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Campbell KM, Heath MN, Tumin D. Increasing the Rural Workforce of Family Medicine Physicians: A Community-Focused Approach. South Med J 2020; 113:148-149. [PMID: 32239225 DOI: 10.14423/smj.0000000000001080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
There is an increased need for Family Medicine physicians who make up approximately 40% of the primary care work. In this article the authors share perspective on how to engage the community in increasing the rural workforce of Family Physicians. Suggestions include introducing the school to the community in which it lives, matching the applicant to the needs of the community and not just the needs of the school, including community members as part of the admissions process and recruiting applicants primarily from inside the state.
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Tumin D, Frech A, Lynch JL, Raman VT, Bhalla T, Tobias JD. Weight Gain Trajectory and Pain Interference in Young Adulthood: Evidence from a Longitudinal Birth Cohort Study. PAIN MEDICINE 2020; 21:439-447. [PMID: 31386156 DOI: 10.1093/pm/pnz184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Obesity is associated with chronic pain, but the contribution of body mass index (BMI) trajectories over the life course to the onset of pain problems remains unclear. We retrospectively analyzed how BMI trajectories during the transition to adulthood were associated with a measure of pain interference obtained at age 29 in a longitudinal birth cohort study. METHODS Data from the National Longitudinal Survey of Youth, 1997 Cohort (follow-up from 1997 to 2015), were used to determine BMI trajectories from age 14 to 29 via group trajectory modeling. At age 29, respondents described whether pain interfered with their work inside and outside the home over the past four weeks (not at all, a little, or a lot). Multivariable ordinal logistic regression was used to evaluate pain interference according to BMI trajectory and study covariates. RESULTS Among 7,875 respondents, 11% reported "a little" and 4% reported "a lot" of pain interference at age 29. Four BMI trajectory groups were identified, varying in starting BMI and rate of weight gain. The "obese" group (8% of respondents) had a starting BMI of 30 kg/m2 and gained an average of 0.7 kg/m2/y. On multivariable analysis, this group was the most likely to have greater pain interference, compared with "high normal weight" (odds ratio [OR] = 1.47, 95% confidence interval [CI] = 1.14-1.88), "low normal weight" (OR = 1.45, 95% CI = 1.13-1.87), and "overweight" trajectories (OR = 1.33, 95% CI = 1.02-1.73). CONCLUSIONS Obesity and rapid weight gain during the transition to adulthood were associated with higher risk of pain interference among young adults.
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Walia H, Banoub R, Cambier GS, Rice J, Tumin D, Tobias JD, Raman VT. Erratum: Perioperative Provider and Staff Competency in Providing Culturally Competent LGBTQ Healthcare in Pediatric Setting [Corrigendum]. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:177. [PMID: 32184696 PMCID: PMC7055280 DOI: 10.2147/amep.s250151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/17/2020] [Indexed: 06/10/2023]
Abstract
[This corrects the article DOI: 10.2147/AMEP.S220578.].
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Havinga J, Tumin D, Peedin L. Birth Weight Gradient in Parent-Reported Special Healthcare Needs among Children Born Preterm. J Pediatr 2020; 217:73-78. [PMID: 31732129 DOI: 10.1016/j.jpeds.2019.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/15/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To characterize the association of birth weight with parent-reported special healthcare needs (SHCN) and unmet healthcare needs among children born prematurely. STUDY DESIGN We analyzed data from the 2016-2017 National Survey of Children's Health. Prematurity, birth weight, SHCN, and unmet healthcare needs were reported for one child per participating household. We analyzed children age 0-5 years, and classified birthweight among children born preterm as very low birth weight (VLBW, <1500 g), low birth weight (LBW, 1500-2500 g), and normal weight (NBW, >2500 g). Term-born NBW children were included as a reference group. RESULTS The analysis included 190 VLBW preterm, 688 LBW preterm, 884 NBW preterm, and 15 629 NBW term-born children. Weighted SHCN prevalence was 10%, and 1% had unmet healthcare needs. On multivariable analysis, children born preterm and VLBW had significantly higher odds of SHCN compared with NBW term-born children (OR, 9.8; 95% CI, 4.9-19.6). Preterm LBW and NBW preterm groups had smaller increases in SHCN odds (OR, 2.5 and OR, 1.6, respectively). The odds of unmet healthcare needs did not differ among the 4 study groups. CONCLUSIONS Among children under 5 years of age, preterm birth and VLBW are associated with very high likelihood of SHCN, compared with LBW/NBW preterm or NBW term-born children. However, requirements for additional health services in this group were adequately met, according to caregiver report.
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Tumin D, Bhalla T. Identifying opioid misuse among adolescents: Is the answer hiding in plain sight? Prev Med 2020; 131:105950. [PMID: 31931979 DOI: 10.1016/j.ypmed.2019.105950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/30/2019] [Indexed: 11/17/2022]
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Campbell KM, Tumin D. The HBCU Medical School Visiting Professorship: A New Approach for Supporting Professional Development of Underrepresented Minority Faculty. J Immigr Minor Health 2020; 22:221-222. [DOI: 10.1007/s10903-020-00971-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wani T, Dabaliz A, Kadah K, Veneziano G, Tumin D, Tobias J. Comparison of the skin-to-epidural space distance at the thoracic and lumbar levels in children using magnetic resonance imaging. Saudi J Anaesth 2020; 14:493-497. [PMID: 33447192 PMCID: PMC7796762 DOI: 10.4103/sja.sja_292_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/15/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Several studies have attempted to estimate the approximate distance from the skin-to-epidural space using different imaging modalities (computed tomography [CT], ultrasound, and magnetic resonance imaging [MRI]) and direct needle measurements. The objective of our study was to compare the distance from the skin to the epidural space (SED) at multiple levels, focusing on T6-7, T9-10, and L2-3 using MRI. Methods: After institutional review board (IRB) approval, sagittal T2-weighted MRI images of the spine of 108 children in the age group ranging from 3 months to 8 years undergoing radiological evaluation in the supine position at our institution were analyzed. The SED at T6-7 and T9-10 levels (straight and inclined) and SED at L2-3 (straight) were determined and compared using repeated-measures ANOVA and paired t-tests with a Bonferroni correction for 10 pairwise comparisons (P < 0.005 was considered statistically significant). Results: The average SED (measured straight and inclined) was 18.2 mm and 21.6 mm at T6-7; 18.3 mm and 20.5 mm at T9-10; and 21.8 mm (straight) at L2-3. The repeated-measures ANOVA F-test indicated significant variability in SED (P < 0.001) among the 5 measurements obtained. At the P < 0.005 significance level, corrected for multiple comparisons, the SED (straight) at T9-10 straight was shorter than the other measured distances. Conclusion: The distance from the skin to the epidural space is not constant at various vertebral levels. At the levels measured, it was greatest at the lumbar level and at least at the thoracic level of T9-10. A single predictive formula was not applicable for calculating the approximate SED at all vertebral levels.
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Campbell KM, Infante Linares JL, Tumin D, Faison K, Heath MN. The Role of North Carolina Medical Schools in Producing Primary Care Physicians for the State. J Prim Care Community Health 2020; 11:2150132720924263. [PMID: 32450749 PMCID: PMC7252369 DOI: 10.1177/2150132720924263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Primary care physicians serve on the front lines of care and provide comprehensive care to patients who may have difficulty accessing subspecialists. However, not enough students are entering residency in primary care fields to meet the primary care physician shortage. The authors sought to compare primary care match rates among graduates of medical schools in the state of North Carolina from 2014 to 2018. Methods: The 4 allopathic medical schools in the state of North Carolina were selected for this study: East Carolina University (ECU) Brody School of Medicine, University of North Carolina (UNC) Chapel Hill, Duke School of Medicine, and Wake Forest School of Medicine. Primary care specialties were defined as family medicine, internal medicine, pediatrics, and internal medicine/pediatrics. The proportion of students matching to a residency in any of these fields, and in each specific field, was compared across schools. Results: Over 2014-2018, 214 ECU Brody School of Medicine graduates, 386 UNC graduates, 165 Duke graduates, and 196 Wake Forest graduates matched to a primary care specialty. ECU had the highest proportion of its graduates match in a primary care specialty (53%, compared with 34% to 45% at other schools; P < .001), and was particularly distinguished by having the highest proportions of graduates match to residencies in family medicine (18%) and pediatrics (16%). Conclusion: During the study period of 2014-2018, the ECU Brody School of Medicine matched more medical students into primary care specialties than the other medical schools in the state. This school’s community-driven mission and rural location, among other characteristics facilitating sustained student commitment to primary care careers, can inform the development of new medical schools in the United States to overcome the primary care physician shortage.
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Tumin D, Tobias JD. Comment on "Race/Ethnicity and Sex and Opioid Administration in the Emergency Room". Anesth Analg 2019; 128:e79. [PMID: 30451724 DOI: 10.1213/ane.0000000000003908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kinlaw S, Dailey M, Scott D, Hanchey S, Tumin D, Higginson A. Improved Physical Exam Documentation in a Pediatric After-Hours Clinic. Am J Med Qual 2019; 35:506. [PMID: 31833380 DOI: 10.1177/1062860619893454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tumin D, Nandi D, Hayes D. Propensity score matching and proportional hazard models: Which is best to understand heart retransplantation outcomes? J Heart Lung Transplant 2019; 39:284. [PMID: 31812488 DOI: 10.1016/j.healun.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/14/2019] [Indexed: 11/25/2022] Open
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Pawlowski C, Buckman C, Tumin D, Smith AW, Crotty J. National Trends in Pediatric Headache and Associated Functional Limitations. Clin Pediatr (Phila) 2019; 58:1502-1508. [PMID: 31522542 DOI: 10.1177/0009922819875560] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective. Frequent or severe headaches are associated with school absenteeism and functional limitation in children, but trends in headache prevalence are uncertain. We used nationally representative data to describe trends in pediatric headache prevalence in the United States, and to evaluate whether headache has remained consistently associated with functional limitations among school-age children. Methods. We analyzed data on children age 5 to 17 years in the 2007 to 2015 National Health Interview Surveys. Caregivers reported whether each child experienced frequent or severe headache in the past 12 months. Weighted proportions and multivariable regression were used to estimate headache prevalence over the study period and associations between headache and measures of functional limitation. Results. The analysis included 57 272 children (mean age = 11 years; 52% female). Frequent or severe headache was reported for 6% of children, with no discernable trend over the study period. On multivariable Poisson regression, headache became more strongly associated with school absenteeism over time. In 2007, frequent or severe headache was associated with a 70% increase in the number of missed school days (incidence risk ratio [IRR] = 1.70; 95% confidence interval [CI] = 1.50-1.91; P < .001), whereas by 2015, headache was associated with a 139% increase in the number of missed school days (IRR = 2.39; 95% CI = 2.02-2.83; P < .001). Conclusion. Though the prevalence of frequent or severe headache in school-age children did not change in 2007 to 2015, headache became more strongly associated with school absenteeism, highlighting the need for improved management of patients with headaches to prevent negative impact on school performance and functional status.
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Hayes D, Wilson KC, Krivchenia K, Hawkins SMM, Balfour-Lynn IM, Gozal D, Panitch HB, Splaingard ML, Rhein LM, Kurland G, Abman SH, Hoffman TM, Carroll CL, Cataletto ME, Tumin D, Oren E, Martin RJ, Baker J, Porta GR, Kaley D, Gettys A, Deterding RR. Home Oxygen Therapy for Children. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2019; 199:e5-e23. [PMID: 30707039 PMCID: PMC6802853 DOI: 10.1164/rccm.201812-2276st] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Home oxygen therapy is often required in children with chronic respiratory conditions. This document provides an evidence-based clinical practice guideline on the implementation, monitoring, and discontinuation of home oxygen therapy for the pediatric population. Methods: A multidisciplinary panel identified pertinent questions regarding home oxygen therapy in children, conducted systematic reviews of the relevant literature, and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach to rate the quality of evidence and strength of clinical recommendations. Results: After considering the panel’s confidence in the estimated effects, the balance of desirable (benefits) and undesirable (harms and burdens) consequences of treatment, patient values and preferences, cost, and feasibility, recommendations were developed for or against home oxygen therapy specific to pediatric lung and pulmonary vascular diseases. Conclusions: Although home oxygen therapy is commonly required in the care of children, there is a striking lack of empirical evidence regarding implementation, monitoring, and discontinuation of supplemental oxygen therapy. The panel formulated and provided the rationale for clinical recommendations for home oxygen therapy based on scant empirical evidence, expert opinion, and clinical experience to aid clinicians in the management of these complex pediatric patients and identified important areas for future research.
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Kedir H, Miller R, Syed F, Hakim M, Walia H, Tumin D, McKee C, Tobias JD. Association between anemia and postoperative complications in infants undergoing pyloromyotomy. J Pediatr Surg 2019; 54:2075-2079. [PMID: 30853249 DOI: 10.1016/j.jpedsurg.2019.01.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/06/2019] [Accepted: 01/19/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although preoperative anemia has been suggested to predict postsurgical morbidity and mortality among infants <1 year of age, the data were drawn from heterogeneous patient cohorts including severely ill infants undergoing complex, high-risk procedures. We aimed to determine whether untreated preoperative anemia was associated with increased risk of postoperative complications in infants <1 year of age who underwent pyloromyotomy, a common and relatively simple surgery. METHODS Infants <1 year of age undergoing pyloromyotomy were identified from the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatric database. Preoperative anemia was defined as a hematocrit ≤40% for infants 0-30 days of age and ≤30% for infants more than 30 days of age. Patients who received pre- or postoperative blood transfusions were excluded. RESULTS We identified 2948 patients who met our inclusion criteria, of whom 843 were anemic (29%). The overall rate of complications in this cohort was 6%. The most common postoperative complications were readmission (97 cases), surgical site infection (43), reoperation (39), prolonged hospital stay (24), urinary tract infection (3), 30-day mortality (3) and cardiac arrest (2). We found no differences in the incidence of complications in anemic versus nonanemic patients on bivariate analysis or multivariable logistic regression (adjusted odds ratio = 1.2; 95% confidence interval: 0.8-1.7; P = 0.319). CONCLUSIONS In relatively healthy infants undergoing pyloromyotomy, untreated preoperative anemia was not associated with postoperative compilations and should not be considered a significant risk factor. Level of evidence III.
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Tumin D, Akpan US, Kohler JA, Uffman JC. Publication Bias Among Conference Abstracts Reporting on Pediatric Quality Improvement Projects. Am J Med Qual 2019; 35:274-280. [DOI: 10.1177/1062860619873716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This study evaluated progress to publication of pediatric quality improvement (QI) projects initially presented as national conference abstracts, according to project findings and other characteristics. QI abstracts were identified among presentations at the 2010-2015 American Academy of Pediatrics National Conference & Exhibition, and publications were tracked through June 2018. Positive findings (improvement on at least 1 quantitative project outcome), interventions, and analyses were correlated with journal publication. Of 142 abstracts, 128 (90%) reported positive findings. Forty-nine positive abstracts and 3 abstracts reporting negative results resulted in publication (38% vs 21%, respectively; P = .256). Median time to publication was 1.2 years for projects with positive findings, compared to >3 years for abstracts with negative findings ( P = .029). Ninety percent of abstracts reported positive findings, and these abstracts progressed to publication more quickly. Overcoming publication bias for pediatric QI projects may enhance selection of promising interventions as new projects are designed.
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Shafy SZ, Hakim M, Kamata M, Tumin D, Krishna SG, Naguib A, Tobias JD. Intracuff pressure during one-lung ventilation in infants and children. J Pediatr Surg 2019; 54:1929-1932. [PMID: 30660384 DOI: 10.1016/j.jpedsurg.2018.10.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/08/2018] [Accepted: 10/31/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We prospectively evaluated intracuff pressure (IP) during one-lung ventilation (OLV) to characterize potential risk associated with overinflation of the cuff used for OLV. DESIGN Prospective observational study over a 2-year period, in infants and children undergoing thoracic surgery. The IPs of the tracheal and bronchial balloon were measured using a manometer and compared to a previously recommended threshold of 30 cmH2O. Data were compared by the device type used to achieve OLV. SETTING Freestanding tertiary-care pediatric hospital. PARTICIPANTS Patients ≤18 years of age undergoing thoracic procedures requiring OLV. INTERVENTIONS Measurement of IP. MEASUREMENTS AND MAIN RESULTS Thirty patients were enrolled (age 5 months-18 years) with a median weight of 28 kg. Median tracheal and bronchial IPs were 32 cmH2O (range: 11, 90) and 44 cmH2O (range: 10, 100), respectively. The tracheal and bronchial IPs exceeded 30 cmH2O in 13 of 20 patients (65%) and 21 of 30 patients (70%), respectively. CONCLUSIONS IP was high and in excess of recommended levels in most children undergoing OLV. Continuous monitoring of IP may be indicated during OLV to address the risks involved and ensure the prevention of complications related to high IP. TYPE OF STUDY Prospective comparative study. LEVEL OF EVIDENCE Level II.
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Hayes S, Miller R, Patel A, Tumin D, Walia H, Hakim M, Syed F, Tobias JD. Comparison of blood pressure measurements in the upper and lower extremities versus arterial blood pressure readings in children under general anesthesia. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:297-303. [PMID: 31686922 PMCID: PMC6709812 DOI: 10.2147/mder.s209629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 08/12/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare invasive blood pressure (IBP) readings obtained from an arterial cannula with non-invasive blood pressure (NIBP) measurements from oscillometric cuffs on the upper and lower extremities of infants and children under general anesthesia. Patients and methods Patients under 10 years of age were enrolled in our study if they were to receive general anesthesia with planned placement of a radial arterial cannula. At 5 mins intervals, IBP was measured using a fluid-coupled pressure transducer and NIBP was measured with two oscillometers with appropriately sized cuffs placed on the upper arm and lower leg, for 10 readings per patient. Results The study enrolled 18 boys and 12 girls, ranging in age from 0 to 8 years. Across 300 data points, the absolute difference between the arm and invasive mean arterial pressure (MAP) measurements was 7±7 mmHg (range: 0–52 mmHg). The absolute difference between the leg and invasive MAP measurements was 8±8 mmHg (range: 0–52 mmHg). Although both non-invasive measurement sites demonstrated frequent deviation from invasive measurement, large deviations were more common when BP was measured at the leg (81 of 298 observations (27%) deviating by >10 mmHg) compared to the arm (60 of 300 observations (20%) deviating by >10 mmHg). Conclusion The frequency of clinically significant NIBP deviation in children under general anesthesia supports the importance of IBP monitoring when hemodynamic fluctuations are likely and would be particularly detrimental. NIBP measured at the lower leg is more likely to result in clinically significant deviation from invasively measured MAP than NIBP values obtained from an upper arm.
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Cartabuke RS, Anderson BJ, Elmaraghy C, Tumin D, Tobias JD. In Response to Hemodynamic and Pharmacokinetic Analysis of Oxymetazoline Use During Nasal Surgery in Children. Laryngoscope 2019; 129:E348. [PMID: 31329301 DOI: 10.1002/lary.28198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 07/08/2019] [Indexed: 11/11/2022]
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Kamata M, Hakim M, Walia H, Tumin D, Tobias JD. Changes in cerebral and renal oxygenation during laparoscopic pyloromyotomy. J Clin Monit Comput 2019; 34:699-703. [PMID: 31325010 DOI: 10.1007/s10877-019-00356-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
Although a laparoscopic approach may be preferred over open procedures for abdominal surgery, there are limited data on the effect of laparoscopic procedures on cerebral and renal oxygenation in neonates and young infants. Here, we evaluated the effect in neonates and infants. In this two-center prospective observational study, we evaluated changes in cerebral and renal regional oxygen saturation (rSO2) in infants during laparoscopic pyloromyotomy. Intraoperative hemodynamic and respiratory parameters and rSO2 were recorded. For the primary outcome, these parameters were compared at incision and at the end of pneumoperitoneum. The study cohort included 25 infants with a mean age of 40 ± 10 days and weight of 4.0 ± 0.6 kg. IAP at the beginning of laparoscopy was 10 ± 2 mmHg (range 7-15 mmHg). Although both cerebral and renal rSO2 decreased from incision compared to the end of laparoscopy, the decrease reached statistical significance only for cerebral rSO2 (81 ± 12 to 76 ± 16, p = 0.033). Similarly, the increase in fractional tissue oxygen extraction (FTOE) was only statistically significant for cerebral FTOE (0.18 ± 0.12 to 0.23 ± 0.16, p = 0.037). No change in hemodynamic or respiratory parameters was found. Although there was a decrease in cerebral rSO2 and increase in cerebral FTOE during pneumoperitoneum, the values did not decrease below those noted before anesthetic induction.
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Datz H, Tumin D, Miller R, Smith TP, Bhalla T, Tobias JD. Pediatric chronic pain and caregiver burden in a national survey. Scand J Pain 2019; 19:109-116. [PMID: 30240360 DOI: 10.1515/sjpain-2018-0121] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/29/2018] [Indexed: 11/15/2022]
Abstract
Background and aims Caring for children with chronic pain incurs burdens of cost and time for families. We aimed to describe variation in caregiver burden among parents of adolescents with chronic pain who responded to a nationally-representative survey. Our secondary aim was to identify child and parent characteristics associated with increased caregiver burden. Methods We used de-identified, publicly-available data from the 2016 National Survey of Children's Health (NSCH), designed to be representative of non-institutionalized children in the United States. We analyzed data for households where an adolescent age 12-17 years old was reported by a parent to have chronic pain. Outcomes included the parent's time spent on the child's health needs, reduced labor force participation, and out-of-pocket medical costs. Results Data on 1,711 adolescents were analyzed. For adolescents with chronic pain, 15% of parents reported spending at least 1 h/week on their child's health care, 14% reported cutting back on paid work, and 36% reported spending ≥$500 on their child's health care in the past 12 months. Adolescents' general health status and extent of specialized health care needs predicted increased caregiver burden across the three measures. Conversely, no consistent differences in caregiver burden were noted according to demographic or socioeconomic characteristics. Conclusions Among adolescents with chronic pain identified on a nationally-representative survey, parents frequently reported reducing work participation and incurring out-of-pocket expenses in providing health care for their child. Caregiver burdens increased with indicators of greater medical complexity (e.g. presence of comorbidities, need for specialized health care) and poorer overall adolescent health status. Implications We add a national-level perspective to studies previously performed in clinical samples addressing caregiver burden in pediatric chronic pain. Initiatives to reduce the burden of caring for children with chronic pain, described in prior work, may be especially beneficial for families with adolescents whose chronic pain is accompanied by other health problems or requires coordination of care among multiple providers.
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Wakimoto M, Miller R, Shafy SZ, Tumin D, Veneziano G, Tobias JD. Safety of Same-Day Discharge Compared to Overnight Observation Following Laparoscopic Appendectomy in the Pediatric-Aged Patient: A National Surgical Quality Improvement Program Project. J Laparoendosc Adv Surg Tech A 2019; 29:965-969. [DOI: 10.1089/lap.2019.0046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sims T, Tumin D, Hayes D, Tobias JD. Age-Dependent Impact of Pre-Transplant Intensive Care Unit Stay on Mortality in Heart Transplant Recipients. Cardiol Res 2019; 10:157-164. [PMID: 31236178 PMCID: PMC6575112 DOI: 10.14740/cr870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 05/30/2019] [Indexed: 11/19/2022] Open
Abstract
Background Heart transplantation (HTx) is a treatment option for refractory end-stage heart failure. Severe illness requiring pre-transplant intensive care unit (ICU) stay may be a risk factor for diminished post-transplant survival, but this association is surprisingly inconsistent in recent studies. To clarify the significance of ICU stay as a risk factor for heart transplant outcomes, we aimed to define if patient age was a factor in which ICU stay was predictive of survival after HTx. Methods De-identified data were obtained on isolated first-time HTx performed during the years 2006 - 2015 from the UNOS Registry. Nine age groups were defined. The primary outcome was 1-year post-transplant mortality. Cox proportional hazard regression estimated unadjusted and adjusted hazard ratio (HR) associated with pre-transplant ICU stay in each age group. Results The analysis included 19,508 patients (9% deceased within 1 year). In the overall cohort, pre-transplant ICU stay was associated with increased hazard of 1-year mortality (HR = 1.3; 95% confidence interval (CI): 1.2 - 1.4; P < 0.001); but further univariate analysis showed a greater hazard of 1-year mortality associated with ICU stay in infants (HR = 2.2; 95% CI: 1.5 - 3.2; P < 0.001). However, the adjusted analysis found that adults ages 40 - 49 had the highest statistically significant hazard of 1-year mortality (HR = 1.5; 95% CI: 1.1 - 2.1; P = 0.011). Conclusions Our study established age variation in the association between ICU stay and survival after HTx, with this association being strongest among adults, 40 to 49 years of age, undergoing HTx. Previous data suggesting decreased survival in infants may be related to the increased use of extracorporeal membrane oxygenation as a mechanical cardiac assist rather than ventricular assist devices.
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Alsuhebani M, Walia H, Miller R, Elmaraghy C, Tumin D, Tobias JD, Raman VT. Overnight inpatient admission and revisit rates after pediatric adenotonsillectomy. Ther Clin Risk Manag 2019; 15:689-699. [PMID: 31239691 PMCID: PMC6560194 DOI: 10.2147/tcrm.s185193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 03/31/2019] [Indexed: 11/28/2022] Open
Abstract
Objective: Overnight admission may be necessary following adenotonsillectomy (T&A) in pediatric patients. This practice may reduce unplanned revisits following hospital discharge. Study design: Retrospective cohort study. Subjects: Children from the PHIS database. Methods: T&A performed in children during the years 2007–2015 were identified in the Pediatric Health Information System. The primary outcome was 7-day, all-cause readmission or emergency department (ED) revisit. Secondary analysis examined specific revisit types and 30-day revisits. The primary exposure was each institution’s annual rate of overnight stay after T&A. Results: The analysis included 411,876 procedures at 48 hospitals. Hospitals’ annual rates of overnight stay following T&A ranged from 3% to 100%, and 7-day revisit rates varied from 0% to 15%. The percentage or rate of 7-day revisits did not differ based on the use of overnight stay following T&A. At hospitals with higher overnight admission rates after T&A, 7-day revisits were more likely to take the form of inpatient admission rather than an ED visit. Conclusions: The current study confirms that pediatric hospitals vary widely in inpatient admission practices following T&A. This variation is not associated with differences in revisit rates at 7 and 30 days related to any cause. Although no mortality was noted in the current study, caution is suggested when deciding on the disposition of patients with comorbid conditions as risks related to various patients, anesthetic, and surgical-related issues exist. Risk stratification with appropriate identification of patients requiring overnight stay may be the most important for preventing acute care revisits after T&A.
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Pfaff K, Tumin D, Tobias JD. Sugammadex for Reversal of Neuromuscular Blockade in a Patient With Renal Failure. J Pediatr Pharmacol Ther 2019; 24:238-241. [PMID: 31093024 DOI: 10.5863/1551-6776-24.3.238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Residual neuromuscular blockade following the use of non-depolarizing neuromuscular blocking agents (NMBAs) can lead to postoperative respiratory complications, including oxygen desaturation, atelectasis, and pneumonia. Sugammadex rapidly reverses steroidal NMBAs by encapsulating them in a highly stable water-soluble complex. This NMBA-sugammadex complex then undergoes renal elimination. In patients with renal insufficiency or failure, concern has been expressed regarding the elimination of the NMBA-sugammadex complex. We present a 19-year-old patient with renal failure who received sugammadex for reversal of neuromuscular blockade. The use of sugammadex in patients with renal dysfunction is discussed and safety concerns are reviewed.
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Beal EW, Akateh C, Tumin D, Bagante F, Black SM, Washburn K, Azouley D, Pawlik TM. Defining a Liver Transplant Benefit Threshold for the Model for End-Stage Liver Disease-Sodium Score. EXP CLIN TRANSPLANT 2019; 18:491-497. [PMID: 31050611 DOI: 10.6002/ect.2018.0346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The benefits of transplant are shown as the difference in survival posttransplant versus that shown if the patient had remained on the wait list. Serum sodium was added to improve prediction. We sought to revisit the question of which Model for End-Stage Liver Disease-Sodium score threshold corresponded to a predicted benefit of liver transplant. MATERIALS AND METHODS Data on adult patients (≥ 18 years old) were obtained from the United Network for Organ Sharing registry (date range of June 18, 2013 to December 2016). Exclusion criteria were individuals listed for multiple organs or liver retransplant, patients who eventually underwent living-donor liver transplant, and patients with MELD score < 12. We used multivariable Cox proportional hazards regression to determine a time-dependent covariate for undergoing transplant with either MELD or MELD-sodium scores to describe the variability in estimated transplant benefit within 6 months of listing. RESULTS Our study included 14 352 patients. There were 902 patients with MELD score of 39 to 40 (6.3%) and 931 patients with MELD-Na score of 39 to 40 (6.5%). Using the original MELD score, we found that 90% of the cohort could derive benefit from transplant compared with 83% when MELD-Na was used. We found that 13% of patients had a predicted transplant benefit when determined using either MELD or MELD-Na but not both. The threshold for transplant benefit was 16 and 17 using MELD and MELD-Na, respectively. CONCLUSIONS Transition to MELD-Na did not define a more precise range at which patients benefited from transplant, and a similar percentage of patients was expected to derive benefit. Future revisions of donor liver allocation may allow better discrimination of expected transplant benefits among candidates currently assigned a high priority for donor livers.
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