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Devine KJ, Diorio C, Richman SA, Henderson AA, Oranges K, Armideo E, Kolb MS, Freedman JL, Aplenc R, Fisher MJ, Minturn JE, Olson T, Bagatell R, Barakat L, Croy C, Mauro J, Vitlip L, Acord MR, Mattei P, Johnson VK, Devine CM, Pasquariello C, Reilly AF. Guideline for Children With Cancer Receiving General Anesthesia for Procedures and Imaging. J Pediatr Hematol Oncol 2022; 44:e859-e865. [PMID: 35235547 DOI: 10.1097/mph.0000000000002430] [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] [Received: 04/16/2021] [Accepted: 01/11/2022] [Indexed: 11/26/2022]
Abstract
Children with cancer and those undergoing hematopoietic stem cell transplantation frequently require anesthesia for imaging as well as diagnostic and therapeutic procedures from diagnosis through follow-up. Due to their underlying disease and side effects of chemotherapy and radiation, they are at risk for complications during this time, yet no published guideline exists for preanesthesia preparation. A comprehensive literature review served as the basis for discussions among our multidisciplinary panel of oncologists, anesthesiologists, nurse practitioners, clinical pharmacists, pediatric psychologists, surgeons and child life specialists at the Children's Hospital of Philadelphia. Due to limited literature available, this panel created an expert consensus guideline addressing anesthesia preparation for this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Lamia Barakat
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Colleen Croy
- Division of Oncology
- Department of Pharmacy, Children's Hospital of Philadelphia
| | - Jane Mauro
- Division of Oncology
- Department of Pharmacy, Children's Hospital of Philadelphia
| | | | - Michael R Acord
- Division of Interventional Radiology
- Radiology, Perelman School of Medicine at the University of Pennsylvania
| | - Peter Mattei
- Surgery, The Children's Hospital of Philadelphia
| | - Victoria K Johnson
- Justin Ingerman Center for Palliative Care, The Children's Hospital of Philadelphia
| | - Conor M Devine
- Division of Otolaryngology
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Diorio C, Vardaro J, Wei Y, Mauro J, Croy C, Oranges KE, Flanagan L, Reilly AF, Bailey LC, Jubelirer T, Elgarten CW, Freedman JL. Improving Guideline-Congruent Care for Chemotherapy-Induced Nausea and Vomiting Prophylaxis in Pediatric Oncology Patients. JCO Oncol Pract 2021; 18:e412-e419. [PMID: 34705478 DOI: 10.1200/op.21.00476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Chemotherapy-induced nausea and vomiting (CINV) is a very common side effect of pediatric cancer therapy. High-quality, evidence-based, pediatric-specific guidelines for prophylaxis and treatment of CINV are available. At many centers, guideline-concordant care is uncommon. We formed a multidisciplinary quality improvement team to implement guideline-concordant care for CINV prophylaxis at our center. We present the results following the first year of our interventions. METHODS We planned and implemented a multipronged approach in three key phases: (1) developing and publishing an acute CINV prophylaxis pathway, (2) education of providers, and (3) updating the computerized provider order entry system. We used iterative, sequential Plan-Do-Study-Act cycles and behavioral economic strategies to improve adherence to guideline-concordant CINV prophylaxis. We focused on aprepitant usage as a key area for improvement. RESULTS At the beginning of the study period, < 50% of patients were receiving guideline-concordant CINV prophylaxis and < 15% of eligible patients were receiving aprepitant. After 1 year, more than 60% of patients were receiving guideline-concordant care and 50% of eligible patients were receiving aprepitant. CONCLUSION We describe the development and implementation of a standardized pathway for prevention of acute CINV in pediatric oncology patients. With a multidisciplinary, multifaceted approach, we demonstrate significant improvements to guideline-congruent CINV prophylaxis.
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Affiliation(s)
- Caroline Diorio
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Julie Vardaro
- Division of Quality and Safety Services, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Yahui Wei
- Division of Quality and Safety Services, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jane Mauro
- Department of Pharmacy Services, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Colleen Croy
- Department of Pharmacy Services, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Katelyn E Oranges
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Lindsay Flanagan
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Anne F Reilly
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - L Charles Bailey
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Tracey Jubelirer
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Caitlin W Elgarten
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jason L Freedman
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Ocampo-Garcés A, Diaz M, Villanueva K, Córdova T, Mauro J, Cáceres T, Bassi A, Repetto G. Sleep architecture in 22q11.2 microdeletion syndrome patients: polysomnographic study of prodromal signs of Parkinson's Disease and obstructive sleep apnea. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wolbarst AB, Blom PF, Chan D, Cherry RN, Doehnert M, Fauver D, Hull HB, MacKinney JA, Mauro J, Richardson AC, Zaragoza L. Sites in the United States contaminated with radioactivity. Health Phys 1999; 77:247-260. [PMID: 10456495 DOI: 10.1097/00004032-199909000-00002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Over the century that radioactive materials have been mined, processed, produced, and utilized, many sites across the United States have become contaminated. Such sites include bases and installations of the Department of Defense, weapons production and research facilities of the Department of Energy, properties under the authority of other Federal agencies, privately-owned and governmental facilities that are licensed by the Nuclear Regulatory Commission and its Agreement States, and sites licensed by or the responsibility of states. This review reports on aspects of work by the Environmental Protection Agency, the Department of Defense, the Department of Energy, the Nuclear Regulatory Commission, and others to identify sites contaminated with radioactive materials. It also describes the principal programs that have been instituted to deal with them.
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Affiliation(s)
- A B Wolbarst
- U.S. Environmental Protection Agency, Office of Radiation and Indoor Air, Washington, DC 20460, USA
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Wolbarst AB, Mauro J, Anigstein R, Beres D, Doehnert M, Hull HB, Marschke S. Model for estimating population impacts averted through the remediation of contaminated soil. Health Phys 1998; 75:67-76. [PMID: 9645669 DOI: 10.1097/00004032-199807000-00012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This is the second in a series of papers that discuss methodologies being developed and employed by the U.S. Environmental Protection Agency in support of its decisions on cleanup levels for radioactively contaminated sites that are to be remediated and released for public use. It describes a model, CU-POP, designed by the U.S. Environmental Protection Agency to obtain estimates of the potential collective radiological health impacts over specific periods of time (100, 1,000 and 10,000 y following cleanup), both on and off site, due to residual radioactive materials in on-site soil. Collective doses and risks are linear in population density for the direct exposure, dust and indoor radon inhalation, and soil ingestion pathways; it is assumed that specific fractions of all food grown and all groundwater pumped at a site are consumed by on- and off-site populations. The model was developed for application to a set of hypothetical "reference" sites; its testing on a simple generic site is discussed briefly here.
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Affiliation(s)
- A B Wolbarst
- U.S. Environmental Protection Agency, Office of Radiation and Indoor Air, Washington, DC 20460, USA
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Wolbarst AB, Mauro J, Anigstein R, Back D, Bartlett JW, Beres D, Chan D, Clark ME, Doehnert M, Durman E, Hay S, Hull HB, Lailas N, MacKinney J, Ralston L, Tsirigotis PL. Technical basis for EPA's proposed regulation on the cleanup of sites contaminated with radioactivity. Health Phys 1996; 71:644-660. [PMID: 8887509 DOI: 10.1097/00004032-199611000-00004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The U.S. Environmental Protection Agency is proposing a regulation for the protection of the public from radioactive contamination at sites that are to be cleaned up and released for public use. The rule will apply to sites under the control of Federal agencies, and will impose limits on radiation doses to individuals living or working on a site following cleanup; it will thereby provide site owners and managers with uniform, consistent cleanup criteria for planning and carrying out remediation. This paper presents an overview of EPA's approach to assessing some of the beneficial and adverse effects associated with various possible values for the annual dose limit. In particular, it discusses the method developed to determine how the choice of cleanup criterion affects (1) the time-integrated potential numbers of non-fatal and fatal radiogenic cancers averted among future populations, (2) the occurrence of radiogenic cancers among remediation workers and the public caused by the cleanup process itself, and (3) the volumes of contaminated soil that may require remediation. The analytic methods described here were used to provide input data and assumptions for the Regulatory Impact Analysis (RIA) that supports the proposed regulation; the RIA also considered non-radiological benefits and costs (i.e., public health, economic, and ecological) of the standards.
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Affiliation(s)
- A B Wolbarst
- U.S. Environmental Protection Agency, Office of Radiation and Indoor Air, Washington, DC 20460, USA
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Mauro J. Seborrheic dermatitis. Am Fam Physician 1977; 15:116-7. [PMID: 139100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Dantzig PI, Mauro J, Rayhanzadeh S, Rudofsky UH. The significance of a positive cutaneous immunofluorescence test in systemic lupus erythematosus. Br J Dermatol 1975; 93:531-7. [PMID: 1203177 DOI: 10.1111/j.1365-2133.1975.tb02245.x] [Citation(s) in RCA: 25] [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: 12/26/2022]
Abstract
Direct cutaneous immunofluorescence microscopical examination of uninvolved skin is an important diagnostic test in systemic lupus erythematosus. Its prognostic significance is undetermined. In twenty-four patients there was an increased incidence of leukopenia, hypocomplementaemia, and LE cells in patients with positive skin immunofluorescence. Positive cutaneous immunofluorescence of uninvolved skin was correlated with the most severe forms of lupus renal disease, membranous glomerulonephritis, and diffuse proliferative glomerulonephritis.
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Mauro J, Lumpkin LR, Dantzig PI. Scanning electron microscopy of psoriatic nail pits. N Y State J Med 1975; 75:339-42. [PMID: 1055862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Mauro J, Serrone D, Somsin P, Stein AA. Cyclic vaginal cytologic patterns in the Macaca mulatta. Acta Cytol 1970; 14:348-52. [PMID: 4998159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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