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Hayward K, Grom A, Muscal E, Nigrovic PA, Rouster-Stevens KA, Ardalan K, Hiraki L, Moorthy LN. Longitudinal program evaluation of an inter-institutional mentorship network for pediatric rheumatology using a quality improvement framework. Res Sq 2023:rs.3.rs-3717708. [PMID: 38168403 PMCID: PMC10760235 DOI: 10.21203/rs.3.rs-3717708/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background The American College of Rheumatology (ACR)/Childhood Arthritis and Rheumatology Research Alliance (CARRA) Mentoring Interest Group (AMIGO) is an inter-institutional mentorship program launched to target mentorship gaps within pediatric rheumatology. Initial program evaluation indicated increased mentorship access. Given the small size of the pediatric rheumatology workforce, maintaining a consistent supply of mentors was a potential threat to the longevity of the network. Our aims were to: (i) describe the sustainability of AMIGO over the period 2011-2018, (ii) highlight ongoing benefits to participants, and (iii) describe challenges in the maintenance of a mentorship network. Methods A mixed-methods approach centered on a quality improvement framework was used to report on process and outcomes measures associated with AMIGO annual cycles. Results US and Canada Pediatric rheumatology workforce surveys identified 504 possible participants during the time period. As of fall 2018, 331 unique individuals had participated in AMIGO as a mentee, mentor or both for a program response rate of 66% (331/504). Survey of mentees indicated high satisfaction with impact on general career development, research/scholarship and work-life balance. Mentors indicated increased sense of connection to the community and satisfaction with helping mentees despite minimal perceived benefit to their academic portfolios. Based on AMIGO's success, a counterpart program, Creating Adult Rheumatology Mentorship in Academia (CARMA), was launched in 2018. Conclusions Despite the challenges of a limited workforce, AMIGO continues to provide consistent access to mentorship opportunities for the pediatric rheumatology community. This experience can inform approaches to mentorship gaps in other academic subspecialties.
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Affiliation(s)
- Kristen Hayward
- Seattle Children's Hospital and University of Washington School of Medicine
| | - Alexi Grom
- CCHMC: Cincinnati Children's Hospital Medical Center
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Danaher P, Hasle N, Nguyen ED, Hayward K, Rosenwasser N, Alpers CE, Reed RC, Okamura DM, Baxter SK, Jackson SW. Single cell spatial transcriptomic profiling of childhood-onset lupus nephritis reveals complex interactions between kidney stroma and infiltrating immune cells. bioRxiv 2023:2023.11.09.566503. [PMID: 38014158 PMCID: PMC10680641 DOI: 10.1101/2023.11.09.566503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Children with systemic lupus erythematosus (SLE) are at increased risk of developing kidney disease, termed childhood-onset lupus nephritis (cLN). Single cell transcriptomics of dissociated kidney tissue has advanced our understanding of LN pathogenesis, but loss of spatial resolution prevents interrogation of in situ cellular interactions. Using a technical advance in spatial transcriptomics, we generated a spatially resolved, single cell resolution atlas of kidney tissue (>400,000 cells) from eight cLN patients and two controls. Annotated cells were assigned to 35 reference cell types, including major kidney subsets and infiltrating immune cells. Analysis of spatial distribution demonstrated that individual immune lineages localize to specific regions in cLN kidneys, including myeloid cells trafficking to inflamed glomeruli and B cells clustering within tubulointerstitial immune hotspots. Notably, gene expression varied as a function of tissue location, demonstrating how incorporation of spatial data can provide new insights into the immunopathogenesis of SLE. Alterations in immune phenotypes were accompanied by parallel changes in gene expression by resident kidney stromal cells. However, there was little correlation between histologic scoring of cLN disease activity and glomerular cell transcriptional signatures at the level of individual glomeruli. Finally, we identified modules of spatially-correlated gene expression with predicted roles in induction of inflammation and the development of tubulointerstitial fibrosis. In summary, single cell spatial transcriptomics allows unprecedented insights into the molecular heterogeneity of cLN, paving the way towards more targeted and personalized treatment approaches.
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Brucia RC, Hayward K, Brunner HI, Lopez‐Pena M, Shenoi S, Soybilgic A, Nocton JJ. Practice Analysis and Determining the Knowledge and Skills Expected of a Pediatric Rheumatologist. ACR Open Rheumatol 2023; 5:619-623. [PMID: 37749708 PMCID: PMC10642243 DOI: 10.1002/acr2.11613] [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] [Received: 08/05/2023] [Revised: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE The scope of clinical practice of pediatric rheumatology has been difficult to define. The lack of definition prevents an accurate understanding of the knowledge and skills required of practicing pediatric rheumatologists. A practice analysis process was used with the goal of establishing a precise definition of clinical pediatric rheumatology practice. The definition of practice will improve training and the creation of relevant certification examinations. METHODS A practice analysis approach used meetings with a representative panel of pediatric rheumatologists to create a practice analysis document (PAD) and a test content outline (TCO). Panel experience, entrustable professional activities, and the current TCO were used to guide the process. Surveys were administered to fellowship program directors (PDs) and a broader group of practicing pediatric rheumatologists to revise and validate the content of the documents. RESULTS A PAD was created, including 14 categories of conditions diagnosed or managed by pediatric rheumatologists and eight domains of practice, with the tasks, knowledge, and skills required to perform these tasks. The survey of PDs (n = 10) indicated that the PAD content is important and useful. A TCO was created and consists of 18 domains used to define content areas to be assessed on certifying examinations. The survey of practicing pediatric rheumatologists (n = 127) indicated that the TCO domains are relevant. CONCLUSION A practice analysis process produced valuable resources for defining the clinical practice of pediatric rheumatology. The PAD and TCO can be used to develop more specific training curricula and to create relevant certification examinations.
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Affiliation(s)
| | - Kristen Hayward
- Seattle Children's Hospital and Research Center and University of WashingtonSeattleWashington
| | - Hermine I. Brunner
- Cincinnati Children's Hospital Medical Center and University of CincinnatiCincinnatiOhio
| | | | - Susan Shenoi
- Seattle Children's Hospital and Research Center and University of WashingtonSeattleWashington
| | | | - James J. Nocton
- Medical College of Wisconsin and Children's WisconsinMilwaukee
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Smitherman EA, Chahine RA, Beukelman T, Lewandowski LB, Rahman AKMF, Wenderfer SE, Curtis JR, Hersh AO, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar‐Smiley F, Barillas‐Arias L, Basiaga M, Baszis K, Becker M, Bell‐Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang‐Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel‐Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie‐Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui‐Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein‐Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PM, McGuire S, McHale I, McMonagle A, McMullen‐Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O'Brien B, O'Brien T, Okeke O, Oliver M, Olson J, O'Neil K, Onel K, Orandi A, Orlando M, Osei‐Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan‐Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas‐Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth‐Wojcicki E, Rouster – Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert‐Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner‐Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care. Arthritis Care Res (Hoboken) 2023; 75:1553-1562. [PMID: 36775844 PMCID: PMC10500561 DOI: 10.1002/acr.25002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/14/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis. METHODS We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded. RESULTS We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers. CONCLUSION In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.
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Hahn T, Daymont C, Beukelman T, Groh B, Hays K, Bingham CA, Scalzi L, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J 2022; 20:107. [PMID: 36434731 PMCID: PMC9701017 DOI: 10.1186/s12969-022-00770-y] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months. METHODS We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed. RESULTS We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05). CONCLUSION While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.
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Affiliation(s)
- Timothy Hahn
- Department of Pediatrics, Penn State Children's Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA, 17033-0855, USA.
| | - Carrie Daymont
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Timothy Beukelman
- grid.265892.20000000106344187Department of Pediatrics, University of Alabama at Birmingham, CPPN G10, 1600 7th Ave South, Birmingham, AL 35233 USA
| | - Brandt Groh
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | | | - Catherine April Bingham
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Lisabeth Scalzi
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
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Gorelik M, Chung SA, Ardalan K, Binstadt BA, Friedman K, Hayward K, Imundo LF, Lapidus SK, Kim S, Son MB, Sule S, Tremoulet AH, Van Mater H, Yildirim-Toruner C, Langford CA, Maz M, Abril A, Guyatt G, Archer AM, Conn DL, Full KA, Grayson PC, Ibarra MF, Merkel PA, Rhee RL, Seo P, Stone JH, Sundel RP, Vitobaldi OI, Warner A, Byram K, Dua AB, Husainat N, James KE, Kalot M, Lin YC, Springer JM, Turgunbaev M, Villa-Forte A, Turner AS, Mustafa RA. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Kawasaki Disease. Arthritis Rheumatol 2022; 74:586-596. [PMID: 35257501 DOI: 10.1002/art.42041] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/18/2021] [Accepted: 12/02/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To provide evidence-based recommendations and expert guidance for the management of Kawasaki disease (KD), focusing on clinical scenarios more commonly addressed by rheumatologists. METHODS Sixteen clinical questions regarding diagnostic testing, treatment, and management of KD were developed in the Patient/Population, Intervention, Comparison, and Outcomes (PICO) question format. Systematic literature reviews were conducted for each PICO question. We used the Grading of Recommendations, Assessment, Development and Evaluation method to assess the quality of evidence and formulate recommendations. Each recommendation required consensus from at least 70% of the Voting Panel. RESULTS We present 1 good practice statement, 11 recommendations, and 1 ungraded position statement to guide the management of KD and clinical scenarios of suspected KD. These recommendations for KD are focused on situations in which input from rheumatologists may be requested by other managing specialists, such as in cases of treatment-refractory, severe, or complicated KD. The good practice statement affirms that all patients with KD should receive initial treatment with intravenous immunoglobulin (IVIG). In addition, we developed 7 strong and 4 conditional recommendations for the management of KD or suspected KD. Strong recommendations include prompt treatment of incomplete KD, treatment with aspirin, and obtaining an echocardiogram in the setting of unexplained macrophage activation syndrome or shock. Conditional recommendations include use of IVIG with other adjuvant agents for patients with KD and high-risk features of IVIG resistance and/or coronary artery aneurysms. These recommendations endorse minimizing risk to the patient by using established therapy promptly at disease onset and identifying situations in which adjunctive therapy may be warranted. CONCLUSION These recommendations provide guidance regarding diagnostic strategies, use of pharmacologic agents, and use of echocardiography in patients with suspected or confirmed KD.
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Affiliation(s)
- Mark Gorelik
- Columbia University School of Medicine, New York, New York
| | | | - Kaveh Ardalan
- Duke University School of Medicine, Durham, North Carolina
| | | | - Kevin Friedman
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kristen Hayward
- Seattle Children's Hospital and University of Washington School of Medicine, Seattle, Washington
| | - Lisa F Imundo
- Columbia University School of Medicine, New York, New York
| | - Sivia K Lapidus
- Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, and Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | - Susan Kim
- University of California, San Francisco
| | - Mary Beth Son
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | - Mehrdad Maz
- University of Kansas Medical Center, Kansas City
| | | | | | | | | | | | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | | | | | - Philip Seo
- Johns Hopkins Medical Institute, Baltimore, Maryland
| | | | - Robert P Sundel
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Ann Warner
- Saint Luke's Health System, Kansas City, Missouri
| | | | | | | | | | | | | | | | | | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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Gorelik M, Chung SA, Ardalan K, Binstadt BA, Friedman K, Hayward K, Imundo LF, Lapidus SK, Kim S, Son MB, Sule S, Tremoulet AH, Van Mater H, Yildirim-Toruner C, Langford CA, Maz M, Abril A, Guyatt G, Archer AM, Conn DL, Full KA, Grayson PC, Ibarra MF, Merkel PA, Rhee RL, Seo P, Stone JH, Sundel RP, Vitobaldi OI, Warner A, Byram K, Dua AB, Husainat N, James KE, Kalot M, Lin YC, Springer JM, Turgunbaev M, Villa-Forte A, Turner AS, Mustafa RA. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Kawasaki Disease. Arthritis Care Res (Hoboken) 2022; 74:538-548. [PMID: 35257507 DOI: 10.1002/acr.24838] [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] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/02/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To provide evidence-based recommendations and expert guidance for the management of Kawasaki disease (KD), focusing on clinical scenarios more commonly addressed by rheumatologists. METHODS Sixteen clinical questions regarding diagnostic testing, treatment, and management of KD were developed in the Patient/Population, Intervention, Comparison, and Outcomes (PICO) question format. Systematic literature reviews were conducted for each PICO question. We used the Grading of Recommendations, Assessment, Development and Evaluation method to assess the quality of evidence and formulate recommendations. Each recommendation required consensus from at least 70% of the Voting Panel. RESULTS We present 1 good practice statement, 11 recommendations, and 1 ungraded position statement to guide the management of KD and clinical scenarios of suspected KD. These recommendations for KD are focused on situations in which input from rheumatologists may be requested by other managing specialists, such as in cases of treatment-refractory, severe, or complicated KD. The good practice statement affirms that all patients with KD should receive initial treatment with intravenous immunoglobulin (IVIG). In addition, we developed 7 strong and 4 conditional recommendations for the management of KD or suspected KD. Strong recommendations include prompt treatment of incomplete KD, treatment with aspirin, and obtaining an echocardiogram in the setting of unexplained macrophage activation syndrome or shock. Conditional recommendations include use of IVIG with other adjuvant agents for patients with KD and high-risk features of IVIG resistance and/or coronary artery aneurysms. These recommendations endorse minimizing risk to the patient by using established therapy promptly at disease onset and identifying situations in which adjunctive therapy may be warranted. CONCLUSION These recommendations provide guidance regarding diagnostic strategies, use of pharmacologic agents, and use of echocardiography in patients with suspected or confirmed KD.
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Affiliation(s)
- Mark Gorelik
- Columbia University School of Medicine, New York, New York
| | | | - Kaveh Ardalan
- Duke University School of Medicine, Durham, North Carolina
| | | | - Kevin Friedman
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kristen Hayward
- Seattle Children's Hospital and University of Washington School of Medicine, Seattle, Washington
| | - Lisa F Imundo
- Columbia University School of Medicine, New York, New York
| | - Sivia K Lapidus
- Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, and Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | - Susan Kim
- University of California, San Francisco
| | - Mary Beth Son
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Adriana H Tremoulet
- Rady Children's Hospital and University of California, San Diego, San Diego, California
| | | | | | | | - Mehrdad Maz
- University of Kansas Medical Center, Kansas City
| | | | | | | | | | | | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | | | | | - Philip Seo
- Johns Hopkins Medical Institute, Baltimore, Maryland
| | | | - Robert P Sundel
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Ann Warner
- Saint Luke's Health System, Kansas City, Missouri
| | | | | | | | | | | | | | | | | | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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Soulsby WD, Balmuri N, Cooley V, Gerber LM, Lawson E, Goodman S, Onel K, Mehta B, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis. Pediatr Rheumatol Online J 2022; 20:18. [PMID: 35255941 PMCID: PMC8903717 DOI: 10.1186/s12969-022-00676-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry. METHODS In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months. RESULTS One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability. CONCLUSION High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.
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Affiliation(s)
- William Daniel Soulsby
- University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA, 94158, USA.
| | - Nayimisha Balmuri
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Victoria Cooley
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Linda M. Gerber
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Erica Lawson
- grid.266102.10000 0001 2297 6811University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA 94158 USA
| | - Susan Goodman
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Karen Onel
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Bella Mehta
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
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Shenoi S, Hayward K, Curran ML, Kessler E, Mehta JJ, Riebschleger MP, Foster HE. Telemedicine in pediatric rheumatology: this is the time for the community to embrace a new way of clinical practice. Pediatr Rheumatol Online J 2020; 18:85. [PMID: 33129319 PMCID: PMC7602754 DOI: 10.1186/s12969-020-00476-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/06/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The use of telemedicine in pediatric rheumatology has been historically low. The current COVID 19 global pandemic has forced a paradigm shift with many centers rapidly adopting virtual visits to conduct care resulting in rapid expansion of use of telemedicine amongst practices. BODY: This commentary discusses practical tips for physicians including guidance around administrative and governance issues, preparation for telemedicine, involving the multidisciplinary care team, and teaching considerations. We also outline a standard proforma and smart phrases for the electronic health record. A proposed variation of the validated pediatric gait arms legs spine examination (pGALS) called the video pGALS (VpGALS) as a means of conducting virtual pediatric rheumatology physical examination is presented. CONCLUSION This commentary provides a starting framework for telemedicine use in pediatric rheumatology and further work on validation and acceptability is needed.
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Affiliation(s)
- Susan Shenoi
- Department of Pediatrics, Division of Rheumatology, Seattle Children's Hospital and Research Center, University of WA, MA.7.110 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Kristen Hayward
- Department of Pediatrics, Division of Rheumatology, Seattle Children’s Hospital and Research Center, University of WA, MA.7.110 4800 Sand Point Way NE, Seattle, WA 98105 USA
| | - Megan L. Curran
- grid.430503.10000 0001 0703 675XDepartment of Pediatrics, Section of Rheumatology, University of Colorado, 13123 E. 16th Ave, B311, Aurora, CO 80045 USA
| | - Elizabeth Kessler
- grid.413656.30000 0004 0450 6121Department of Pediatrics, Section of Rheumatology, Helen DeVos Children’s Hospital, Grand Rapids, MI. 35 Michigan St NE, Grand Rapids, MI 49503 USA
| | - Jay J. Mehta
- grid.239552.a0000 0001 0680 8770Division of Rheumatology, Children’s Hospital of Philadelphia, 3501 Civic Center Blvd, Philadelphia CTRB 10109, Philadelphia, PA 19104 USA
| | - Meredith P. Riebschleger
- grid.214458.e0000000086837370Department of Pediatrics, Division of Rheumatology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI 48109 USA
| | - Helen E. Foster
- grid.1006.70000 0001 0462 7212Professor Pediatric Rheumatology, Population Health Sciences Institute, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
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Al-Shaikhly T, Hayward K, Basiaga ML, Allenspach EJ. Bacterial infections in a pediatric cohort of primary and acquired complement deficiencies. Pediatr Rheumatol Online J 2020; 18:74. [PMID: 32972440 PMCID: PMC7513499 DOI: 10.1186/s12969-020-00467-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 09/03/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Acquired complement deficiency can occur in the setting of autoimmune syndromes, such as systemic lupus erythematosus (SLE), with very low or, occasionally, undetectable C3 levels. Based on inherited complement defects, patients with transiently low complement may be at similar risk for serious bacterial infection, but the degree of risk related to C3 level and temporal association is unknown. METHODS We performed a retrospective study including pediatric patients with undetectable total complement activity or absent individual complement components measured at our institution from 2002 to 2018. We assessed annual rate of serious bacterial infection (SBI) defined as requiring hospitalization and/or parenteral antibiotics by manual chart review. Among included SLE patients, we assessed the 30-day probability of SBI for given C3 measurements using a logistic regression model to determine risk. Primary complement deficiency was analyzed for SBI rate as comparison. Covariates included age, level of immune suppression and history of lupus nephritis. RESULTS Acquired complement deficiency secondary to SLE-related disease [n = 44] was the most common underlying diagnosis associated with depressed complement levels and were compared to a cohort of primary complement deficient patients [n = 18]. SBI per 100 person-years and cohort demographics were described in parallel. Our logistic regression analysis of pediatric patients with SLE showed low C3 level was temporally associated with having an SBI event. Given equivalent immunosuppression, patients with an SBI had lower C3 levels at the beginning of the observation period relative to patients without SBI. CONCLUSION Pediatric patients with the diagnosis of SLE can develop very low C3 levels that associate with risk of serious bacterial infection comparable to that of patients with primary complement deficiency. Patients prone to severe complement consumption may particularly be at risk.
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Affiliation(s)
- Taha Al-Shaikhly
- grid.240473.60000 0004 0543 9901Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Penn State College of Medicine, Hershey, PA USA
| | - Kristen Hayward
- grid.34477.330000000122986657Division of Rheumatology, Department of Pediatrics, University of Washington, Seattle, WA 98101 USA
| | - Matthew L. Basiaga
- grid.66875.3a0000 0004 0459 167XDivision of Pediatric Rheumatology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN USA
| | - Eric J. Allenspach
- grid.34477.330000000122986657Division of Rheumatology, Department of Pediatrics, University of Washington, Seattle, WA 98101 USA
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11
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Petrochilos P, Elmalem M, Selai C, Patel D, Hayward K, Ranu J, Louissaint H. 16 Outcomes of a novel 5-week individualized multidisciplinary outpatient (day-patient) treatment programme for functional (psychogenic) neurological symptoms. J Neurol Psychiatry 2020. [DOI: 10.1136/jnnp-2020-bnpa.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AimWe report the results of a novel 5-week treatment programme, delivered by a multi-disciplinary team, with individualised sessions to treat functional neurological symptoms in a neuropsychiatric outpatient setting. The primary aims of this MDT programme were to (a) reduce symptoms (b) improve health and social functioning (c) improve functional performance (d) improve health status.MethodTreatment involved individual sessions of neuropsychiatry, cognitive behavioural therapy, physiotherapy, occupational therapy, education and family meetings. Outcome measures were collected at the beginning and end of treatment and at a 6 month face to face follow-up. These were both patient and clinician reported. The aims were assessed by the following measures: symptom reduction (PHQ15, PHQ9, GAD7, SPIN, Rosenberg, CGI); health and social functioning (HONOS, WSAS); functional performance (COPM); and improvements in health status (EQ5DL). Results: Analyses were conducted on 78 patients who started and completed the programme and attended a 6 month face to face review. There were high baseline levels of disability compared to EQ5DL population norms and high rates of disability and psychopathology as indicated by the WSAS and mental health indices (PHQ9, GAD7, SPIN, Rosenberg’s self-esteem). At baseline, 92.3% met the IAPT caseness threshold for depression (PHQ9 >10) and 71% met the IAPT caseness threshold for anxiety (GAD7 >8). A repeated measures Freidman’s ANOVA over 3 timepoints (admission, discharge and 6 month follow-up) followed by Dunn-Bonferroni post hoc tests indicated statistically significant improvements from admission to discharge and admission to 6 months follow up. These improvements were seen in in somatic symptoms (PHQ15), depression (PHQ9) and anxiety (GAD7) symptoms, health and social functioning (HONOS), functional performance (COPM), health status (EQ5D-5L and EQ5D-EL VAS) and patient ratings of clinical global improvement (CGI). There was a high acceptance of this neuropsychiatry led MDT programme indicated by the patient reported visual analogue scale for benefit of programme averaging at 90%.ConclusionAn MDT can effectively deliver an outpatient programme for FNS which can serve as an alternative to an inpatient programme for patients with fewer or no nursing needs, for those whose preference is an outpatient setting or for those seeking to minimise disruption to work or family life. There may be potential cost reductions for institutions compared to inpatient treatment depending on local calculations. In the future, earlier identification and treatment of co-morbidities may modify some predisposing and perpetuating factors.
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Petrochilos P, Elmalem MS, Patel D, Louissaint H, Hayward K, Ranu J, Selai C. Outcomes of a 5-week individualised MDT outpatient (day-patient) treatment programme for functional neurological symptom disorder (FNSD). J Neurol 2020; 267:2655-2666. [PMID: 32410018 PMCID: PMC7419475 DOI: 10.1007/s00415-020-09874-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 11/29/2022]
Abstract
Aim We report results from a 5-week MDT treatment programme, with individualised sessions, for a selected group of patients with FNSD, delivered in a neuropsychiatric outpatient setting. Primary aims were to (1) reduce symptoms, (2) improve functional performance and (3) improve health status. Methods Treatment involved individual sessions of neuropsychiatry, cognitive behavioural therapy, physiotherapy, occupational-therapy, education and family meetings. Outcome measures collected at the beginning and end of treatment and at 6 months, were patient and clinician reported. Aims were assessed by the following: symptom reduction (PHQ15, PHQ9, GAD7, SPIN, Rosenberg); health and social functioning (HONOS, WSAS); functional performance (COPM); health status (EQ-5D-5L) and patient-rated perception of improvement (CGI). Results Analyses of 78 patients completing the programme and attending a 6-month review revealed high-baseline levels of disability compared to EQ-5DL population norms and high rates of disability and psychopathology as indicated by the WSAS and mental health indices (PHQ9, GAD7, SPIN, Rosenberg’s self-esteem). At baseline, 92.3% met the IAPT caseness threshold for depression and 71% met the IAPT caseness threshold for anxiety. A Friedman ANOVA over the three time points and Dunn-Bonferroni post hoc tests indicated statistically significant improvements from admission to discharge and admission to 6-month follow-up. Sustained improvements were seen in somatic symptoms (PHQ15), depression (PHQ9), anxiety (GAD7), health and social functioning (HONOS), functionality (COPM), health status (EQ-5D-5L) and patient-rated clinical global improvement (CGI). Conclusion An MDT can effectively deliver an outpatient programme for FNSD which can serve as an alternative to costlier inpatient programmes. Early identification and treatment of co-morbidities is advised. Electronic supplementary material The online version of this article (10.1007/s00415-020-09874-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Panayiota Petrochilos
- Department of Neuropsychiatry, National Hospital for Neurology and Neurosurgery, Queen Square, Box 19, London, WC1N 3BG, UK.
| | - M S Elmalem
- Department of Clinical and Movement Neurosciences, National Hospital for Neurology and Neurosurgery, UCL Queen Square Institute of Neurology, Queen Square, Box 95, London, WC1N 3BG, UK
| | - D Patel
- Department of Neuropsychiatry, National Hospital for Neurology and Neurosurgery, Queen Square, Box 19, London, WC1N 3BG, UK
| | - H Louissaint
- Therapies Services Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - K Hayward
- Therapies Services Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - J Ranu
- Therapies Services Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - C Selai
- Department of Clinical and Movement Neurosciences, National Hospital for Neurology and Neurosurgery, UCL Queen Square Institute of Neurology, Queen Square, Box 95, London, WC1N 3BG, UK
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13
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Connelly M, Schanberg LE, Ardoin S, Blakley M, Carrasco R, Chira P, Hayward K, Ibarra M, Kimura Y, Kingsbury DJ, Klein-Gitelman MS, Lawson E, Stinson J. Multisite Randomized Clinical Trial Evaluating an Online Self-Management Program for Adolescents With Juvenile Idiopathic Arthritis. J Pediatr Psychol 2020; 44:363-374. [PMID: 30204919 DOI: 10.1093/jpepsy/jsy066] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 05/05/2018] [Revised: 07/03/2018] [Accepted: 07/31/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the efficacy in improving pain and health-related quality of life (HRQOL) of an online self-management program for adolescents with juvenile idiopathic arthritis (JIA). METHODS Youth ages 12-18 years with JIA were recruited from 10 rheumatology clinics across the United States and randomized to complete an online self-management program (n = 144) or an online disease education program (n = 145). Participants in the self-management group worked through multimedia-based modules comprising psychoeducation, training in cognitive-behavioral coping skills and stress management, and other self-management topics over a 12-week period. Participants in the control group viewed a series of preselected quality educational websites about JIA over the same interval. Online content for both groups was made available in English and Spanish to facilitate inclusion of Hispanic participants. Blinded assessment of main outcomes (pain intensity, pain interference, and HRQOL) and process outcomes (disease knowledge, self-efficacy, pain coping, and emotional adjustment) occurred at baseline, posttreatment, and at 6- and 12-month postrandomization follow-up visits. RESULTS Participants on average demonstrated significant improvements over the study period in the main outcomes, with no significant group differences in the degree of improvement. Effect sizes for these improvements were small. The amount of improvement in self-efficacy, emotional avoidance coping, disease knowledge, and emotional functioning in part predicted improvement in pain and HRQOL outcomes. CONCLUSIONS Primarily self-directed online self-management training and online disease education comparably and modestly improve pain and HRQOL in youth with JIA.
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Abstract
"E-learning" refers to instruction occurring via digital media and ideally uses an engaging and learner-centered approach. Advantages of e-learning methods include (1) they can enable consistent messages, (2) they may use novel instructional methods, and (3) they enable documentation of usage and assessment. This article discusses principles for and challenges to developing e-learning materials. The authors provide a collection of available e-learning materials used to teach adult and pediatric rheumatology developed by individuals, professional societies, and private companies. Finally, they discuss challenges to using e-learning materials.
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Affiliation(s)
- Megan L Curran
- Section of Rheumatology, Children's Hospital of Colorado, University of Colorado School of Medicine, 13123 East 16th Street, Box 311, Aurora, CO 80045, USA.
| | - Kristen Hayward
- Division of Rheumatology, Seattle Children's Hospital, University of Washington, School of Medicine, 4800 Sand Point Way Northeast, M/S MA.7.110, Seattle, WA 98105, USA
| | - Jay Mehta
- Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, 3501 Civic Center Boulevard, CTRB 10109, Philadelphia, PA 19104, USA
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15
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Firth N, Barker R, Hayward K, Bernhardt J, Bellingan M, Gunnarsson R. Safety and efficacy of recovery-promoting drugs for motor function after stroke: A systematic review of randomized controlled trials. J Rehabil Med 2019; 51:319-330. [DOI: 10.2340/16501977-2536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Bernatsky S, Clarke AE, Zahedi Niaki O, Labrecque J, Schanberg LE, Silverman ED, Hayward K, Imundo L, Brunner HI, Haines KA, Cron RQ, Oen K, Wagner-Weiner L, Rosenberg AM, O'Neil KM, Duffy CM, von Scheven E, Joseph L, Lee JL, Ramsey-Goldman R. Malignancy in Pediatric-onset Systemic Lupus Erythematosus. J Rheumatol 2017; 44:1484-1486. [PMID: 28765255 DOI: 10.3899/jrheum.170179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine cancer incidence in a large pediatric-onset systemic lupus erythematosus (SLE) population. METHODS Data were examined from 12 pediatric SLE registries in North America. Patients were linked to their regional cancer registries to detect cancers observed after cohort entry, defined as date first seen in the clinic. The expected number of malignancies was obtained by multiplying the person-years in the cohort (defined from cohort entry to end of followup) by the geographically matched age-, sex-, and calendar year-specific cancer rates. The standardized incidence ratio (SIR; ratio of cancers observed to expected) was generated, with 95% CI. RESULTS A total of 1168 patients were identified from the registries. The mean age at cohort entry was 13 years (SD 3.3), and 83.7% of the subjects were female. The mean duration of followup was 7.6 years, resulting in a total observation period of 8839 years spanning the calendar period 1974-2009. During followup, fourteen invasive cancers occurred (1.6 cancers per 1000 person-yrs, SIR 4.13, 95% CI 2.26-6.93). Three of these were hematologic (all lymphomas), resulting in an SIR for hematologic cancers of 4.68 (95% CI 0.96-13.67). SIR were increased for both male and female patients, and across age groups. CONCLUSION Although cancer remains a relatively rare outcome in pediatric-onset SLE, our data do suggest an increase in cancer for patients followed an average of 7.6 years. About one-fifth of the cancers were hematologic. Longer followup, and study of drug effects and disease activity, is warranted.
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Affiliation(s)
- Sasha Bernatsky
- From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA. .,S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine.
| | - Ann E Clarke
- From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA.,S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine
| | - Omid Zahedi Niaki
- From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA.,S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine
| | - Jeremy Labrecque
- From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA.,S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine
| | - Laura E Schanberg
- From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA.,S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine
| | - Earl D Silverman
- From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA.,S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine
| | - Kristen Hayward
- From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA.,S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine
| | - Lisa Imundo
- From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA.,S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine
| | - Hermine I Brunner
- From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA.,S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine
| | - Kathleen A Haines
- From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA.,S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine
| | - Randy Q Cron
- From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA.,S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine
| | - Kiem Oen
- From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA.,S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine
| | - Linda Wagner-Weiner
- From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA.,S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine
| | - Alan M Rosenberg
- From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA.,S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine
| | - Kathleen M O'Neil
- From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA.,S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine
| | - Ciarán M Duffy
- From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA.,S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine
| | - Emily von Scheven
- From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA.,S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine
| | - Lawrence Joseph
- From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA.,S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine
| | - Jennifer L Lee
- From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA.,S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine
| | - Rosalind Ramsey-Goldman
- From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA.,S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine
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Hayward K, Haaland WL, Hrachovec J, Leu M, Vora S, Clifton H, Rascoff N, Crowell CS. Reliable Pregnancy Testing Before Intravenous Cyclophosphamide: A Quality Improvement Study. Pediatrics 2016; 138:peds.2016-0378. [PMID: 27940668 DOI: 10.1542/peds.2016-0378] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 06/09/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Cyclophosphamide is a teratogenic medication used in the treatment of adolescents with autoimmune disorders. This adolescent population is sexually active, does not receive adequate contraceptive care, and is at risk for unintended pregnancy. We undertook a quality improvement initiative to improve rates of pregnancy screening before intravenous cyclophosphamide administration in our adolescent girl patients. METHODS Data were collected from the electronic medical record. The primary outcome was completion of a urine pregnancy test before intravenous cyclophosphamide infusion in girls aged 12 to 21 years between July 2011 and June 2015. Data were reviewed quarterly and an iterative quality improvement approach was used. Interventions included staff education, electronic order set updates, and a Maintenance of Certification project. Interrupted time series analysis and multivariable mixed effects logistic regression were used to evaluate trends over time and to adjust for potential confounders. RESULTS Thirty girls received 153 cyclophosphamide infusions during the study. Pregnancy testing before medication administration increased from 25% to 100% by study completion. Infusions in the last time period were significantly more likely to be accompanied by a pregnancy test versus those in the first time period (odds ratio: 17.7; 95% confidence interval [CI]: 3.1-101.6) after adjustment for patient age, managing service, infusion setting, and insurance type. CONCLUSIONS Our institution achieved a significant increase in standard pregnancy screening in adolescent girls receiving intravenous cyclophosphamide. The interventions most valuable in increasing screening rates were updating electronic order sets, educating staff, and physician engagement in the Maintenance of Certification program.
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Affiliation(s)
| | - Wren L Haaland
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington; and
| | - Jennifer Hrachovec
- Clinical Effectiveness, Seattle Children's Hospital, Seattle, Washington
| | - Michael Leu
- Departments of Pediatrics, and.,Clinical Effectiveness, Seattle Children's Hospital, Seattle, Washington.,Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington
| | - Surabhi Vora
- Departments of Pediatrics, and.,Clinical Effectiveness, Seattle Children's Hospital, Seattle, Washington
| | - Holly Clifton
- Clinical Effectiveness, Seattle Children's Hospital, Seattle, Washington
| | | | - Claudia S Crowell
- Departments of Pediatrics, and.,Clinical Effectiveness, Seattle Children's Hospital, Seattle, Washington
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18
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Zahedi Niaki O, Clarke AE, Ramsey-Goldman R, Yeung R, Hayward K, Oen K, Duffy CM, Rosenberg A, O'Neil KM, von Scheven E, Schanberg L, Labrecque J, Tse SML, Hasija R, Lee JLF, Bernatsky S. Malignancy incidence in 5294 patients with juvenile arthritis. RMD Open 2016; 2:e000212. [PMID: 27175293 PMCID: PMC4860862 DOI: 10.1136/rmdopen-2015-000212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 11/05/2022] Open
Abstract
Objective To determine cancer incidence in a large clinical juvenile-onset arthritis population. Methods We combined data from 6 existing North American juvenile-onset arthritis cohorts. Patients with juvenile-onset arthritis were linked to regional cancer registries to detect incident cancers after cohort entry, defined as first date seen in the paediatric rheumatology clinic. The expected number of malignancies was obtained by multiplying the person-years observed (defined from cohort entry to end of follow-up) by the geographically matched age, sex and calendar year-specific cancer rates. The standardised incidence ratios (SIR; ratio of cancers observed to expected) were generated, with 95% CIs. Results The 6 juvenile arthritis registries provided a total of 5294 patients. The mean age at cohort entry was 8.9 (SD 5.0) years and 68% of participants were female. The mean duration of follow-up was 6.8 years with a total of 36 063 person-years spanning 1978–2012. During follow-up, 9 invasive cancers occurred, compared with 10.9 expected (SIR 0.82, 95% CI 0.38 to 1.5). 3 of these were haematological (Hodgkin's, non-Hodgkin's lymphoma and leukaemia). 6 of the patients with cancer were exposed to disease-modifying drugs; 5 of these had also been exposed to biological agents. Conclusions We did not clearly demonstrate an increase in overall malignancy risk in patients with juvenile-onset arthritis followed for an average of almost 7 years. 3 of the 9 observed cancers were haematological. 5 of the cancers arose in children exposed to biological agents. Longer follow-up of this population is warranted, with further study of drug effects.
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Affiliation(s)
- Omid Zahedi Niaki
- Department of Medicine , McGill University , Montreal, Quebec , Canada
| | - Ann E Clarke
- Department of Medicine , University of Calgary , Calgary, Alberta , Canada
| | | | - Rae Yeung
- Division of Rheumatology , The Hospital for Sick Children , Toronto, Ontario , Canada
| | - Kristen Hayward
- Department of Rheumatology , Seattle Children's Hospital , Seattle, Washington , USA
| | - Kiem Oen
- Department of Pediatrics , University of Manitoba , Winnipeg, Manitoba , Canada
| | - Ciarán M Duffy
- Department of Pediatrics , Children's Hospital of Eastern Ontario , Ottawa, Ontario , Canada
| | - Alan Rosenberg
- Department of Pediatrics , Royal University Hospital , Saskatoon, Saskatchewan , Canada
| | - Kathleen M O'Neil
- Division of Pediatric Rheumatology , Riley Hospital for Children , Indianapolis, Indiana , USA
| | - Emily von Scheven
- Department of Pediatric Rheum San Francisco , University of California , San Francisco, California , USA
| | - Laura Schanberg
- Department of Pediatrics , Duke University Medical Center , Durham, North Carolina , USA
| | - Jeremy Labrecque
- Department of Medicine , McGill University , Montreal, Quebec , Canada
| | - Shirley M L Tse
- Division of Rheumatology , The Hospital for Sick Children , Toronto, Ontario , Canada
| | - Rachana Hasija
- Division of Rheumatology , The Hospital for Sick Children , Toronto, Ontario , Canada
| | - Jennifer L F Lee
- Department of Medicine , McGill University , Montreal, Quebec , Canada
| | - Sasha Bernatsky
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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Goss LB, Ortiz JR, Okamura DM, Hayward K, Goss CH. Correction: Significant Reductions in Mortality in Hospitalized Patients with Systemic Lupus Erythematosus in Washington State from 2003 to 2011. PLoS One 2015; 10:e0140698. [PMID: 26452063 PMCID: PMC4599824 DOI: 10.1371/journal.pone.0140698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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20
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Rascoff N, Hayward K. A142: Implementation of a Quality Improvement Initiative to Reduce Unintended Fetal Exposure to Teratogenic Medications among Female Pediatric Rheumatology Patients. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rosen P, Popescu V, Hayward K, Wyman C. Nonpinhole approximations for interactive rendering. IEEE Comput Graph Appl 2011; 31:68-83. [PMID: 24808260 DOI: 10.1109/mcg.2011.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Diraison F, Hayward K, Sanders KL, Brozzi F, Lajus S, Hancock J, Francis JE, Ainscow E, Bommer UA, Molnar E, Avent ND, Varadi A. Translationally controlled tumour protein (TCTP) is a novel glucose-regulated protein that is important for survival of pancreatic beta cells. Diabetologia 2011; 54:368-79. [PMID: 21063673 DOI: 10.1007/s00125-010-1958-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [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: 07/21/2010] [Accepted: 09/27/2010] [Indexed: 12/25/2022]
Abstract
AIMS/HYPOTHESIS This study used proteomics and biochemical approaches to identify novel glucose-regulated proteins and to unveil their role in pancreatic beta cell function. Translationally controlled tumour protein (TCTP) was identified to be one such protein, and further investigations into its function and regulation were carried out. METHODS Global protein profiling of beta cell homogenates following glucose stimulation was performed using two-dimensional gel electrophoresis. Proteins were identified by mass spectroscopy analysis. Immunoblotting was used to investigate alterations in TCTP protein levels in response to glucose stimulation or cell stress induced by palmitate. To investigate the biological function of TCTP, immunolocalisation, gene knockdown and overexpression of Tctp (also known as Tpt1) were performed. Apoptosis was measured in Tctp knockdown or Tctp-overexpressing cells. Glucose-stimulated insulin secretion was carried out in Tctp knockdown cells. RESULTS TCTP was identified as a novel glucose-regulated protein, the level of which is increased at stimulatory glucose concentration. Glucose also induced TCTP dephosphorylation and its partial translocation to the mitochondria and the nucleus. TCTP protein levels were downregulated in response to cell stress induced by palmitate or thapsigargin treatments. Gene knockdown by small interfering RNA led to increased apoptosis, whereas overproduction of TCTP prevented palmitate-induced cell death. CONCLUSIONS/INTERPRETATION Regulation of TCTP protein levels by glucose is likely to be an important cyto-protective mechanism for pancreatic beta cells against damage caused by hyperglycaemia. In contrast, high concentration of palmitate causes cell stress, reduction in TCTP levels and consequently reduced cell viability. Our results imply that TCTP levels influence the sensitivity of beta cells to apoptosis.
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Affiliation(s)
- F Diraison
- Centre for Research in Biomedicine, Faculty of Health and Life Sciences, University of the West of England, Bristol BS16 1QY, UK
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Davies Morel M, Newcombe J, Hayward K. Factors affecting pre-ovulatory follicle diameter in the mare: the effect of mare age, season and presence of other ovulatory follicles (multiple ovulation). Theriogenology 2010; 74:1241-7. [DOI: 10.1016/j.theriogenology.2010.05.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 05/19/2010] [Accepted: 05/19/2010] [Indexed: 10/19/2022]
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Parodi A, Davì S, Pringe AB, Pistorio A, Ruperto N, Magni-Manzoni S, Miettunen P, Bader-Meunier B, Espada G, Sterba G, Ozen S, Wright D, Magalhães CS, Khubchandani R, Michels H, Woo P, Iglesias A, Guseinova D, Bracaglia C, Hayward K, Wouters C, Grom A, Vivarelli M, Fischer A, Breda L, Martini A, Ravelli A. Macrophage activation syndrome in juvenile systemic lupus erythematosus: a multinational multicenter study of thirty-eight patients. ACTA ACUST UNITED AC 2010; 60:3388-99. [PMID: 19877067 DOI: 10.1002/art.24883] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe the clinical and laboratory features of macrophage activation syndrome as a complication of juvenile systemic lupus erythematosus (SLE). METHODS Cases of juvenile SLE-associated macrophage activation syndrome were provided by investigators belonging to 3 pediatric rheumatology networks or were found in the literature. Patients who had evidence of macrophage hemophagocytosis on bone marrow aspiration were considered to have definite macrophage activation syndrome, and those who did not have such evidence were considered to have probable macrophage activation syndrome. Clinical and laboratory findings in patients with macrophage activation syndrome were contrasted with those of 2 control groups composed of patients with active juvenile SLE without macrophage activation syndrome. The ability of each feature to discriminate macrophage activation syndrome from active disease was evaluated by calculating sensitivity, specificity, and area under the receiver operating characteristic curve. RESULTS The study included 38 patients (20 with definite macrophage activation syndrome and 18 with probable macrophage activation syndrome). Patients with definite and probable macrophage activation syndrome were comparable with regard to all clinical and laboratory features of the syndrome, except for a greater frequency of lymphadenopathy, leukopenia, and thrombocytopenia in patients with definite macrophage activation syndrome. Overall, clinical features had better specificity than sensitivity, except for fever, which was highly sensitive but had low specificity. Among laboratory features, the best sensitivity and specificity was achieved using hyperferritinemia, followed by increased levels of lactate dehydrogenase, hypertriglyceridemia, and hypofibrinogenemia. Based on the results of statistical analysis, preliminary diagnostic guidelines for macrophage activation syndrome in juvenile SLE were developed. CONCLUSION Our findings indicate that the occurrence of unexplained fever and cytopenia, when associated with hyperferritinemia, in a patient with juvenile SLE should raise the suspicion of macrophage activation syndrome. We propose preliminary guidelines for this syndrome in juvenile SLE to facilitate timely diagnosis and correct classification of patients.
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Affiliation(s)
- Alessandro Parodi
- Istituto di Ricovero e Cura a Carattere Scientifico G. Gaslini, Genoa, Italy
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Abstract
Juvenile idiopathic arthritis (JIA) is the most common autoimmune-autoinflammatory disease in childhood and affects approximately 1 in 1,000 children. Despite advances in diagnosis and treatment options, JIA remains a chronic condition for most affected children. Recent evidence suggests that disease control at onset may determine the tempo of subsequent disease course and long-term outcomes, and raises the concept of a therapeutic window of opportunity in patients with JIA. This underscores the importance of early aggressive treatment in patients with JIA. With the advent of novel biologic therapeutics, the repertoire of agents available for treatment of children with JIA has greatly increased. The present article will summarize recent developments in the medical treatment of children with JIA and will offer insights into emerging therapies.
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Affiliation(s)
- Kristen Hayward
- Division of Rheumatology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way, NE MS R-5420, Seattle, WA 98105, USA.
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Parodi A, Davì S, Pringe AB, Magni-Manzoni S, Miettunen P, Bader-Meunier B, Espada G, Ozen S, Wright D, Magalhaes C, Woo P, Kubchandani R, Grom A, Michels H, Wouters C, Gutierrez CET, Sterba G, Hayward K, Guseinova D, Fischer A, Cortis E, Vivarelli M, Pistorio A, Ruperto N, Sala I, Martini A, Ravelli A. Macrophage activation syndrome (MAS) in juvenile systemic lupus erythematosus (JSLE): an underrecognized complication? Pediatr Rheumatol Online J 2008. [PMCID: PMC3334041 DOI: 10.1186/1546-0096-6-s1-p236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Hayward K, Jeremy RJ, Jenkins S, Barkovich AJ, Gultekin SH, Kramer J, Crittenden M, Matthay KK. Long-term neurobehavioral outcomes in children with neuroblastoma and opsoclonus-myoclonus-ataxia syndrome: relationship to MRI findings and anti-neuronal antibodies. J Pediatr 2001; 139:552-9. [PMID: 11598603 DOI: 10.1067/mpd.2001.118200] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [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: 11/22/2022]
Abstract
OBJECTIVES Opsoclonus-myoclonus-ataxia (OMA) syndrome affects 2% to 3% of patients with neuroblastoma. This study examined relationships between long-term neurobehavioral outcomes and potential biologic markers of OMA, including chronic changes on magnetic resonance imaging (MRI) brain scanning and prevalence of late antineuronal antibodies. STUDY DESIGN Children with neuroblastoma and OMA were identified through medical record review of patients treated at the University of California at San Francisco Medical Center from 1979 to 1999. Eleven patients with a mean follow-up time of 7.6 years underwent standard neurologic, neurocognitive, developmental/behavioral, and academic assessments. Consenting patients underwent MRI brain scanning and a blood draw. Sera were analyzed for the presence of antineuronal immunoreactivity. RESULTS Two (18%) patients had no observed neurologic abnormalities, 7 (64%) demonstrated mild deficits, and 2 (18%) had severe neurologic deficits. However, on neurocognitive, behavioral, and academic assessments, 6 (55%) children performed within the average range, 1 (9%) was moderately below average and 4 (36%) had severe cognitive and behavioral deficiencies. Brain MRI in 5 of 5 patients was notable for cerebellar atrophy without supratentorial involvement. Antineuronal activity was detected in sera of 0 of 10 children at follow-up. CONCLUSIONS Certain patients with neuroblastoma associated OMA may achieve average-range neurobehavioral function in spite of residual neurologic abnormalities, with suggestion of continued improvement over time. Late cerebellar atrophy appears to be a common finding regardless of neurologic outcome, whereas antineuronal immune reactivity does not appear to be a long-term feature of OMA.
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Affiliation(s)
- K Hayward
- Department of Pediatrics, the Pediatric Clinical Research Center, University of California San Francisco, USA
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Hayward LM, Nixon C, Jasper MP, Murphy KM, Harlan V, Swirda L, Hayward K. The process of restructuring and the treatment of obesity in women. Health Care Women Int 2000; 21:615-30. [PMID: 11813769 DOI: 10.1080/07399330050151851] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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: 10/17/2022]
Abstract
Obesity is a prevalent health behavior that is difficult to treat because of its complexity, constraints on provider time, and negligible insurer reimbursement. In this comparative case study the authors describe two obese women's weight loss and lifestyle change efforts while enrolled in a nine-month, multidisciplinary weight loss program. The researchers conducted three semistructured interviews during six months. Eight major themes were identified: (1) support networks. (2) internalization/externalization, (3) routines, (4) relapse, (5) change in perspective, (6) reward/punishment, (7) emotional issues, and (8) life balance. These themes parallel Johnson's three-stage theory of cognitive restructuring. (See Johnson, 1990, "Restructuring: An Emerging Theory on the Process of Losing Weight." Journal of Advanced Nursing, 15, 1289-1296.) Researchers reveal that complex health problems are replete with social and psychological factors that may undermine treatment success. Understanding a client's experience while attempting behavior change is crucial for the development of interventions that address difficult and costly health behaviors.
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Affiliation(s)
- L M Hayward
- Department of Physical Therapy, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts 02115, USA.
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Abstract
PURPOSE To evaluate a ten-year experience (1983-1993) with a part-time residency curriculum. METHOD In 1994, the authors analyzed the curriculum through interviews with graduates of a part-time residency track, surveys of faculty and graduates of a full-time residency program, and a quantitative comparison of faculty evaluations of those part-time and full-time residents. RESULTS Both participants and full-time residents supported the part-time track and reported no adverse effect on the residency program as a whole. Analysis of faculty evaluations found that part-time residents scored significantly higher with respect to clinical skills (p = .0005) and humanistic skills (p = .0001), while there was no difference between the groups in leadership or teaching skills. CONCLUSIONS This part-time residency curriculum provided a highly useful program track for a group of internal medicine residents with concomitant obligations, allowing them to complete their training in an uninterrupted fashion. The part-time structure did not adversely affect clinical competence and may have fostered humanistic attributes. The authors believe that this form of curriculum deserves wider consideration in residency training.
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Affiliation(s)
- P C Carling
- Department of Medicine, Carney Hospital, Boston University School of Medicine, Massachusetts, USA
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Abstract
Here, the author describes how an information booklet for oncology patients was developed. The booklet's positive reception suggests that the idea could be used in other settings.
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Affiliation(s)
- K Hayward
- St James's University Hospital NHS Trut, Leeds
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