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Westphal K, Adib H, Doraiswamy V, Basiago K, Lee J, Banker SL, Morrison J, McCartor S, Berger S, Schmit EO, Van Meurs A, Mitchell M, Lee C, Wood JK, Tapp LG, Kunkel D, Halvorson EE, Potisek NM. Performance of Febrile Infant Decision Tools on Hypothermic Infants Evaluated for Infection. Hosp Pediatr 2024; 14:163-171. [PMID: 38312006 DOI: 10.1542/hpeds.2023-007525] [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] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
BACKGROUND Given the lack of evidence-based guidelines for hypothermic infants, providers may be inclined to use febrile infant decision-making tools to guide management decisions. Our objective was to assess the diagnostic performance of febrile infant decision tools for identifying hypothermic infants at low risk of bacterial infection. METHODS We conducted a secondary analysis of a retrospective cohort study of hypothermic (≤36.0 C) infants ≤90 days of age presenting to the emergency department or inpatient unit among 9 participating sites between September 1, 2016 and May 5, 2021. Well-appearing infants evaluated for bacterial infections via laboratory testing were included. Infants with complex chronic conditions or premature birth were excluded. Performance characteristics for detecting serious bacterial infection (SBI; urinary tract infection, bacteremia, bacterial meningitis) and invasive bacterial infection (IBI; bacteremia, bacterial meningitis) were calculated for each tool. RESULTS Overall, 314 infants met the general inclusion criteria, including 14 cases of SBI (4.5%) and 7 cases of IBI (2.2%). The median age was 5 days, and 68.1% of the infants (214/314) underwent a full sepsis evaluation. The Philadelphia, Boston, IBI Score, and American Academy of Pediatrics Clinical Practice Guideline did not misclassify any SBI or IBI as low risk; however, they had low specificity and positive predictive value. Rochester and Pediatric Emergency Care Applied Research Network tools misclassified infants with bacterial infections. CONCLUSIONS Several febrile infant decision tools were highly sensitive, minimizing missed SBIs and IBIs in hypothermic infants. However, the low specificity of these decision tools may lead to unnecessary testing, antimicrobial exposure, and hospitalization.
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Affiliation(s)
- Kathryn Westphal
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Hania Adib
- Department of Pediatrics, Keck School of Medicine of USC, Children's Hospital Los Angeles, Los Angeles, California
| | - Vignesh Doraiswamy
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Kevin Basiago
- Department of Pediatrics, Keck School of Medicine of USC, Children's Hospital Los Angeles, Los Angeles, California
| | - Jennifer Lee
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, New York
| | - Sumeet L Banker
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, New York
| | - John Morrison
- Division of Pediatric Hospital Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Saylor McCartor
- Department of Pediatrics, University of South Carolina School of Medicine Greenville, Prisma Health Children's Hospital-Upstate, Greenville, South Carolina
| | - Stephanie Berger
- Department of Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Erinn O Schmit
- Department of Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Annalise Van Meurs
- Department of Pediatrics, Oregon Health and Science University, Doernbecher Children's Hospital, Portland, Oregon
| | - Meredith Mitchell
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Clifton Lee
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Julie K Wood
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lauren G Tapp
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Deborah Kunkel
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, South Carolina
| | - Elizabeth E Halvorson
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Nicholas M Potisek
- Department of Pediatrics, University of South Carolina School of Medicine Greenville, Prisma Health Children's Hospital-Upstate, Greenville, South Carolina
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Garstka ME, Randolph GW, Haddad AB, Nathan CAO, Ibraheem K, Farag M, Deot N, Adib H, Hoof M, French K, Killackey MT, Kandil E. Gender disparities are present in academic rank and leadership positions despite overall equivalence in research productivity indices among senior members of American Head and Neck Society (AHNS) Fellowship Faculty. Head Neck 2019; 41:3818-3825. [PMID: 31418942 DOI: 10.1002/hed.25913] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/09/2019] [Accepted: 07/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to examine potential disparities in scholarly performance based on sex, academic rank, leadership positions, and regional distribution of faculty in accredited Head and Neck Surgery fellowships in the United States. METHODS Online faculty listings for 37 accredited fellowships were organized according to academic rank, leadership position, sex, and institutional location. Academic productivity was measured with three bibliometric indices: h-index, m-index, and the weighted relative citation ratio. RESULTS A total of 732 faculty members were included, of which 153 (21%) were female. Fifty-eight males (89.2%) held leadership positions, compared to seven females (10.8%). There was no significant difference in overall productivity between male and female senior faculty. There were regional differences in productivity by sex. CONCLUSIONS Females are underrepresented in senior faculty and within three common leadership positions, although scholarly productivity for male and female senior faculty and for those in leadership positions is similar.
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Affiliation(s)
- Meghan E Garstka
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Antoine B Haddad
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Kareem Ibraheem
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Mahmoud Farag
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Neal Deot
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Hania Adib
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Marcus Hoof
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Kaley French
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Mary T Killackey
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Monga SP, Wadleigh R, Sharma A, Adib H, Strader D, Singh G, Harmon JW, Berlin M, Monga DK, Mishra L. Intratumoral therapy of cisplatin/epinephrine injectable gel for palliation in patients with obstructive esophageal cancer. Am J Clin Oncol 2000; 23:386-92. [PMID: 10955870 DOI: 10.1097/00000421-200008000-00016] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Obstructing esophageal cancer produces severe dysphagia with ensuing death within 90 days. Palliation is possible with modalities like stent placement, laser, and photodynamic therapy. However, these treatments have a high rate of complications, and the overall mortality is not altered. A new alternative treatment evaluated in this study is endoscopic intratumoral injection with cisplatin/epinephrine (CDDP/epi) gel. CDDP/epi gel injections were administered weekly for 3 to 8 weeks in nine patients, median age, 72 years; mean tumor volume (+/-SEM), 41.44 (+/-22.4) cm3. Eight patients had stage IV, and one had stage III esophageal carcinoma. The mean dysphagia score (+/-SEM) was 3.5 (+/-0.17). All patients were followed up until death. Dysphagia resolved in eight patients with reduction in mean dysphagia score (+/-SEM) from 3.5 (+/-0.17) to 0.75 (+/-0.28; p = 0.005). Tumor volume was reduced by 75% in one patient and by 50% in two patients. The median survival was 4 months. The longest follow-up has been 15 months (458 days). In this pilot study, intratumoral injection of CDDP/epi gel restored swallowing in eight of nine patients and was an effective and safe outpatient treatment in patients with obstructive esophageal cancer.
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Affiliation(s)
- S P Monga
- Department of Gastroenterology/Development and Molecular Biology, Department of Veterans Affairs Medical Center, Washington, DC 20422, USA
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Sidawy AN, Neville RF, Adib H, Curry KM. Femoral arteriovenous fistula following cardiac catheterization: an anatomic explanation. Cardiovasc Surg 1993; 1:134-7. [PMID: 8076015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The exact etiology of femoral iatrogenic arteriovenous fistula (AVF) following cardiac catheterization is not known. The most common explanation is simultaneous placement of arterial and venous catheters for left and right heart catheterization. Using a strict protocol for groin examination before and after cardiac catheterization, seven patients were found to have a groin thrill and/or bruit as a result of AVF after catheterization in the period from July 1986 to December 1990; one patient had two fistulas, making a total of eight. During the same period, a total of 2609 cardiac catheterizations were performed using the Seldinger technique; the incidence of AVF after the procedure was thus 0.22%. Arteriography was used to confirm the presence of the fistulas and identify their exact location. All eight lesions originated below the bifurcation of the common femoral artery (CFA). Three originated at the superficial femoral artery (SFA) and five at the profunda femoris artery (PFA). In the patient with two fistulas, one originated at the SFA and one at the PFA. The veins involved were the superficial femoral (SFV) in two AVFs and the profunda femoris (PFV) or its lateral circumflex branch in six. The fact that all eight fistulas originated below the bifurcation of the CFA points to a possible anatomic explanation for the formation of iatrogenic AVF. The CFA and common femoral vein (CFV) are located side by side, which makes it difficult to puncture both with one stick. Below the bifurcation, the PFV crosses laterally behind the proximal SFA and then lies in a posterior location to the PFA.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A N Sidawy
- Department of Surgery, Veterans Affairs Medical Center, Washington, DC
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