups (69.5% retention [2754 adolescents]). The CASSY algorithms had excellent predictive accuracy for suicide attempt (area under the curve, 0.89 [95% CI, 0.85-0.91]) in study 1. The mean number of adaptively administered items was 11 (range, 5-21). At a specificity of 80%, the CASSY had a sensitivity of 83%. It also demonstrated excellent accuracy in the study 2 validation sample (area under the curve, 0.87 [95% CI, 0.85-0.89]). In this study, the CASSY had a sensitivity of 82.4% for prediction of a suicide attempt at the 80% specificity cutoff established in study 1. CONCLUSIONS AND RELEVANCE In this study, the adaptive and personalized CASSY demonstrated excellent suicide attempt risk recognition, which has the potential to facilitate linkage to services.
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Affiliation(s)
- Cheryl A. King
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - David Brent
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | - Lauren S. Chernick
- Department of Emergency Medicine and Pediatrics, Columbia University Medical Center, New York, New York
| | - Joel A. Fein
- Center for Violence Prevention, Children’s Hospital of Philadelphia, Division of Emergency Medicine, University of Pennsylvania, Philadelphia
| | | | - Shilpa J. Patel
- Division of Emergency Medicine, Children’s National Hospital, Washington, DC
| | - Rakesh D. Mistry
- Department of Pediatrics–Emergency Medicine, University of Colorado School of Medicine, Aurora
| | - Susan Duffy
- Department of Emergency Medicine, Alpert Medical School at Brown University, Providence, Rhode Island,Department of Pediatrics, Alpert Medical School at Brown University, Providence, Rhode Island
| | | | - Alexander Rogers
- Department of Emergency Medicine, University of Michigan, Ann Arbor,Department of Pediatrics, University of Michigan, Ann Arbor
| | - Daniel M. Cohen
- Division of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Allison Keller
- Department of Pediatric Emergency Medicine, The University of Utah, Salt Lake City
| | - Rohit Shenoi
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Robert W. Hickey
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Margaret Rea
- Medical Center at the University of California School of Medicine, Davis, Sacramento
| | - Mary Cwik
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kent Page
- The University of Utah School of Medicine, Salt Lake City
| | | | - Jiebiao Wang
- Department of Statistics and Data Science, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Robert Gibbons
- Department of Medicine, The University of Chicago, Chicago, Illinois,Department of Public Health Sciences (Biostatistics), The University of Chicago, Chicago, Illinois,Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois,Department of Comparative Human Development, The University of Chicago, Chicago, Illinois
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21
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Patel SJ, Badolato GM, Parikh K, Iqbal SF, Goyal MK. Sociodemographic Factors and Outcomes by Intent of Firearm Injury. Pediatrics 2021; 147:peds.2020-011957. [PMID: 33782104 DOI: 10.1542/peds.2020-011957] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Firearm injuries are a leading and preventable cause of morbidity and mortality among youth. We sought to explore differences in sociodemographic factors and youth firearm injury outcomes by injury intent (unintentional, assault, and self-harm). METHODS We conducted a repeated cross-sectional analysis of emergency department (ED) visits among youth aged 21 and younger presenting to an ED with a firearm injury between 2009 and 2016 using the Nationwide Emergency Department Sample. We performed multivariable logistic regression to measure the strength of association between (1) patient-level factors, (2) visit-level characteristics, and (3) clinical outcomes and intent of firearm injury. RESULTS We identified 178 299 weighted visits for firearm injuries. The mean age was 17.9 (95% confidence interval 17.8-18.0) years; 89.0% of patients were male, 43.0% were publicly insured, 28.8% were admitted, and 6.0% died. Approximately one-third of the injuries were categorized as unintentional (39.4%), another third as assault (37.7%), and a small proportion as self-harm (1.7%). Unintentional firearm injuries were associated with younger age, rural hospital location, Southern region, ED discharge, and extremity injury. Self-harm firearm injuries were associated with older age, higher socioeconomic status, rural hospital location, transfer or death, and brain, back, or spinal cord injury. Firearm injuries by assault were associated with lower socioeconomic status, urban hospital location, and requiring admission. CONCLUSIONS We identified distinct risk profiles for youth with unintentional, self-harm-, and assault-related firearm injuries. Sociodemographic factors related to intent may be useful in guiding policy and informing tailored interventions for the prevention of firearm injuries in at-risk youth.
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Affiliation(s)
- Shilpa J Patel
- Children's National Hospital, Washington, District of Columbia; .,Divisions of Emergency Medicine and
| | - Gia M Badolato
- Children's National Hospital, Washington, District of Columbia.,Divisions of Emergency Medicine and
| | - Kavita Parikh
- Children's National Hospital, Washington, District of Columbia.,Hospitalist Medicine, Department of Pediatrics, The George Washington University, Washington, District of Columbia; and
| | - Sabah F Iqbal
- Emergency Medicine, PM Pediatrics, Bethesda, Maryland
| | - Monika K Goyal
- Children's National Hospital, Washington, District of Columbia.,Divisions of Emergency Medicine and
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22
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Choi T, Devries M, Bacharier LB, Busse W, Camargo CA, Cohen R, Demuri GP, Evans MD, Fitzpatrick AM, Gergen PJ, Grindle K, Gruchalla R, Hartert T, Hasegawa K, Khurana Hershey GK, Holt P, Homil K, Jartti T, Kattan M, Kercsmar C, Kim H, Laing IA, LeBeau P, Lee KE, Le Souëf PN, Liu A, Mauger DT, Ober C, Pappas T, Patel SJ, Phipatanakul W, Pongracic J, Seroogy C, Sly PD, Tisler C, Wald ER, Wood R, Gangnon R, Jackson DJ, Lemanske RF, Gern JE, Bochkov YA. Enhanced Neutralizing Antibody Responses to Rhinovirus C and Age-Dependent Patterns of Infection. Am J Respir Crit Care Med 2021; 203:822-830. [PMID: 33357024 PMCID: PMC8017585 DOI: 10.1164/rccm.202010-3753oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/23/2020] [Indexed: 01/10/2023] Open
Abstract
Rationale: Rhinovirus (RV) C can cause asymptomatic infection and respiratory illnesses ranging from the common cold to severe wheezing.Objectives: To identify how age and other individual-level factors are associated with susceptibility to RV-C illnesses.Methods: Longitudinal data from the COAST (Childhood Origins of Asthma) birth cohort study were analyzed to determine relationships between age and RV-C infections. Neutralizing antibodies specific for RV-A and RV-C (three types each) were determined using a novel PCR-based assay. Data were pooled from 14 study cohorts in the United States, Finland, and Australia, and mixed-effects logistic regression was used to identify factors related to the proportion of RV-C versus RV-A detection.Measurements and Main Results: In COAST, RV-A and RV-C infections were similarly common in infancy, whereas RV-C was detected much less often than RV-A during both respiratory illnesses and scheduled surveillance visits (P < 0.001, χ2) in older children. The prevalence of neutralizing antibodies to RV-A or RV-C types was low (5-27%) at the age of 2 years, but by the age of 16 years, RV-C seropositivity was more prevalent (78% vs. 18% for RV-A; P < 0.0001). In the pooled analysis, the RV-C to RV-A detection ratio during illnesses was significantly related to age (P < 0.0001), CDHR3 genotype (P < 0.05), and wheezing illnesses (P < 0.05). Furthermore, certain RV types (e.g., C2, C11, A78, and A12) were consistently more virulent and prevalent over time.Conclusions: Knowledge of prevalent RV types, antibody responses, and populations at risk based on age and genetics may guide the development of vaccines or other novel therapies against this important respiratory pathogen.
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Affiliation(s)
- Timothy Choi
- University of Wisconsin-Madison, Madison, Wisconsin
| | - Mark Devries
- University of Wisconsin-Madison, Madison, Wisconsin
| | | | | | | | | | | | | | - Anne M Fitzpatrick
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Peter J Gergen
- National Institute of Allergy and Infectious Disease, National Institutes of Health, Rockville, Maryland
| | | | | | | | | | | | - Patrick Holt
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | | | - Tuomas Jartti
- University of Turku, Turku, Finland
- Universities of Oulu, Oulu, Finland
| | | | | | - Haejin Kim
- Henry Ford Health Systems, Detroit, Michigan
| | - Ingrid A Laing
- University of Western Australia, Perth, Western Australia, Australia
| | | | | | - Peter N Le Souëf
- University of Western Australia, Perth, Western Australia, Australia
| | - Andrew Liu
- University of Colorado, Denver, Colorado
| | | | | | | | | | | | | | | | - Peter D Sly
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia; and
| | | | - Ellen R Wald
- University of Wisconsin-Madison, Madison, Wisconsin
| | - Robert Wood
- Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - James E Gern
- University of Wisconsin-Madison, Madison, Wisconsin
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Jayaram P, Liu C, Dawson B, Ketkar S, Patel SJ, Lee BH, Grol MW. Leukocyte-dependent effects of platelet-rich plasma on cartilage loss and thermal hyperalgesia in a mouse model of post-traumatic osteoarthritis. Osteoarthritis Cartilage 2020; 28:1385-1393. [PMID: 32629163 PMCID: PMC7787501 DOI: 10.1016/j.joca.2020.06.004] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 06/14/2020] [Accepted: 06/22/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Platelet-rich plasma (PRP) is an emerging therapeutic strategy for treatment of osteoarthritis (OA); however, there is a lack of preclinical and clinical evidence for its efficacy and its mechanism of action is unclear. In the current study, we utilized leukocyte poor-PRP (LP-PRP) and leukocyte rich-PRP (LR-PRP) to mimic clinical point of care formulations and assessed their potential to alter disease progression in a mouse model of post-traumatic OA. METHOD Three-month-old wild-type male FVB/N mice received destabilization of the medial meniscus (DMM) surgery to induce OA. To assess the efficacy of LP-PRP and LR-PRP, mice were given intraarticular injections at 2-, 7- and 28-days post-surgery. Mice were then assessed at 5-, 9-, and 13-weeks post-surgery for changes in chronic pain using the hot plate nociceptive assay. At 14-weeks, OA pathogenesis was evaluated using histology and phase-contrast μCT. RESULTS Treatment with LP-PRP and to a lesser extent LR-PRP preserved cartilage volume and surface area compared to phosphate-buffered saline (PBS) as measured by phase-contrast μCT. However, both treatments had higher Osteoarthritis Research Society International (OARSI) and synovitis scores compared to sham, and neither substantially improved scores compared to PBS controls. With respect to thermal hyperalgesia, PBS-treated mice displayed reduced latency to response compared to sham, and LR-PRP but not LP-PRP improved latency to response at 5-, 9- and 13-weeks post-surgery compared to PBS. CONCLUSION The results of this study suggest that effects of PRP therapy on OA progression and disease-induced hyperalgesia may be leukocyte-dependent. And while LP-PRP and to a lesser extent LR-PRP protect from volume and surface loss, significant pathology is still seen within OA joints. Future work is needed to understand how the different components of PRP effect OA pathogenesis and pain, and how these could be modified to achieve greater therapeutic efficacy.
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Affiliation(s)
- P Jayaram
- H. Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX, USA; Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - C Liu
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - B Dawson
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - S Ketkar
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - S J Patel
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - B H Lee
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.
| | - M W Grol
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.
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Agrawal S, Iqbal S, Patel SJ, Freishtat R, Kochhar-Bryant C. Quality of life in at-risk school-aged children with asthma. J Asthma 2020; 58:1680-1688. [PMID: 32942908 DOI: 10.1080/02770903.2020.1825732] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Asthma is the most common chronic condition of childhood. Urban, minority children from families of lower socioeconomic status have disproportionately higher rates of asthma and worse outcomes. We investigated the association between the presence of asthma and asthma severity among American, urban, minority children and reported quality of life (QOL) of children and their families. METHODS We performed a prospective, cross-sectional study comparing QOL of urban, minority elementary school-age children with and without asthma. A convenience sample of children was enrolled from the pediatric emergency department (ED) and a specialized asthma clinic, at a large urban children's hospital. We measured child and parent QOL using the Pediatric Quality of Life Inventory Version 4 (PEDSQL4), and evaluated associations with asthma, parental educational attainment, and frequency of ED visits. RESULTS We enrolled 66 children, 76% were African American, and 61% were female. Overall child QOL was higher for those without asthma (p = 0.017, d = 0.59). Children with asthma also visited the ED almost twice as frequently (t [64] = -3.505, p < 0.001, d = 0.8), and parents of children with asthma reported a lower overall QOL (p = 0.04, d = 0.53) than those without asthma. Among children with asthma, a higher overall child QOL was associated with decreased asthma severity, more ED visits, and higher parental educational attainment. CONCLUSIONS Urban, minority elementary school-age children with asthma report a lower QOL than those children without asthma, and decreased asthma severity was associated with higher QOL.
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Affiliation(s)
- Seema Agrawal
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sabah Iqbal
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA
| | - Shilpa J Patel
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA
| | - Robert Freishtat
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA
| | - Carol Kochhar-Bryant
- Special Education and Disability Studies, The George Washington University, Washington, DC, USA
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Abstract
Firearms remain a common cause of injury in children. Advocacy is a tool that can be useful in effecting systemic change. Yet for firearm injury prevention, traditional methods of effecting change face unique barriers not experienced in other areas of pediatric injury prevention. As pediatric emergency medicine physicians, we are on the front lines, and as part of the receiving end of the trauma inflicted on our communities by firearms, ours is a powerful voice well suited to overcome these barriers. Current firearm advocacy efforts include raising awareness via social media or editorials, organizing larger advocacy groups for support, challenging legislation, and implementing hospital-based violence intervention programs. Future advocacy directions should include collaborating with unique partners, teleadvocacy, direct action, and finding common ground with gun regulation opposition. Physician advocacy is essential to firearm injury prevention. Continuing to innovate around our advocacy efforts will be vital to the health and safety of our patients.
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Affiliation(s)
- Katie A Donnelly
- Children's National Hospital, Division of Emergency Medicine, Washington, DC
- George Washington University Hospital, Departments of Pediatrics and Emergency Medicine,George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Shilpa J Patel
- Children's National Hospital, Division of Emergency Medicine, Washington, DC
- George Washington University Hospital, Departments of Pediatrics and Emergency Medicine,George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Monika K Goyal
- Children's National Hospital, Division of Emergency Medicine, Washington, DC
- George Washington University Hospital, Departments of Pediatrics and Emergency Medicine,George Washington University School of Medicine and Health Sciences, Washington, DC
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Taenzer AH, Patel SJ, Allen TL, Doerfler ME, Park TR, Savitz LA, Park JG. Improvement in Mortality With Early Fluid Bolus in Sepsis Patients With a History of Congestive Heart Failure. Mayo Clin Proc Innov Qual Outcomes 2020; 4:537-541. [PMID: 33083702 PMCID: PMC7557190 DOI: 10.1016/j.mayocpiqo.2020.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 12/29/2022] Open
Abstract
Objective To determine whether rapid administration of a crystalloid bolus of 30 mL/kg within 3 hours of presentation harms or benefits hypotensive patients with sepsis with a history of congestive heart failure (CHF). Patients and Methods A retrospective cohort study using Medicare claims data enhanced by medical record data from members of the High Value Healthcare Collaborative from July 1, 2013, to June 30, 2015, examining patients with a history of CHF who did (fluid bundle compliant [FBC]) or did not (NFBC) receive a volume bolus of 30 mL/kg within 3 hours of presentation to the emergency department. A proportional Cox hazard model was used to evaluate the association of FBC with 1-year survival. Results Of the 211 patients examined, 190 were FBC and 21 were NFBC. The FBC patients had higher average hierarchical condition category scores but were otherwise similar to NFBC patients. The NFBC patients had higher adjusted in-hospital and postdischarge mortality rates. The risk-adjusted 1-year mortality rate was higher for NFBC patients (hazard ratio, 2.18; 95% CI, 1.2 to 4.0; P=.01) than for FBC patients. Conclusion In a retrospective claim data-based study of elderly patients with a history of CHF presenting with severe sepsis or septic shock, there is an association of improved mortality with adherence to the initial fluid resuscitation guidelines as part of the 3-hour sepsis bundle.
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Affiliation(s)
- Andreas H. Taenzer
- Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Shilpa J. Patel
- Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, HI
- Kapiolani Medical Center for Women & Children, Honolulu, HI
| | - Todd L. Allen
- Healthcare Delivery Institute, Intermountain Healthcare, Salt Lake City, UT
| | - Martin E. Doerfler
- Clinical Strategy and Development, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Tae-Ryong Park
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH
| | - Lucy A. Savitz
- Center for Health Research, Kaiser Permanente, Portland, OR
| | - John G. Park
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
- Correspondence: Address to John G. Park, MD, 200 First Ave SW, Gonda 17W, Rochester, MN 55905. @intub8_pccm
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Kurahara D, Hamamura FD, Ifuku C, Chen JJ, Liu CA, Seamon EM, Miwa CS, Maestas B, Oba R, Patel SJ, Shiramizu B. Medical School Location and Sex Affect the In-State Retention of Pediatric Residency Program Graduates in Hawai'i. Hawaii J Health Soc Welf 2020; 79:240-245. [PMID: 32789294 PMCID: PMC7417638] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The objective of this study was to assess the impact of medical school, sex, career choice, and location of practice of one pediatric residency program on physician workforce. This is a retrospective study of all categorical pediatric graduates of a residency program located in Honolulu, Hawai'i from 1968 to 2015. Information on medical school training, sex, career choice (general pediatrics or specialty), and location of practice were studied by examining data into five 10-year graduation periods. The program graduated 319 residents over nearly a 50-year timespan. Of these, 181 (56.7%) residents remained in Hawai'i to practice (adjusted odds ratio [OR] = 7.46, 95% confidence interval [CI]: 3.61-15.43). There were 125 (39.1%) graduates who relocated to the continental US with the majority moving to the West (55.2%), while other graduates moved to the South, Midwest, and Northeast (25.6%, 13.6%, and 5.6%, respectively). The remaining 13 (4.1%) graduates moved internationally. Female residents steadily increased over time (P < .001), with females significantly choosing general pediatrics (OR = 3.05, 95% CI: 1.91-4.89). In the time periods with the highest percentage of University of Hawai'i medical school graduates, there was an increased percentage of graduates staying in Hawai'i. This study examined the regional and national impact of a small residency program. The results indicated that trends in gender and the impact of medical school location were important in establishing a pediatrician workforce for local communities. Support of both medical school and residency education should be considered when assessing future workforce needs.
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Affiliation(s)
- David Kurahara
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (DK, FDH, CI, CAL, EMS, CSM, BM, RO, SJP, BS)
| | - Faith D. Hamamura
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (DK, FDH, CI, CAL, EMS, CSM, BM, RO, SJP, BS)
| | - Christine Ifuku
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (DK, FDH, CI, CAL, EMS, CSM, BM, RO, SJP, BS)
| | | | - Chloe A. Liu
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (DK, FDH, CI, CAL, EMS, CSM, BM, RO, SJP, BS)
| | - Elisabeth M. Seamon
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (DK, FDH, CI, CAL, EMS, CSM, BM, RO, SJP, BS)
| | - Chloe S. Miwa
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (DK, FDH, CI, CAL, EMS, CSM, BM, RO, SJP, BS)
| | - Brienna Maestas
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (DK, FDH, CI, CAL, EMS, CSM, BM, RO, SJP, BS)
| | - Ria Oba
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (DK, FDH, CI, CAL, EMS, CSM, BM, RO, SJP, BS)
| | - Shilpa J. Patel
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (DK, FDH, CI, CAL, EMS, CSM, BM, RO, SJP, BS)
| | - Bruce Shiramizu
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (DK, FDH, CI, CAL, EMS, CSM, BM, RO, SJP, BS)
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Das A, Henderson FC, Alshareef M, Porto GBF, Kanginakudru I, Infinger LK, Vandergrift WA, Lindhorst SM, Varma AK, Patel SJ, Cachia D. MGMT-inhibitor in combination with TGF-βRI inhibitor or CDK 4/6 inhibitor increases temozolomide sensitivity in temozolomide-resistant glioblastoma cells. Clin Transl Oncol 2020; 23:612-619. [PMID: 32710211 DOI: 10.1007/s12094-020-02456-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/21/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Glioblastoma (GB) remains an incurable and deadly brain malignancy that often proves resistant to upfront treatment with temozolomide. Nevertheless, temozolomide remains the most commonly prescribed FDA-approved chemotherapy for GB. The DNA repair protein methylguanine-DNA methyl transferase (MGMT) confers resistance to temozolomide. Unsurprisingly temozolomide-resistant tumors tend to possess elevated MGMT protein levels or lack inhibitory MGMT promotor methylation. In this study, cultured human temozolomide resistance GB (43RG) cells were introduced to the MGMT inhibitor O6-benzylguanine combined with temozolomide and either LY2835219 (CDK 4/6 inhibitor) or LY2157299 (TGF-βRI inhibitor) seeking to overcome GB treatment resistance. METHODS Treatment effects were assessed using MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay, western blot, cell viability, and cell cycle progression. RESULTS Our in vitro study demonstrated that sequential treatment of O6-Benzylguanine with either LY2385219 or LY2157299-enhanced temozolomide enhanced sensitivity in MGMT+ 43RG cells. Importantly, normal human neurons and astrocytes remained impervious to the drug therapies under these conditions. Furthermore, LY2835219 has additional anti-proliferative effects on cell cycling, including induction of an RB-associated G (1) arrest via suppression of cyclin D-CDK4/6-Rb pathway. LY2157299 enhances anti-tumor effect by disrupting TGF-β-dependent HIF-1α signaling and by activating both Smad and PI3K-AKT pathways towards transcription of S/G2 checkpoints. CONCLUSION This study establishes the groundwork for the development of a combinatorial pharmacologic approach by using either LY2385219 or LY2157299 inhibitor plus O6-Benzylguanine to augment temozolomide response in temozolomide-resistant GB cells.
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Affiliation(s)
- A Das
- Department of Neurosurgery (Divisions of Neuro-Oncology) and MUSC Brain and Spine Tumor Program CSB 310, Medical University of South Carolina at Charleston, Charleston, SC, 29425, USA.
| | - F C Henderson
- Department of Neurosurgery (Divisions of Neuro-Oncology) and MUSC Brain and Spine Tumor Program CSB 310, Medical University of South Carolina at Charleston, Charleston, SC, 29425, USA
| | - M Alshareef
- Department of Neurosurgery (Divisions of Neuro-Oncology) and MUSC Brain and Spine Tumor Program CSB 310, Medical University of South Carolina at Charleston, Charleston, SC, 29425, USA
| | - G B F Porto
- Department of Neurosurgery (Divisions of Neuro-Oncology) and MUSC Brain and Spine Tumor Program CSB 310, Medical University of South Carolina at Charleston, Charleston, SC, 29425, USA
| | - I Kanginakudru
- Department of Neurosurgery (Divisions of Neuro-Oncology) and MUSC Brain and Spine Tumor Program CSB 310, Medical University of South Carolina at Charleston, Charleston, SC, 29425, USA
| | - L K Infinger
- Department of Neurosurgery (Divisions of Neuro-Oncology) and MUSC Brain and Spine Tumor Program CSB 310, Medical University of South Carolina at Charleston, Charleston, SC, 29425, USA
| | - W A Vandergrift
- Department of Neurosurgery (Divisions of Neuro-Oncology) and MUSC Brain and Spine Tumor Program CSB 310, Medical University of South Carolina at Charleston, Charleston, SC, 29425, USA
| | - S M Lindhorst
- Department of Neurosurgery (Divisions of Neuro-Oncology) and MUSC Brain and Spine Tumor Program CSB 310, Medical University of South Carolina at Charleston, Charleston, SC, 29425, USA
| | - A K Varma
- Department of Neurosurgery (Divisions of Neuro-Oncology) and MUSC Brain and Spine Tumor Program CSB 310, Medical University of South Carolina at Charleston, Charleston, SC, 29425, USA
| | - S J Patel
- Department of Neurosurgery (Divisions of Neuro-Oncology) and MUSC Brain and Spine Tumor Program CSB 310, Medical University of South Carolina at Charleston, Charleston, SC, 29425, USA
| | - D Cachia
- Department of Neurosurgery (Divisions of Neuro-Oncology) and MUSC Brain and Spine Tumor Program CSB 310, Medical University of South Carolina at Charleston, Charleston, SC, 29425, USA
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Rosenbluth G, Good BP, Litterer KP, Markle P, Baird JD, Khan A, Landrigan CP, Spector ND, Patel SJ. Communicating Effectively With Hospitalized Patients and Families During the COVID-19 Pandemic. J Hosp Med 2020; 15:440-442. [PMID: 32584245 DOI: 10.12788/jhm.3466] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/08/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Glenn Rosenbluth
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco School of Medicine, San Francisco, California
| | - Brian P Good
- Department of Pediatrics, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Peggy Markle
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Jennifer D Baird
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California
| | - Alisa Khan
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Christopher P Landrigan
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Nancy D Spector
- Executive Leadership in Academic Medicine Program (ELAM) and Office of Faculty Development, Drexel University College of Medicine, Philadelphia, Pennsylvania
- Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Shilpa J Patel
- Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
- Hawai'i Pacific Health, Honolulu, Hawaii
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O'Toole JK, Hepps J, Starmer AJ, Patel SJ, Rosenbluth G, Calaman S, Campos ML, Lopreiato JO, Schnipper JL, Sectish TC, Srivastava R, West DC, Landrigan CP, Spector ND, Yu CE. I-PASS Mentored Implementation Handoff Curriculum: Frontline Provider Training Materials. MedEdPORTAL 2020; 16:10912. [PMID: 32715086 PMCID: PMC7375701 DOI: 10.15766/mep_2374-8265.10912] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/01/2019] [Indexed: 05/22/2023]
Abstract
INTRODUCTION The I-PASS Handoff Program is a comprehensive handoff curriculum that has been shown to decrease rates of medical errors and adverse events during patient handoffs. Frontline providers are the key individuals participating in handoffs of patient care. It is important they receive robust handoff training. METHODS The I-PASS Mentored Implementation Handoff Curriculum frontline provider training materials were created as part of the original I-PASS Study and adapted for the Society of Hospital Medicine (SHM) I-PASS Mentored Implementation Program. The adapted materials embrace a flipped classroom approach with an emphasis on adult learning theory principles. The training includes an overview of I-PASS handoff techniques, TeamSTEPPS team communication strategies, verbal handoff simulation scenarios, and a printed handoff document exercise. RESULTS As part of the SHM I-PASS Mentored Implementation Program, 2,735 frontline providers were trained at 32 study sites (16 adult and 16 pediatric) across North America. At the end of their training, 1,762 frontline providers completed the workshop evaluation form (64% response rate). After receiving the training, over 90% agreed/strongly agreed that they were able to distinguish a good- from a poor-quality handoff, articulate the elements of the I-PASS mnemonic, construct a high-quality patient summary, advocate for an appropriate environment for handoffs, and participate in handoff simulations. Universally, the training provided them with knowledge and skills relevant to their patient care activities. DISCUSSION The I-PASS frontline training materials were rated highly by those trained and are an integral part of a successful I-PASS Handoff Program implementation.
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Affiliation(s)
- Jennifer K. O'Toole
- Program Director, Internal Medicine-Pediatrics Residency Program, University of Cincinnati College of Medicine; Associate Professor, Department of Pediatrics, Cincinnati Children's Hospital Medical Center; Associate Professor, Department of Internal Medicine, University of Cincinnati College of Medicine
- Corresponding author:
| | - Jennifer Hepps
- Program Director, National Capital Consortium Transitional Year Internship, Walter Reed National Military Medical Center; Associate Professor, Department of Pediatrics, Uniformed Services University of the Health Sciences
| | - Amy J. Starmer
- Director of Primary Care Quality Improvement, Boston Children's Hospital; Assistant Professor, Department of Pediatrics, Harvard Medical School
| | - Shilpa J. Patel
- Associate Professor, Department of Pediatrics, University of Hawaii John A. Burns School of Medicine; Pediatric Hospitalist, Kapi'olani Medical Center for Women & Children
| | - Glenn Rosenbluth
- Associate Director, Pediatric Residency Program, Benioff Children's Hospital; Professor, Department of Pediatrics, University of California, San Francisco, School of Medicine
| | - Sharon Calaman
- Program Director, Pediatric Residency Program, St. Christopher's Hospital for Children; Professor, Department of Pediatrics, Drexel University College of Medicine
| | - Maria-Lucia Campos
- Research Study Coordinator, Division of General Pediatrics, Boston Children's Hospital
| | - Joseph O. Lopreiato
- Associate Dean, Simulation Education, Uniformed Services University of the Health Sciences; Professor, Department of Pediatrics, Uniformed Services University of the Health Sciences
| | - Jeffrey L. Schnipper
- Associate Professor, Department of Medicine, Harvard Medical School; Associate Professor, Department of Medicine, Brigham and Women's Hospital
| | - Theodore C. Sectish
- Program Director, Boston Combined Residency Program in Pediatrics, Boston Children's Hospital; Vice Chair for Education, Boston Combined Residency Program in Pediatrics, Boston Children's Hospital; Professor, Department of Pediatrics, Harvard Medical School
| | - Rajendu Srivastava
- Assistant Vice President of Research, Intermountain Healthcare; Tenured Professor, Department of Pediatrics, Intermountain Primary Children's Hospital; Tenured Professor, Department of Pediatrics, University of Utah School of Medicine
| | - Daniel C. West
- Associate Chair for Education, Children's Hospital of Philadelphia; Professor, Department of Pediatrics, University of Pennsylvania School of Medicine
| | - Christopher P. Landrigan
- Chief, Division of General Pediatrics, Boston Children's Hospital; Director, Sleep and Patient Safety Program, Brigham and Women's Hospital; William Berenberg Professor of Pediatrics, Harvard Medical School
| | - Nancy D. Spector
- Executive Director, Executive Leadership in Academic Medicine Program, Drexel University College of Medicine; Associate Dean for Faculty Development, Drexel University College of Medicine; Professor, Department of Pediatrics, Drexel University College of Medicine
| | - Clifton E. Yu
- Deputy Director, Education, Training, and Research, Walter Reed National Military Medical Center; Professor, Department of Pediatrics, Uniformed Services University of the Health Sciences
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Donnelly KA, Kafashzadeh D, Goyal MK, Badolato GM, Patel SJ, Bhansali P, Roche KM, Cohen JS. Barriers to Firearm Injury Research. Am J Prev Med 2020; 58:825-831. [PMID: 32147369 DOI: 10.1016/j.amepre.2020.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 09/19/2019] [Revised: 01/05/2020] [Accepted: 01/06/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Firearm injuries and motor vehicle injuries are 2 leading causes of fatal injury in the U.S., each accounting for approximately 35,000 deaths annually. Research on firearm injuries is under-represented compared with research on motor vehicle collisions. This study seeks to identify perceived barriers to firearm injury research versus motor vehicle injury research. METHODS This was a mixed-methods survey of corresponding authors of a minimum of 1 study, archived in PubMed, related to firearm injury or motor vehicle injury between 2014 and 2018. Analyses were performed in 2019. Electronic surveys included both closed- and open-ended questions to assess barriers to research. Bivariable and multivariable logistic regression was performed to identify differences in perceptions to barriers between the 2 groups. Qualitative analysis of free-text responses was performed through inductive derivation of themes. RESULTS Surveys were distributed to 113 firearm injury researchers (42% response rate) and 241 motor vehicle injury researchers (31.5% response rate). After adjustment, firearm injury researchers were less likely to cite institutional support (AOR=0.3, 95% CI=0.1, 0.8) as a factor contributing to their success, than motor vehicle injury researchers. Firearm injury researchers were more likely to report fear of personal threats (AOR=10.4, 95% CI=2.4, 44.4) and experiencing personal threats (AOR=16.1, 95% CI=1.6, 165.4). Thematic analysis revealed 4 themes: career, political, funding, and harassment. CONCLUSIONS When compared with motor vehicle injury researchers, firearm injury researchers are significantly more likely to report limited support and threats to personal safety as barriers to research. Further research to understand the impact of these barriers and methods to overcome them is needed.
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Affiliation(s)
- Katie A Donnelly
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia; Departments of Pediatrics and Emergency Medicine, George Washington University Hospital, Washington, District of Columbia.
| | - Dariush Kafashzadeh
- School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Monika K Goyal
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia; Departments of Pediatrics and Emergency Medicine, George Washington University Hospital, Washington, District of Columbia
| | - Gia M Badolato
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
| | - Shilpa J Patel
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia; Departments of Pediatrics and Emergency Medicine, George Washington University Hospital, Washington, District of Columbia
| | - Priti Bhansali
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
| | - Kathleen M Roche
- Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Joanna S Cohen
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia; Departments of Pediatrics and Emergency Medicine, George Washington University Hospital, Washington, District of Columbia
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Di Rocco JR, Okado CK, Kimata C, Patel SJ. Patient Safety Initiative Using Peer Observations and Feedback Inspire Collegial Workplace Culture. Hawaii J Health Soc Welf 2020; 79:112-117. [PMID: 32490397 PMCID: PMC7260866] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Following Joint Commission recommendations for standardizing patient handoffs, direct peer observations and feedback were utilized in order to improve patient safety related to transitions of care in the Division of Pediatric Hospital Medicine at Kapi'olani Medical Center for Women & Children. All hospitalist attendings were trained in an evidence-based handoff bundle inclusive of team communication and feedback strategies. For the initial project, each hospitalist performed 12 peer observations and feedback sessions using validated tools for verbal and written handoffs over 6 months. For a subsequent "refresher" project, each hospitalist performed 6 handoff observations. Attendings were surveyed several times before, during, and after completion of the multiple iterations of the project. A qualitative interview was conducted 6 years after the initial handoff project. In total, 204 observations were completed by 17 hospitalists during the initial project. The perceived overall quality of the patient handoff improved significantly across shifts (P < .001 for the quality of each of two critical daily handoffs) as did pediatric hospitalists' confidence in providing peer feedback (P < .001). Downstream effects of this activity led to additional benefits towards the cohesive growth of the division. Themes from post-project qualitative interviews regarding the peer observation and feedback portion of the study included that it was "helpful," "collaborative," and inspired "camaraderie" that led to increased comfort and participation during future opportunities for observation and feedback. Performing direct peer observations with feedback strengthened the workplace culture, promoted growth through collaboration, and allowed acceptance and success of future projects involving peer observations and feedback.
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Affiliation(s)
- Jennifer R. Di Rocco
- Department of Pediatrics, John A Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Cheryl K. Okado
- Department of Pediatrics, John A Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Chieko Kimata
- Department of Pediatrics, John A Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Shilpa J. Patel
- Department of Pediatrics, John A Burns School of Medicine, University of Hawai‘i, Honolulu, HI
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Das A, Alshareef M, Martinez Santos JL, Porto GBF, McDonald DG, Infinger LK, Vandergrift WA, Lindhorst SM, Varma AK, Patel SJ, Cachia D. Evaluating anti-tumor activity of palbociclib plus radiation in anaplastic and radiation-induced meningiomas: pre-clinical investigations. Clin Transl Oncol 2020; 22:2017-2025. [PMID: 32253706 DOI: 10.1007/s12094-020-02341-7] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/16/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE Meningiomas are common brain tumors, the majority of which are considered benign. Despite surgery and/or radiation therapy, recurrence rates are approximately 8-10%. One likely cause is the dysregulation of cyclin D-cyclin-dependent kinases 4 and 6 (CDK4/6)-retinoblastoma (Rb) pathway, which controls the cell cycle restriction point. This pathway is commonly dysregulated in anaplastic meningioma cell lines (AM) and radiation-induced meningioma cells (RIM), making it a rational target for anti-meningioma therapy. In this study, we investigate the effect of a CDK4/6 inhibitor, palbociclib, with radiation in relevant pre-clinical models. METHODS In vitro cell culture, ex vivo slice culture and in vivo cell line-derived orthotopic xenograft animal models of AM/RIM were utilized to assess treatment efficacy with palbociclib plus radiation. Treatment effects were examined by immunoblot, cell viability, apoptosis, and cell cycle progression. RESULTS The in vitro and ex vivo studies demonstrate that palbociclib plus radiation treatment reduced proliferation and has additional effects on cell cycling, including induction of an RB-associated G (1) arrest in Rb+ AM and RIM cells, but not in Rb- cells. Our results also demonstrated reduced CDK4 and CDK6 expression as well as reduced E2F target gene expression (CCNA2 and CCNE2) with the combination therapy. MRI results in vivo demonstrated reduced tumor size at 5 weeks when treated with 14 days palbociclib (10 mg/kg) plus 6 Gy radiation compared to saline-treated tumors. Finally, no hepatic toxicity was found after treatments. CONCLUSION A pre-clinical murine model provides preclinical evidence for use of palbociclib plus radiation as a therapeutic agent for Rb+ meningiomas.
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Affiliation(s)
- A Das
- Department of Neurosurgery (Neuro-oncology Division), Medical University of South Carolina, Charleston, SC, USA.
| | - M Alshareef
- Department of Neurosurgery (Neuro-oncology Division), Medical University of South Carolina, Charleston, SC, USA
| | - J L Martinez Santos
- Department of Neurosurgery (Neuro-oncology Division), Medical University of South Carolina, Charleston, SC, USA
| | - G B F Porto
- Department of Neurosurgery (Neuro-oncology Division), Medical University of South Carolina, Charleston, SC, USA
| | - D G McDonald
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - L K Infinger
- Department of Neurosurgery (Neuro-oncology Division), Medical University of South Carolina, Charleston, SC, USA
| | - W A Vandergrift
- Department of Neurosurgery (Neuro-oncology Division), Medical University of South Carolina, Charleston, SC, USA
| | - S M Lindhorst
- Department of Neurosurgery (Neuro-oncology Division), Medical University of South Carolina, Charleston, SC, USA
| | - A K Varma
- Department of Neurosurgery (Neuro-oncology Division), Medical University of South Carolina, Charleston, SC, USA
| | - S J Patel
- Department of Neurosurgery (Neuro-oncology Division), Medical University of South Carolina, Charleston, SC, USA
| | - D Cachia
- Department of Neurosurgery (Neuro-oncology Division), Medical University of South Carolina, Charleston, SC, USA
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Das A, Alshareef M, Henderson F, Martinez Santos JL, Vandergrift WA, Lindhorst SM, Varma AK, Infinger L, Patel SJ, Cachia D. Ganoderic acid A/DM-induced NDRG2 over-expression suppresses high-grade meningioma growth. Clin Transl Oncol 2019; 22:1138-1145. [PMID: 31732915 DOI: 10.1007/s12094-019-02240-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 09/04/2019] [Accepted: 10/28/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE N-myc downstream-regulated gene 2 (NDRG2) is down-regulated in grade-III meningioma [anaplastic meningioma (AM)] and associated with clinically aggressive behavior. Current therapies in the treatment of high-grade meningioma are lacking with limited success. This study aims to validate the effect of NDRG2-targeted therapy using structurally related bioactive triterpene compounds derived from the edible mushroom Ganoderma lucidum (ganoderic acid A:GA-A/ganoderic acid DM:GA-DM) in human AM in relevant pre-clinical models. METHODS Tissue samples from the AM tumor regions of three human patients and control non-tumor samples were used to analyze the expression pattern of NDRG2. In vitro cell culture and in vivo cell-line-derived orthotopic xenograft animal models of AM were utilized to assess efficacy of treatment with GA-A/DM. RESULTS Downregulation of NDRG2 expression was observed in surgically resected high-grade meningiomas compared to normal brain. These results prompt us to use NDRG2-targeting agents GA-A/DM. In vitro results showed that 72-h treatments of 25 µM GA-A/DM induced AM cell death, upregulate NDRG2 protein expression, downregulate NDRG2 promoter methylation in meningioma cells as compared to azacitidine and decitabine, the most commonly used demethylating agents. Our results also demonstrated that GA-A/DM does not have any detrimental effect on normal human neurons and arachnoid cells. GA-A/DM promoted apoptotic factors (Bax) while suppressing MMP-9, p-P13K, p-AKT, p-mTOR, and Wnt-2 protein expression. RNAi-mediated knockdown of NDRG2 protein expression increased tumor proliferation, while forced expression of wt-NDRG2 decreased proliferation in an in vitro model. Magnetic resonance (MR) imaging and Hematoxylin (H&E) staining demonstrated gross reduction of tumor volume in GA-A/DM treated mice at 5 weeks when compared with saline-treated orthotopic AM xenografted controls. There was an overall decrease in tumor cell proliferation with increased survival in GA-A/DM-treated animals. Enzyme assays showed that GA-A/DM did not negatively impact hepatic function. CONCLUSION GA-A/DM may be a promising natural therapeutic reagent in the treatment of AM by suppressing growth via NDRG2 modulation and altering of intracellular signal pathways. We have shown it could potentially be an effective treatment for AM with decreased cellular proliferation in vitro, decreased tumor volume and increased survival in vivo.
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Affiliation(s)
- A Das
- Department of Neurosurgery (Divisions of Neuro-oncology) and MUSC Brain and Spine Tumor Program CSB 310, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - M Alshareef
- Department of Neurosurgery (Divisions of Neuro-oncology) and MUSC Brain and Spine Tumor Program CSB 310, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - F Henderson
- Department of Neurosurgery (Divisions of Neuro-oncology) and MUSC Brain and Spine Tumor Program CSB 310, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - J L Martinez Santos
- Department of Neurosurgery (Divisions of Neuro-oncology) and MUSC Brain and Spine Tumor Program CSB 310, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - W A Vandergrift
- Department of Neurosurgery (Divisions of Neuro-oncology) and MUSC Brain and Spine Tumor Program CSB 310, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - S M Lindhorst
- Department of Neurosurgery (Divisions of Neuro-oncology) and MUSC Brain and Spine Tumor Program CSB 310, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - A K Varma
- Department of Neurosurgery (Divisions of Neuro-oncology) and MUSC Brain and Spine Tumor Program CSB 310, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - L Infinger
- Department of Neurosurgery (Divisions of Neuro-oncology) and MUSC Brain and Spine Tumor Program CSB 310, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - S J Patel
- Department of Neurosurgery (Divisions of Neuro-oncology) and MUSC Brain and Spine Tumor Program CSB 310, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - D Cachia
- Department of Neurosurgery (Divisions of Neuro-oncology) and MUSC Brain and Spine Tumor Program CSB 310, Medical University of South Carolina, Charleston, SC, 29425, USA
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Affiliation(s)
- Shilpa J Patel
- Division of Emergency Medicine, Children's National Medical Center, Washington, DC
| | - Stephen J Teach
- Division of Emergency Medicine, Children's National Medical Center, Washington, DC
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Sheth KR, Anaissie J, Patel SJ, White JT, Seth A. The efficacy of unilateral laparoscopic nephrectomy in the pediatric hypertensive patient. J Pediatr Urol 2019; 15:470.e1-470.e6. [PMID: 31331808 DOI: 10.1016/j.jpurol.2019.05.039] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 05/30/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Secondary hypertension due to a poorly functioning or non-functional kidney may be refractory to medical management. In such cases, nephrectomy can improve or cure hypertension. With the routine use of laparoscopy, nephrectomy can be performed in a minimally invasive manner, but surgery still carries inherent risks and complications. OBJECTIVE The objective of this study is to evaluate the outcomes of laparoscopic nephrectomy performed for secondary hypertension and identify potential predictors of postoperative hypertension resolution. METHODS After obtaining approval from institutional review board, patients from January 2002 to March 2018 who underwent laparoscopic nephrectomy were identified using Current Procedural Technology codes. All charts were then manually reviewed to isolate those patients with secondary hypertension present preoperatively. Patient demographics, urologic history, and laboratory and imaging findings were recorded for all patients. Serial blood pressures were recorded at all renal visits along with any antihypertensive medication changes. Postoperative outcomes and complications were also noted for all patients. RESULTS A total of 20 patients (7 girls, 13 boys) underwent laparoscopic nephrectomy to treat hypertension at an average age of 10.6 years (range 1.7-17.0 years). Etiology of a solitary non-functional kidney was vesicoureteral reflux in 10 of 20 patients, multicystic dysplastic kidney in 5 of 20, ureteropelvic junction obstruction in 2 of 20, ureteral obstruction in 1 of 20, and renal artery stenosis in 2 of 20 patients. At time of surgery, 3 of 20 patients were on two antihypertensives, 10 of 20 were on one antihypertensive, and 7 of 20 proceeded to surgery with no medical management. In the 30-day postoperative period, no complications were noted. Hypertension improved in 10 of 20 (50%) patients, all of whom were not on any antihypertensive medications after surgery. Hypertension persisted in 4 of 20 (20%) patients, requiring the same antihypertensive regimen and worsened in 6 of 20 (30%) patients, requiring increased doses and/or additional antihypertensives. Average follow-up time was 2.7 years. No significant predictors of postoperative hypertension result were identified when comparing the groups of responders and non-responders. DISCUSSION While laparoscopic nephrectomy for a non-functioning kidney in the setting of hypertension is a safe procedure, the cure rate for hypertension in the cohort appears to be on the low side of what was previously reported. While the small sample size is a main limitation, it is among the largest sample sizes for pediatric hypertensive patients. Previously shown predictors were not predictive in the similar-sized cohort. CONCLUSIONS Patients should be carefully counseled on the risks and benefits of nephrectomy to treat hypertension, the importance of continued follow-up after nephrectomy, and the possible need for chronic medical management with antihypertensives.
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Affiliation(s)
- K R Sheth
- Department of Surgery, Texas Children's Hospital, Houston, TX, 77030, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - J Anaissie
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - S J Patel
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - J T White
- Division of Pediatric Urology, Norton Children's Hospital, Louisville, KY, 40207, USA
| | - A Seth
- Department of Surgery, Texas Children's Hospital, Houston, TX, 77030, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, 77030, USA.
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Langerman SD, Badolato GM, Rucker A, Jarvis L, Patel SJ, Goyal MK. Acceptability of Adolescent Social and Behavioral Health Screening in the Emergency Department. J Adolesc Health 2019; 65:543-548. [PMID: 31377163 PMCID: PMC6764595 DOI: 10.1016/j.jadohealth.2019.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/20/2019] [Revised: 04/19/2019] [Accepted: 05/17/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE The American Academy of Pediatrics recommends routine screening for social and behavioral health risks (SBHR) in adolescents. Because adolescents who seek care in emergency departments (EDs) may have riskier behaviors than adolescents who access primary care, the ED may be a strategic additional setting for screening. We sought to identify acceptable domains for comprehensive SBHR screening in a pediatric ED. METHODS We conducted a cross-sectional survey to assess adolescent and caregiver acceptance of ED-based SBHR screening across multiple domains. Logistic regression was performed to identify factors associated with screening acceptance. McNemar's test was used to assess agreement within patient/caregiver dyads across domains. RESULTS Among our 516 study participants (347 adolescents and 169 caregivers), those who indicated that they "agree" or "strongly agree" that ED-based screening should be conducted were classified as finding screening acceptable. Acceptability rates ranged from 45.0% (firearm access) to 77.5% (suicidality) among adolescents and 61.5% (firearm access) to 84.0% (substance use) among caregivers. After adjusting for gender, race/ethnicity, and insurance status, adolescents were less accepting than caregivers of screening for: substance use (adjusted odds ratio [aOR]: .51; .31, .83; p < .01); violence (aOR: .63; .41, .97; p = .04); depression (aOR: .65; .42, .99; p = .04); human trafficking (aOR: .58; .39, .86; p < .01); and access to firearms (aOR: .47; .32, .70; p < .01). Shared agreement within adolescent/caregiver dyads ranged from 25.2% to 67.1%. CONCLUSIONS A majority of adolescents and caregivers agree that ED-based SBHR screening should be conducted across most domains. Caregivers generally had higher rates of screening acceptance than adolescents.
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Affiliation(s)
- Steven D. Langerman
- The George Washington University, School of Medicine and Health Sciences, Washington, DC
| | | | - Alexandra Rucker
- The George Washington University, School of Medicine and Health Sciences, Washington, DC,Children’s National Health System, Washington, DC
| | - Lenore Jarvis
- The George Washington University, School of Medicine and Health Sciences, Washington, DC,Children’s National Health System, Washington, DC
| | - Shilpa J. Patel
- The George Washington University, School of Medicine and Health Sciences, Washington, DC,Children’s National Health System, Washington, DC
| | - Monika K. Goyal
- The George Washington University, School of Medicine and Health Sciences, Washington, DC,Children’s National Health System, Washington, DC
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Abstract
Communication errors during transitions of care are a leading source of adverse events for hospitalized patients. This article provides an overview of the role of communication errors in adverse events, describes the complexities of communication for hospitalized patients, and provides evidence regarding the positive effects of applying high-reliability principles to transitions of care and culture of safety. Elements of effective handoffs and a detailed approach for successful implementation of a handoff program are provided. The role of handoff communication in medical education at all levels, as well as for the interprofessional team, is discussed.
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Affiliation(s)
- Shilpa J Patel
- John A. Burns School of Medicine, Kapi`olani Medical Center for Women & Children, Hawaii Pacific Health, 1319 Punahou Street, 7th Floor, Honolulu, HI 96826, USA.
| | - Christopher P Landrigan
- Boston Children's Hospital, Brigham & Women's Hospital, Harvard Medical School, 300 Longwood Avenue, Enders 1, Boston, MA 02115, USA
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Goyal MK, Badolato GM, Patel SJ, Iqbal SF, Parikh K, McCarter R. State Gun Laws and Pediatric Firearm-Related Mortality. Pediatrics 2019; 144:peds.2018-3283. [PMID: 31308258 DOI: 10.1542/peds.2018-3283] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Firearms are the second leading cause of pediatric death in the United States. There is significant variation in firearm legislation at the state level. Recently, 3 state laws were associated with a reduction in overall deaths from firearms: universal background checks for firearm purchases, universal background checks for ammunition purchases, and identification requirement for firearms. We sought to determine if stricter firearm legislation at the state level is associated with lower pediatric firearm-related mortality. METHODS This was a cross-sectional study in which we used 2011-2015 Web-based Injury Statistics Query and Reporting System and Census data. We measured the association of the (1) strictness of firearm legislation (gun law score) and (2) presence of the 3 aforementioned gun laws with pediatric firearm-related mortality. We performed negative binomial regression accounting for differences in state-level characteristics (population-based race and ethnicity, education, income, and gun ownership) to derive mortality rate ratios associated with a 10-point change in each predictor and predicted mortality rates. RESULTS A total of 21 241 children died of firearm-related injuries during the 5-year period. States with stricter gun laws had lower rates of firearm-related pediatric mortality (adjusted incident rate ratio 0.96 [0.93-0.99]). States with laws requiring universal background checks for firearm purchase in effect for ≥5 years had lower pediatric firearm-related mortality rates (adjusted incident rate ratio 0.65 [0.46-0.90]). CONCLUSIONS In this 5-year analysis, states with stricter gun laws and laws requiring universal background checks for firearm purchase had lower firearm-related pediatric mortality rates. These findings support the need for further investigation to understand the impact of firearm legislation on pediatric mortality.
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Affiliation(s)
- Monika K Goyal
- Children's National Health System, Washington, District of Columbia; .,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia; and
| | - Gia M Badolato
- Children's National Health System, Washington, District of Columbia
| | - Shilpa J Patel
- Children's National Health System, Washington, District of Columbia.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia; and
| | | | - Kavita Parikh
- Children's National Health System, Washington, District of Columbia.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia; and
| | - Robert McCarter
- Children's National Health System, Washington, District of Columbia.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia; and
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Patel SJ, Goyal MK, Parikh K. "Smart" Choices: Shared Decision-making in Firearm Storage and Personalized Firearms. Pediatrics 2019; 143:peds.2018-3611. [PMID: 30835248 DOI: 10.1542/peds.2018-3611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Shilpa J Patel
- Children's National Health System, Washington, District of Columbia
| | - Monika K Goyal
- Children's National Health System, Washington, District of Columbia
| | - Kavita Parikh
- Children's National Health System, Washington, District of Columbia
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O'Toole JK, Starmer AJ, Calaman S, Campos ML, Hepps J, Lopreiato JO, Patel SJ, Rosenbluth G, Schnipper JL, Sectish TC, Srivastava R, West DC, Yu CE, Landrigan CP, Spector ND. I-PASS Mentored Implementation Handoff Curriculum: Champion Training Materials. MedEdPORTAL 2019; 15:10794. [PMID: 30800994 PMCID: PMC6354793 DOI: 10.15766/mep_2374-8265.10794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 06/28/2018] [Accepted: 12/01/2018] [Indexed: 05/22/2023]
Abstract
INTRODUCTION The I-PASS Handoff Program is a comprehensive handoff curriculum that has been shown to decrease rates of medical errors and adverse events during patient handoffs. I-PASS champions are a critical part of the implementation and sustainment of this curriculum, and therefore, a rigorous program to support their training is necessary. METHODS The I-PASS Handoff champion training materials were created for the original I-PASS Study and adapted for the Society of Hospital Medicine (SHM) I-PASS Mentored Implementation Program. The adapted materials embrace a flipped classroom approach and adult learning theory. The training includes an overview of I-PASS handoff techniques, an opportunity to practice evaluating handoffs with the I-PASS observation tools using a handoff video vignette, and other key implementation principles. RESULTS As part of the SHM I-PASS Mentored Implementation Program, 366 champions were trained at 32 sites across North America and participated in a total of 3,491 handoff observations. A total of 346 champions completed the I-PASS Champion Workshop evaluation form at the end of their training (response rate: 94.5%). After receiving the training, over 90% agreed/strongly agreed that it provided them with knowledge or skills critical to their patient care activities and that they were able to distinguish the difference between high- and poor-quality handoffs, competently use the I-PASS handoff assessment tools, and articulate the importance of handoff observations. CONCLUSION The I-PASS champion training materials were rated highly by those trained and are an integral part of a successful I-PASS Handoff Program implementation.
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Affiliation(s)
- Jennifer K. O'Toole
- Director, Internal Medicine-Pediatrics Residency Program, University of Cincinnati College of Medicine; Associate Professor, Department of Pediatrics, Cincinnati Children's Hospital Medical Center; Associate Professor, Department of Internal Medicine, University of Cincinnati College of Medicine
- Corresponding author:
| | - Amy J. Starmer
- Director of Primary Care Quality Improvement, Boston Children's Hospital; Assistant Professor, Department of Pediatrics, Harvard Medical School
| | - Sharon Calaman
- Associate Professor, Department of Pediatrics, Drexel University College of Medicine; Director, Pediatric Residency Program, St. Christopher's Hospital for Children
| | - Maria-Lucia Campos
- Research Study Coordinator, Division of General Pediatrics, Boston Children's Hospital
| | - Jennifer Hepps
- Assistant Professor, Department of Pediatrics, Uniformed Services University of the Health Sciences
| | - Joseph O. Lopreiato
- Professor, Department of Pediatrics, Uniformed Services University of the Health Sciences; Associate Dean for Simulation Education, Uniformed Services University of the Health Sciences
| | - Shilpa J. Patel
- Associate Professor, Department of Pediatrics, University of Hawaii, John A. Burns School of Medicine; Pediatric Hospitalist, Kapi'olani Medical Center for Women & Children
| | - Glenn Rosenbluth
- Associate Director, Pediatric Residency Program, Benioff Children's Hospital; Professor, Department of Pediatrics, University of California, San Francisco, School of Medicine
| | - Jeffrey L. Schnipper
- Associate Professor, Department of Medicine, Harvard Medical School; Associate Professor, Department of Medicine, Brigham and Women's Hospital
| | - Theodore C. Sectish
- Program Director, Boston Combined Residency Program in Pediatrics, Boston Children's Hospital; Vice Chair for Education, Boston Combined Residency Program in Pediatrics, Boston Children's Hospital; Professor, Department of Pediatrics, Harvard Medical School
| | - Rajendu Srivastava
- Assistant Vice President of Research, Intermountain Healthcare; Tenured Associate Professor, Department of Pediatrics, Division of Inpatient Medicine, University of Utah School of Medicine
| | - Daniel C. West
- Director, Pediatric Residency Program, University of California, San Francisco, School of Medicine; Vice-Chair for Education, University of California, San Francisco, School of Medicine; Professor, Department of Pediatrics, University of California, San Francisco, School of Medicine
| | - Clifton E. Yu
- Director, Graduate Medical Education, Walter Reed National Military Medical Center; Associate Professor, Department of Pediatrics, Uniformed Services University of the Health Sciences
| | - Christopher P. Landrigan
- Director of Research, Inpatient Pediatrics Service, Boston Children's Hospital; Director, Sleep and Patient Safety Program, Brigham and Women's Hospital; Associate Professor, Department of Medicine, Harvard Medical School; Associate Professor, Department of Pediatrics, Harvard Medical School
| | - Nancy D. Spector
- Executive Director, Executive Leadership in Academic Medicine Program, Drexel University College of Medicine; Associate Dean for Faculty Development, Drexel University College of Medicine; Professor, Department of Pediatrics, Drexel University College of Medicine
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Khan A, Spector ND, Baird JD, Ashland M, Starmer AJ, Rosenbluth G, Garcia BM, Litterer KP, Rogers JE, Dalal AK, Lipsitz S, Yoon CS, Zigmont KR, Guiot A, O'Toole JK, Patel A, Bismilla Z, Coffey M, Langrish K, Blankenburg RL, Destino LA, Everhart JL, Good BP, Kocolas I, Srivastava R, Calaman S, Cray S, Kuzma N, Lewis K, Thompson ED, Hepps JH, Lopreiato JO, Yu CE, Haskell H, Kruvand E, Micalizzi DA, Alvarado-Little W, Dreyer BP, Yin HS, Subramony A, Patel SJ, Sectish TC, West DC, Landrigan CP. Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study. BMJ 2018; 363:k4764. [PMID: 30518517 PMCID: PMC6278585 DOI: 10.1136/bmj.k4764] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether medical errors, family experience, and communication processes improved after implementation of an intervention to standardize the structure of healthcare provider-family communication on family centered rounds. DESIGN Prospective, multicenter before and after intervention study. SETTING Pediatric inpatient units in seven North American hospitals, 17 December 2014 to 3 January 2017. PARTICIPANTS All patients admitted to study units (3106 admissions, 13171 patient days); 2148 parents or caregivers, 435 nurses, 203 medical students, and 586 residents. INTERVENTION Families, nurses, and physicians coproduced an intervention to standardize healthcare provider-family communication on ward rounds ("family centered rounds"), which included structured, high reliability communication on bedside rounds emphasizing health literacy, family engagement, and bidirectional communication; structured, written real-time summaries of rounds; a formal training programme for healthcare providers; and strategies to support teamwork, implementation, and process improvement. MAIN OUTCOME MEASURES Medical errors (primary outcome), including harmful errors (preventable adverse events) and non-harmful errors, modeled using Poisson regression and generalized estimating equations clustered by site; family experience; and communication processes (eg, family engagement on rounds). Errors were measured via an established systematic surveillance methodology including family safety reporting. RESULTS The overall rate of medical errors (per 1000 patient days) was unchanged (41.2 (95% confidence interval 31.2 to 54.5) pre-intervention v 35.8 (26.9 to 47.7) post-intervention, P=0.21), but harmful errors (preventable adverse events) decreased by 37.9% (20.7 (15.3 to 28.1) v 12.9 (8.9 to 18.6), P=0.01) post-intervention. Non-preventable adverse events also decreased (12.6 (8.9 to 17.9) v 5.2 (3.1 to 8.8), P=0.003). Top box (eg, "excellent") ratings for six of 25 components of family reported experience improved; none worsened. Family centered rounds occurred more frequently (72.2% (53.5% to 85.4%) v 82.8% (64.9% to 92.6%), P=0.02). Family engagement 55.6% (32.9% to 76.2%) v 66.7% (43.0% to 84.1%), P=0.04) and nurse engagement (20.4% (7.0% to 46.6%) v 35.5% (17.0% to 59.6%), P=0.03) on rounds improved. Families expressing concerns at the start of rounds (18.2% (5.6% to 45.3%) v 37.7% (17.6% to 63.3%), P=0.03) and reading back plans (4.7% (0.7% to 25.2%) v 26.5% (12.7% to 7.3%), P=0.02) increased. Trainee teaching and the duration of rounds did not change significantly. CONCLUSIONS Although overall errors were unchanged, harmful medical errors decreased and family experience and communication processes improved after implementation of a structured communication intervention for family centered rounds coproduced by families, nurses, and physicians. Family centered care processes may improve safety and quality of care without negatively impacting teaching or duration of rounds. TRIAL REGISTRATION ClinicalTrials.gov NCT02320175.
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Affiliation(s)
- Alisa Khan
- Harvard Medical School, Boston, MA, USA
- Department of Medicine and Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Nancy D Spector
- Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Jennifer D Baird
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Michele Ashland
- Family-Centered Care Department, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Amy J Starmer
- Harvard Medical School, Boston, MA, USA
- Department of Medicine and Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Glenn Rosenbluth
- University of California San Francisco School of Medicine, San Francisco, CA, USA
- Department of Pediatrics, Benioff Children's Hospital, San Francisco, CA, USA
| | - Briana M Garcia
- University of California San Francisco School of Medicine, San Francisco, CA, USA
- Department of Medicine and Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | | | - Jayne E Rogers
- Inpatient Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Anuj K Dalal
- Harvard Medical School, Boston, MA, USA
- Center for Patient Safety Research, Division of General Medicine, Department of Medicine at Brigham and Women's Hospital, Boston, MA, USA
| | - Stuart Lipsitz
- Harvard Medical School, Boston, MA, USA
- Center for Patient Safety Research, Division of General Medicine, Department of Medicine at Brigham and Women's Hospital, Boston, MA, USA
| | - Catherine S Yoon
- Center for Patient Safety Research, Division of General Medicine, Department of Medicine at Brigham and Women's Hospital, Boston, MA, USA
| | - Katherine R Zigmont
- Center for Patient Safety Research, Division of General Medicine, Department of Medicine at Brigham and Women's Hospital, Boston, MA, USA
| | - Amy Guiot
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jennifer K O'Toole
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Aarti Patel
- University of California San Diego School of Medicine, San Diego, CA, USA
- Division of Pediatric Hospital Medicine, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Zia Bismilla
- Pediatrics, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Maitreya Coffey
- Pediatrics, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Kate Langrish
- Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Division of Pediatric Hospital Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Rebecca L Blankenburg
- Stanford School of Medicine, Palo Alto, CA, USA
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Lauren A Destino
- Stanford School of Medicine, Palo Alto, CA, USA
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Jennifer L Everhart
- Stanford School of Medicine, Palo Alto, CA, USA
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Brian P Good
- University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Irene Kocolas
- University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Rajendu Srivastava
- University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Sharon Calaman
- Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Sharon Cray
- Family Advisory Council, St Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Nicholas Kuzma
- Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Kheyandra Lewis
- Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, PA, USA
| | - E Douglas Thompson
- Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Jennifer H Hepps
- Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Joseph O Lopreiato
- Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Clifton E Yu
- Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | - Elizabeth Kruvand
- Family Partner Program, St Louis Children's Hospital, St Louis, MO, USA
- St Louis Children's Hospital, St Louis, MO, USA
| | - Dale A Micalizzi
- The Justin's HOPE Project, Task Force for Global Health, Decatur, GA, USA
| | - Wilma Alvarado-Little
- New York State Department of Health, New York, NY, USA
- New York State Department of Health, New York, NY, USA
| | - Benard P Dreyer
- New York University School of Medicine, New York, NY, USA
- Division of Developmental-Behavioral Pediatrics, New York University Langone Medical Center, New York, NY, USA
| | - H Shonna Yin
- New York University School of Medicine, New York, NY, USA
- Departments of Pediatrics and Population Health at New York University Langone Medical Center, New York, NY, USA
| | - Anupama Subramony
- Cohen Children's Medical Center, New York, NY, USA
- Hofstra Northwell School of Medicine, Queens, NY, USA
| | - Shilpa J Patel
- University of Hawaii John A Burns School of Medicine, Honolulu, HI, USA
- Hawai'i Pacific Health, Honolulu, HI, USA
| | - Theodore C Sectish
- Harvard Medical School, Boston, MA, USA
- Department of Medicine and Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Daniel C West
- University of California San Francisco School of Medicine, San Francisco, CA, USA
- Department of Pediatrics, Benioff Children's Hospital, San Francisco, CA, USA
| | - Christopher P Landrigan
- Harvard Medical School, Boston, MA, USA
- Department of Medicine and Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
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Patel SJ, Chamberlain DB, Chamberlain JM. A Machine Learning Approach to Predicting Need for Hospitalization for Pediatric Asthma Exacerbation at the Time of Emergency Department Triage. Acad Emerg Med 2018; 25:1463-1470. [PMID: 30382605 DOI: 10.1111/acem.13655] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/24/2018] [Accepted: 10/29/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Pediatric asthma is a leading cause of emergency department (ED) utilization and hospitalization. Earlier identification of need for hospital-level care could triage patients more efficiently to high- or low-resource ED tracks. Existing tools to predict disposition for pediatric asthma use only clinical data, perform best several hours into the ED stay, and are static or score-based. Machine learning offers a population-specific, dynamic option that allows real-time integration of available nonclinical data at triage. Our objective was to compare the performance of four common machine learning approaches, incorporating clinical data available at the time of triage with information about weather, neighborhood characteristics, and community viral load for early prediction of the need for hospital-level care in pediatric asthma. METHODS Retrospective analysis of patients ages 2 to 18 years seen at two urban pediatric EDs with asthma exacerbation over 4 years. Asthma exacerbation was defined as receiving both albuterol and systemic corticosteroids. We included patient features, measures of illness severity available in triage, weather features, and Centers for Disease Control and Prevention influenza patterns. We tested four models: decision trees, LASSO logistic regression, random forests, and gradient boosting machines. For each model, 80% of the data set was used for training and 20% was used to validate the models. The area under the receiver operating characteristic (AUC) curve was calculated for each model. RESULTS There were 29,392 patients included in the analyses: mean (±SD) age of 7.0 (±4.2) years, 42% female, 77% non-Hispanic black, and 76% public insurance. The AUCs for each model were: decision tree 0.72 (95% confidence interval [CI] = 0.66-0.77), logistic regression 0.83 (95% CI = 0.82-0.83), random forests 0.82 (95% CI = 0.81-0.83), and gradient boosting machines 0.84 (95% CI = 0.83-0.85). In the lowest decile of risk, only 3% of patients required hospitalization; in the highest decile this rate was 100%. After patient vital signs and acuity, age and weight, followed by socioeconomic status (SES) and weather-related features, were the most important for predicting hospitalization. CONCLUSIONS Three of the four machine learning models performed well with decision trees preforming the worst. The gradient boosting machines model demonstrated a slight advantage over other approaches at predicting need for hospital-level care at the time of triage in pediatric patients presenting with asthma exacerbation. The addition of weight, SES, and weather data improved the performance of this model.
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Affiliation(s)
- Shilpa J. Patel
- Division of Emergency Medicine Children's National Health System Washington DC UK
| | | | - James M. Chamberlain
- Division of Emergency Medicine Children's National Health System Washington DC UK
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O'Toole JK, Starmer AJ, Calaman S, Campos ML, Goldstein J, Hepps J, Maynard GA, Owolabi M, Patel SJ, Rosenbluth G, Schnipper JL, Sectish TC, Srivastava R, West DC, Yu CE, Landrigan CP, Spector ND. I-PASS Mentored Implementation Handoff Curriculum: Implementation Guide and Resources. MedEdPORTAL 2018; 14:10736. [PMID: 30800936 PMCID: PMC6342372 DOI: 10.15766/mep_2374-8265.10736] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/27/2018] [Indexed: 05/30/2023]
Abstract
Introduction Communication failures during shift-to-shift handoffs of patient care have been identified as a leading cause of adverse events in health care institutions. The I-PASS Handoff Program is a comprehensive handoff program that has been shown to decrease rates of medical errors and adverse events. As part of the spread and adaptation of this program, a comprehensive implementation guide was created to assist individuals in the implementation process. Methods The I-PASS Mentored Implementation Guide grew out of materials created for the original I-PASS Study, Society of Hospital Medicine (SHM) mentored implementation programs, and the experience of members of the I-PASS Study Group. The guide provides a comprehensive framework of all elements required to implement the large-scale I-PASS Handoff Program and contains detailed information on generating institutional support, training activities, a campaign, measuring impact, and sustaining the program. Results Thirty-two sites across North America utilized the guide as part of the SHM program. The guide served as a main reference for 477 hours of mentoring phone calls between site leads and their mentors. Postprogram surveys from wave 2 sites revealed that 85% (N = 34) of respondents felt the quality of the guide was very good/excellent. Site leads noted that they referenced the guide most often during the early part of the program and that they referenced the sections on the curriculum and handoff observations most often. Discussion The I-PASS Mentored Implementation Guide is an essential resource for those looking to implement the large-scale I-PASS Handoff Program at their institution.
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Affiliation(s)
- Jennifer K. O'Toole
- Program Director, Internal Medicine-Pediatrics Residency Program, University of Cincinnati College of Medicine
- Associate Professor, Department of Pediatrics, Cincinnati Children's Hospital Medical Center
- Associate Professor, Department of Internal Medicine, University of Cincinnati College of Medicine
| | - Amy J. Starmer
- Director of Primary Care Quality Improvement, Boston Children's Hospital
- Assistant Professor, Department of Pediatrics, Harvard Medical School
| | - Sharon Calaman
- Associate Professor, Department of Pediatrics, Drexel University College of Medicine
- Director, Pediatric Residency Program, St. Christopher's Hospital for Children
| | - Maria-Lucia Campos
- Research Study Coordinator, Division of General Pediatrics, Boston Children's Hospital
| | - Jenna Goldstein
- Director, Center for Hospital Innovation and Improvement, Society of Hospital Medicine
| | - Jennifer Hepps
- Assistant Professor, Department of Pediatrics, Uniformed Services University of the Health Sciences
| | - Gregory A. Maynard
- Chief Quality Officer, UC Davis Medical Center
- Clinical Professor, Department of Internal Medicine, UC Davis Medical Center
| | | | - Shilpa J. Patel
- Associate Professor, Department of Pediatrics, University of Hawaii, John A. Burns School of Medicine
- Pediatric Hospitalist, Kapi'olani Medical Center for Women & Children
| | - Glenn Rosenbluth
- Associate Director, Pediatric Residency Program, Benioff Children's Hospital
- Associate Professor, Department of Pediatrics, University of California, San Francisco, School of Medicine
| | - Jeffrey L. Schnipper
- Associate Professor, Department of Medicine, Harvard Medical School
- Associate Professor, Department of Medicine, Brigham and Women's Hospital
| | - Theodore C. Sectish
- Program Director, Boston Combined Residency Program in Pediatrics, Boston Children's Hospital
- Vice Chair for Education, Boston Combined Residency Program in Pediatrics, Boston Children's Hospital
- Professor, Department of Pediatrics, Harvard Medical School
| | - Rajendu Srivastava
- Assistant Vice President of Research, Intermountain Healthcare
- Tenured Associate Professor, Department of Pediatrics, Division of Inpatient Medicine, University of Utah School of Medicine
| | - Daniel C. West
- Director, Pediatric Residency Program, University of California, San Francisco, School of Medicine
- Vice-Chair for Education, University of California, San Francisco, School of Medicine
- Professor, Department of Pediatrics, University of California, San Francisco, School of Medicine
| | - Clifton E. Yu
- Director, Graduate Medical Education, Walter Reed National Military Medical Center
- Associate Professor, Department of Pediatrics, Uniformed Services University of the Health Sciences
| | - Christopher P. Landrigan
- Associate Professor, Department of Medicine, Harvard Medical School
- Director of Research, Inpatient Pediatrics Service, Boston Children's Hospital
- Director, Sleep and Patient Safety Program, Brigham and Women's Hospital
- Associate Professor, Department of Pediatrics, Harvard Medical School
| | - Nancy D. Spector
- Executive Director, Executive Leadership in Academic Medicine, Drexel University College of Medicine
- Associate Dean for Faculty Development, Drexel University College of Medicine
- Professor, Department of Pediatrics, Drexel University College of Medicine
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45
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Shah AY, Dooley D, Shelef DQ, Patel SJ. Improving Asthma Outcomes in Children: From the Emergency Department and Into the Community. Clinical Pediatric Emergency Medicine 2018. [DOI: 10.1016/j.cpem.2018.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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Patel SJ, Arnold DH, Topoz I, Sills MR. Literature Review: Prediction Modeling of Emergency Department Disposition Decisions for Children with Acute Asthma Exacerbations. Clinical Pediatric Emergency Medicine 2018. [DOI: 10.1016/j.cpem.2018.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
Pediatric firearm-related deaths and injuries are a national public health crisis. In this Special Review Article, we characterize the epidemiology of firearm-related injuries in the United States and discuss public health programs, the role of pediatricians, and legislative efforts to address this health crisis. Firearm-related injuries are leading causes of unintentional injury deaths in children and adolescents. Children are more likely to be victims of unintentional injuries, the majority of which occur in the home, and adolescents are more likely to suffer from intentional injuries due to either assault or suicide attempts. Guns are present in 18% to 64% of US households, with significant variability by geographic region. Almost 40% of parents erroneously believe their children are unaware of the storage location of household guns, and 22% of parents wrongly believe that their children have never handled household guns. Public health interventions to increase firearm safety have demonstrated varying results, but the most effective programs have provided free gun safety devices to families. Pediatricians should continue working to reduce gun violence by asking patients and their families about firearm access, encouraging safe storage, and supporting firearm-related injury prevention research. Pediatricians should also play a role in educating trainees about gun violence. From a legislative perspective, universal background checks have been shown to decrease firearm homicides across all ages, and child safety laws have been shown to decrease unintentional firearm deaths and suicide deaths in youth. A collective, data-driven public health approach is crucial to halt the epidemic of pediatric firearm-related injury.
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Affiliation(s)
- Kavita Parikh
- Hospitalist Division, Children's National Health System, Washington, DC;
| | - Alyssa Silver
- Division of Pediatric Hospital Medicine, Children's Hospital at Montefiore, Bronx, New York; and
| | - Shilpa J Patel
- Division of Emergency Medicine, Children's National Health System, Washington, DC
| | - Sabah F Iqbal
- Division of Emergency Medicine, Children's National Health System, Washington, DC
| | - Monika Goyal
- Division of Emergency Medicine, Children's National Health System, Washington, DC
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Khan A, Coffey M, Litterer KP, Baird JD, Furtak SL, Garcia BM, Ashland MA, Calaman S, Kuzma NC, O'Toole JK, Patel A, Rosenbluth G, Destino LA, Everhart JL, Good BP, Hepps JH, Dalal AK, Lipsitz SR, Yoon CS, Zigmont KR, Srivastava R, Starmer AJ, Sectish TC, Spector ND, West DC, Landrigan CP, Allair BK, Alminde C, Alvarado-Little W, Atsatt M, Aylor ME, Bale JF, Balmer D, Barton KT, Beck C, Bismilla Z, Blankenburg RL, Chandler D, Choudhary A, Christensen E, Coghlan-McDonald S, Cole FS, Corless E, Cray S, Da Silva R, Dahale D, Dreyer B, Growdon AS, Gubler L, Guiot A, Harris R, Haskell H, Kocolas I, Kruvand E, Lane MM, Langrish K, Ledford CJW, Lewis K, Lopreiato JO, Maloney CG, Mangan A, Markle P, Mendoza F, Micalizzi DA, Mittal V, Obermeyer M, O'Donnell KA, Ottolini M, Patel SJ, Pickler R, Rogers JE, Sanders LM, Sauder K, Shah SS, Sharma M, Simpkin A, Subramony A, Thompson ED, Trueman L, Trujillo T, Turmelle MP, Warnick C, Welch C, White AJ, Wien MF, Winn AS, Wintch S, Wolf M, Yin HS, Yu CE. Families as Partners in Hospital Error and Adverse Event Surveillance. JAMA Pediatr 2017; 171:372-381. [PMID: 28241211 PMCID: PMC5526631 DOI: 10.1001/jamapediatrics.2016.4812] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [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: 01/20/2023]
Abstract
Importance Medical errors and adverse events (AEs) are common among hospitalized children. While clinician reports are the foundation of operational hospital safety surveillance and a key component of multifaceted research surveillance, patient and family reports are not routinely gathered. We hypothesized that a novel family-reporting mechanism would improve incident detection. Objective To compare error and AE rates (1) gathered systematically with vs without family reporting, (2) reported by families vs clinicians, and (3) reported by families vs hospital incident reports. Design, Setting, and Participants We conducted a prospective cohort study including the parents/caregivers of 989 hospitalized patients 17 years and younger (total 3902 patient-days) and their clinicians from December 2014 to July 2015 in 4 US pediatric centers. Clinician abstractors identified potential errors and AEs by reviewing medical records, hospital incident reports, and clinician reports as well as weekly and discharge Family Safety Interviews (FSIs). Two physicians reviewed and independently categorized all incidents, rating severity and preventability (agreement, 68%-90%; κ, 0.50-0.68). Discordant categorizations were reconciled. Rates were generated using Poisson regression estimated via generalized estimating equations to account for repeated measures on the same patient. Main Outcomes and Measures Error and AE rates. Results Overall, 746 parents/caregivers consented for the study. Of these, 717 completed FSIs. Their median (interquartile range) age was 32.5 (26-40) years; 380 (53.0%) were nonwhite, 566 (78.9%) were female, 603 (84.1%) were English speaking, and 380 (53.0%) had attended college. Of 717 parents/caregivers completing FSIs, 185 (25.8%) reported a total of 255 incidents, which were classified as 132 safety concerns (51.8%), 102 nonsafety-related quality concerns (40.0%), and 21 other concerns (8.2%). These included 22 preventable AEs (8.6%), 17 nonharmful medical errors (6.7%), and 11 nonpreventable AEs (4.3%) on the study unit. In total, 179 errors and 113 AEs were identified from all sources. Family reports included 8 otherwise unidentified AEs, including 7 preventable AEs. Error rates with family reporting (45.9 per 1000 patient-days) were 1.2-fold (95% CI, 1.1-1.2) higher than rates without family reporting (39.7 per 1000 patient-days). Adverse event rates with family reporting (28.7 per 1000 patient-days) were 1.1-fold (95% CI, 1.0-1.2; P = .006) higher than rates without (26.1 per 1000 patient-days). Families and clinicians reported similar rates of errors (10.0 vs 12.8 per 1000 patient-days; relative rate, 0.8; 95% CI, .5-1.2) and AEs (8.5 vs 6.2 per 1000 patient-days; relative rate, 1.4; 95% CI, 0.8-2.2). Family-reported error rates were 5.0-fold (95% CI, 1.9-13.0) higher and AE rates 2.9-fold (95% CI, 1.2-6.7) higher than hospital incident report rates. Conclusions and Relevance Families provide unique information about hospital safety and should be included in hospital safety surveillance in order to facilitate better design and assessment of interventions to improve safety.
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Affiliation(s)
- Alisa Khan
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Maitreya Coffey
- Centre for Quality Improvement and Patient Safety, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Jennifer D Baird
- Department of Nursing, Cardiovascular, and Critical Care Services, Boston Children's Hospital, Boston, Massachusetts
| | - Stephannie L Furtak
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Briana M Garcia
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Michele A Ashland
- Family-Centered Care, Lucile Packard Children's Hospital, Palo Alto, California
| | - Sharon Calaman
- Section of Critical Care, Department of Pediatrics, St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Nicholas C Kuzma
- Section of Hospital Medicine, Department of Pediatrics, St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Jennifer K O'Toole
- Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Aarti Patel
- Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Glenn Rosenbluth
- Department of Pediatrics, Benioff Children's Hospital, University of California-San Francisco School of Medicine, San Francisco
| | - Lauren A Destino
- Division of Pediatric Hospital Medicine, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California
| | - Jennifer L Everhart
- Division of Pediatric Hospital Medicine, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California
| | - Brian P Good
- Department of Pediatrics, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City
| | - Jennifer H Hepps
- Department of Pediatrics, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Anuj K Dalal
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- The Center for Patient Safety Research and Practice, Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stuart R Lipsitz
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- The Center for Patient Safety Research and Practice, Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Catherine S Yoon
- The Center for Patient Safety Research and Practice, Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Katherine R Zigmont
- The Center for Patient Safety Research and Practice, Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rajendu Srivastava
- Department of Pediatrics, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City
- Institute for Healthcare Delivery Research, Intermountain Healthcare, Salt Lake City, Utah
| | - Amy J Starmer
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Theodore C Sectish
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Nancy D Spector
- Section of General Pediatrics, Department of Pediatrics, St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Daniel C West
- Department of Pediatrics, Benioff Children's Hospital, University of California-San Francisco School of Medicine, San Francisco
| | - Christopher P Landrigan
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Claire Alminde
- St Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | | | - Marisa Atsatt
- Lucile Packard Children's Hospital, Stanford, California
| | - Megan E Aylor
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland
| | - James F Bale
- Primary Children's Hospital, Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City
| | - Dorene Balmer
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Kevin T Barton
- St Louis Children's Hospital, Washington University School of Medicine, St Louis, Missouri
| | - Carolyn Beck
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Zia Bismilla
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Debra Chandler
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | - F Sessions Cole
- St Louis Children's Hospital, Washington University School of Medicine, St Louis, Missouri
| | | | - Sharon Cray
- St Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Roxi Da Silva
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Devesh Dahale
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Benard Dreyer
- New York University Langone Medical Center, New York University School of Medicine, New York
| | - Amanda S Growdon
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - LeAnn Gubler
- Primary Children's Hospital, Salt Lake City, Utah
| | - Amy Guiot
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Roben Harris
- St Louis Children's Hospital, St Louis, Missouri
| | - Helen Haskell
- Mothers Against Medical Error, Columbia, South Carolina
| | - Irene Kocolas
- Primary Children's Hospital, Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City
| | | | | | - Kathleen Langrish
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Christy J W Ledford
- Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kheyandra Lewis
- St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Joseph O Lopreiato
- Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Christopher G Maloney
- Primary Children's Hospital, Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City
| | - Amanda Mangan
- Benioff Children's Hospital, San Francisco, California
| | - Peggy Markle
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Fernando Mendoza
- Lucile Packard Children's Hospital, Stanford University, Stanford, California
| | | | - Vineeta Mittal
- Children's Medical Center Dallas, University of Texas Southwestern Medical Center, Dallas
| | - Maria Obermeyer
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Mary Ottolini
- Children's National Health System, George Washington University School of Medicine, Washington, DC
| | - Shilpa J Patel
- Kapi'olani Medical Center for Women and Children, University of Hawai'i John A. Burns School of Medicine, Honolulu
| | | | | | - Lee M Sanders
- Lucile Packard Children's Hospital, Stanford University, Stanford, California
| | | | - Samir S Shah
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | - Anupama Subramony
- Cohen Children's Medical Center, Hofstra Northwell School of Medicine, East Garden City, New York
| | - E Douglas Thompson
- St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Laura Trueman
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Michael P Turmelle
- St Louis Children's Hospital, Washington University School of Medicine, St Louis, Missouri
| | | | | | - Andrew J White
- St Louis Children's Hospital, Washington University School of Medicine, St Louis, Missouri
| | | | - Ariel S Winn
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Michael Wolf
- Northwestern University Feinberg School of Medicine, Evanston, Illinois
| | - H Shonna Yin
- New York University Langone Medical Center, New York University School of Medicine, New York
| | - Clifton E Yu
- Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Patel SJ, Kuten SA, Musick WL, Gaber AO, Monsour HP, Knight RJ. Combination Drug Products for HIV-A Word of Caution for the Transplant Clinician. Am J Transplant 2016; 16:2479-82. [PMID: 27089541 DOI: 10.1111/ajt.13826] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 02/25/2016] [Revised: 03/21/2016] [Accepted: 04/09/2016] [Indexed: 01/25/2023]
Abstract
Modern-day treatment regimens for human immunodeficiency virus (HIV) are not only highly effective, but are now more often available as convenient fixed-dose combination products. Furthermore, as medication adherence is of utmost importance in this setting, national guidelines endorse the use of such products. Transplant providers of HIV-infected patients will undoubtedly encounter these products, some of which contain medications known to drastically alter the metabolism of certain immunosuppressants. Herein, we describe an instance of drug interaction-induced calcineurin inhibitor (CNI) nephrotoxicity in a renal transplant recipient being started on a cobicistat-containing combination product for HIV. CNI toxicity, in turn, was resolved with the aid of phenytoin as an inducer of drug metabolism. This case underscores the importance of familiarity with newer combination products on the market and constant communication with HIV-positive transplant recipients and their providers.
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Affiliation(s)
- S J Patel
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX
| | - S A Kuten
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX
| | - W L Musick
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX
| | - A O Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, TX
| | - H P Monsour
- Department of Medicine, Houston Methodist Hospital, Houston, TX
| | - R J Knight
- Department of Surgery, Houston Methodist Hospital, Houston, TX
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50
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Joshi-Khadke S, Khadke VV, Patel SJ, Borse YM, Kelkar KV, Dighe JP, Subhedar RD. Efficacy of spinal additives neostigmine and magnesium sulfate on characteristics of subarachnoid block, hemodynamic stability and postoperative pain relief: A randomized clinical trial. Anesth Essays Res 2015; 9:63-71. [PMID: 25886423 PMCID: PMC4383107 DOI: 10.4103/0259-1162.150168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Indexed: 11/24/2022] Open
Abstract
Background: Intrathecal neostigmine and magnesium sulfate (MgSO4) produce substantial antinociception, potentiate analgesia of bupivacaine without neurotoxicity. Aims: The aim was to investigate the effect of neostigmine and MgSO4 on characteristics of spinal anesthesia (SA), hemodynamic stability and postoperative analgesia when added to 0.5% hyperbaric bupivacaine for SA. Subjects and Methods: In this prospective, randomized, double-blind study 75 American Society of Anesthesiologist status I and II adult females posted for major gynecological surgery were assigned to one of the three groups (n = 25). Group N received Neostigmine 25 μg, Group M received MgSO4 50 mg, Group C received 0.5 ml saline as an adjuvant to 17.5 mg hyperbaric bupivacaine. Onset, duration of block, heart rate, mean arterial pressure, postoperative analgesia, analgesic requirement, and adverse effects were recorded. Data expressed as mean (standard deviation) or number (%). P <0.05 were statistically significant. Results: The three groups were comparable in characteristics of SA. The mean duration of analgesia was significantly longer in Group N (5.1 h) followed by Group M (4.2 h) and Group C (3.8 h) (P = 0.0134). Analgesic requirement was significantly less in Group N followed by Group M and Group C (P = 0.00232). The pain score was significantly less in Group M (P < 0.05). The incidence of hypotension and vasopressor requirement was lowest (48%) in Group N than in Group M (64%) and Group C 84% (P = 0.0276). The incidence of bradycardia and atropine requirement was the lowest in Group M (P = 0.0354). Sedation was observed in 56% patients in Group M compared to 20% in Group N and 8% in Group C (P = 0.0004). Conclusion: Intrathecal Neostigmine and MgSo4 does not affect characteristics of SA. Postoperative analgesia of neostigmine was better than MgSO4. Neostigmine provides some protection against hypotension of SA whereas MgSO4 protects against bradycardia.
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Affiliation(s)
- Suchita Joshi-Khadke
- Department of Anesthesiology, Shri Bhausaheb Hire Government Medical College, Dhule, Maharashtra, India
| | - V V Khadke
- Department of Pharmacology, Shri Bhausaheb Hire Government Medical College, Dhule, Maharashtra, India
| | - S J Patel
- Department of Anesthesiology, Shri Bhausaheb Hire Government Medical College, Dhule, Maharashtra, India
| | - Y M Borse
- Department of Anesthesiology, Shri Bhausaheb Hire Government Medical College, Dhule, Maharashtra, India
| | - K V Kelkar
- Department of Anesthesiology, Shri Bhausaheb Hire Government Medical College, Dhule, Maharashtra, India
| | - J P Dighe
- Department of Anesthesiology, Shri Bhausaheb Hire Government Medical College, Dhule, Maharashtra, India
| | - R D Subhedar
- Department of Anesthesiology, Shri Bhausaheb Hire Government Medical College, Dhule, Maharashtra, India
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