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Thrope A, Gerber LM, Thomas C, Antal Z. Longitudinal assessment of Leydig cell function in male survivors of childhood cancer. Pediatr Blood Cancer 2024; 71:e30829. [PMID: 38149843 PMCID: PMC10843544 DOI: 10.1002/pbc.30829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND As the number and longevity of childhood cancer survivors increases, assessing treatment-associated late effects remains crucial. We longitudinally examined the incidence of and associated risk factors for Leydig cell dysfunction (LCD) and Leydig cell failure (LCF) in men treated for pediatric cancers at our institution. PROCEDURE We performed a retrospective longitudinal cohort study of adult male survivors treated for various childhood cancers who are at risk for LCD. The outcomes of interest were serum testosterone and luteinizing hormone (LH) levels during childhood and adulthood. Risk factors assessed included treatment with stem cell transplant, total body irradiation (TBI), and exposure to alkylating agents. RESULTS Out of 118 eligible subjects, 7.6% had LCF and 14.4% had LCD. Median age at last testosterone level was 20 years. Subjects with sufficient testosterone levels in adulthood (N = 105) remained sufficient for a mean of 11.1 years following completion of cancer treatment. We found significant associations between LCF and treatment with TBI (p < .003) and between LCF in adulthood and testosterone insufficiency in childhood (p < .001). No statistically significant association was found between LCF and cyclophosphamide equivalent dose greater than 20 g/m2 (p = .2). LCF/LCD occurred in a small number of nonirradiated patients treated with the highest doses of alkylators. CONCLUSIONS Incidence of LCF and LCD are low in male survivors of childhood cancer. Longitudinally, there is an association between childhood testosterone insufficiency and LCF in adulthood. Alkylating agents and stem cell transplant without TBI were not associated with LCF in our study.
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Affiliation(s)
- Alexandra Thrope
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center New York, NY 10065
| | | | | | - Zoltan Antal
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center New York, NY 10065
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Fins JJ, Knitter J, Mukherjee D, Conti K, Donleavy-Hiller B, Gerber LM, Hersh JE, Kotorac-Erlbaum R, Milch B, Klein SM. A Descriptive Analysis of Access to Assistive Technology in Children With Acquired Brain Injury: The Right to Assistive Devices. J Head Trauma Rehabil 2024; 39:152-159. [PMID: 37492972 PMCID: PMC10811270 DOI: 10.1097/htr.0000000000000876] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
OBJECTIVE Pediatric clinicians caring for children with acquired brain injury have noted that many individuals requiring assistive technology (AT) go unserved or face delays until devices are obtained, with potential adverse implications for recovery and development. In this article we map the pathways by which AT is prescribed and assess delays and barriers to access. METHODS We conducted a retrospective chart review of patients with moderate to severe brain injury admitted to Blythedale Children's Hospital over a 2-year period using a database drawn from the medical record. RESULTS We identified 72 children diagnosed with brain injury requiring at least 1 device. Devices were used to improve mobility and positioning, self-care, safety, and communication, and enable access to other technologies and foster social integration. We found that 55% of devices were delivered, with most deliveries to home or the hospital's outpatient department for fitting, training, and instruction. Time to delivery ranged from 12 to 250 days with an average of 69.4 days. Twenty percent of nondeliveries were attributable to change in medical status, transfer to a skilled nursing facility, or continued inpatient status, while 31% were canceled by the family. Other nondeliveries were attributed to insurance coverage. We also found that the medical record is not designed for the longitudinal tracking of devices, indicating the need for a prospective process to document the AT trajectory. CONCLUSION Instead of tolerating delays and denials, there should be a normative expectation that children have a right to medically necessary devices, consistent with disability law. This analysis was undertaken as a step toward formulating a prospective means of tracking AT recommendations, approvals, denials, and/or deliveries. Our findings should be understood as a promissory note toward structural reforms that are reflective of society's responsibility to better meet the needs of vulnerable children and their families.
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Affiliation(s)
- Joseph J Fins
- Author Affiliations: Division of Medical Ethics (Drs Fins and Mukherjee and Ms Hersh) and Department of Population Health Science (Dr Gerber), Weill Cornell Medical College, New York, New York; Solomon Center for Health Law and Policy, Yale Law School, New Haven, Connecticut (Dr Fins); and Blythedale Children's Hospital, Valhalla, New York (Mss Knitter, Donleavy-Hiller, Kotorac-Erlbaum, and Milch and Drs Conti and Klein)
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Gerber LM, Whitcomb BW, Verjee MA, Sievert LL. Bothersome symptoms at midlife in relation to body fat percentage. Am J Hum Biol 2024:e24054. [PMID: 38420692 DOI: 10.1002/ajhb.24054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES Increasing obesity has been associated with a higher frequency of symptoms at midlife. Bothersomeness represents an important measure of perceived symptom severity, but has received relatively little consideration, and relationships between symptom bothersomeness and obesity are not known. We evaluated the association between body fat percentage (%BF) and the bothersomeness of symptoms at midlife. METHODS This cross-sectional study included women aged 40-60 in Qatar (n = 841). Participants reported frequency and bothersomeness of midlife symptoms hypothesized to be related to body composition. Initially, we characterized the relationship between continuous %BF and presence (yes/no) and bothersomeness (yes/no) for each symptom using restricted cubic spline (RCS) models to test nonlinearity. Subsequently, we used multinomial logistic regressions to evaluate associations between %BF and multilevel symptom outcomes, where categories were: (a) no symptoms or bother, (b) symptoms without bothersomeness, and (c) symptoms with bothersomeness. RESULTS The highest frequency of bothersomeness was reported for aches/stiffness in joints (51%), followed by trouble sleeping (34%), night sweats (21%), urinary incontinence (18%), hot flashes (16%), and shortness of breath (15%). In unadjusted multinomial logistic regressions, aches/stiffness in joints with and without bothersomeness had the same significant relationship with %BF. Bothersome night sweats, urinary incontinence, and hot flashes were significantly associated with %BF (p < .05), but those same symptoms without bothersomeness were not significantly associated with %BF. CONCLUSIONS Our findings suggest that bothersomeness is an important variable that tracks with body fat and gives different information than report of the presence/absence of a symptom alone.
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Affiliation(s)
- L M Gerber
- Department of Population Health Sciences and Medicine, Weill Cornell Medical College, New York, New York, USA
| | - B W Whitcomb
- Department of Biostatistics and Epidemiology, UMass Amherst, Amherst, Massachusetts, USA
| | - M A Verjee
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | - L L Sievert
- Department of Anthropology, UMass Amherst, Amherst, Massachusetts, USA
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Hu X, Karthigeyan KP, Herbek S, Valencia SM, Jenks JA, Webster H, Miller IG, Connors M, Pollara J, Andy C, Gerber LM, Walter EB, Edwards KM, Bernstein DI, Hou J, Koch M, Panther L, Carfi A, Wu K, Permar SR. Human Cytomegalovirus mRNA-1647 Vaccine Candidate Elicits Potent and Broad Neutralization and Higher Antibody-Dependent Cellular Cytotoxicity Responses Than the gB/MF59 Vaccine. J Infect Dis 2024:jiad593. [PMID: 38324766 DOI: 10.1093/infdis/jiad593] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND MF59-adjuvanted gB subunit (gB/MF59) vaccine demonstrated approximately 50% efficacy against human cytomegalovirus (HCMV) acquisition in multiple clinical trials, suggesting that efforts to improve this vaccine design might yield a vaccine suitable for licensure. METHODS A messenger RNA (mRNA)-based vaccine candidate encoding HCMV gB and pentameric complex (PC), mRNA-1647, is currently in late-stage efficacy trials. However, its immunogenicity has not been compared to the partially effective gB/MF59 vaccine. We assessed neutralizing and Fc-mediated immunoglobulin G (IgG) effector antibody responses induced by mRNA-1647 in both HCMV-seropositive and -seronegative vaccinees from a first-in-human clinical trial through 1 year following third vaccination using a systems serology approach. Furthermore, we compared peak anti-gB antibody responses in seronegative mRNA-1647 vaccinees to that of seronegative gB/MF59 vaccine recipients. RESULTS mRNA-1647 vaccination elicited and boosted HCMV-specific IgG responses in seronegative and seropositive vaccinees, respectively, including neutralizing and Fc-mediated effector antibody responses. gB-specific IgG responses were lower than PC-specific IgG responses. gB-specific IgG and antibody-dependent cellular phagocytosis responses were lower than those elicited by gB/MF59. However, mRNA-1647 elicited higher neutralization and antibody-dependent cellular cytotoxicity (ADCC) responses. CONCLUSIONS Overall, mRNA-1647 vaccination induced polyfunctional and durable HCMV-specific antibody responses, with lower gB-specific IgG responses but higher neutralization and ADCC responses compared to the gB/MF59 vaccine. CLINICAL TRIALS REGISTRATION NCT03382405 (mRNA-1647) and NCT00133497 (gB/MF59).
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Affiliation(s)
- Xintao Hu
- Department of Pediatrics, Weill Cornell Medicine, New York, New York
| | | | - Savannah Herbek
- Department of Pediatrics, Weill Cornell Medicine, New York, New York
| | - Sarah M Valencia
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina
| | - Jennifer A Jenks
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina
| | - Helen Webster
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina
| | - Itzayana G Miller
- Department of Pediatrics, Weill Cornell Medicine, New York, New York
| | - Megan Connors
- Department of Pediatrics, Weill Cornell Medicine, New York, New York
| | - Justin Pollara
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina
| | - Caroline Andy
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Linda M Gerber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Emmanuel B Walter
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina
| | - Kathryn M Edwards
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David I Bernstein
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Jacob Hou
- Moderna, Inc, Cambridge, Massachusetts
| | | | | | | | - Kai Wu
- Moderna, Inc, Cambridge, Massachusetts
| | - Sallie R Permar
- Department of Pediatrics, Weill Cornell Medicine, New York, New York
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5
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Garagozlo K, Han JY, Worgall S, Thomas C, Wu A, Chang N, Gerber LM, Fiorino EK. Validation of diagnostic coding for children's interstitial lung disease (chILD). Pediatr Pulmonol 2024; 59:521-525. [PMID: 38014614 DOI: 10.1002/ppul.26773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Katiana Garagozlo
- Department of Pediatrics, New York Presbyterian-Weill Cornell Medicine, New York, New York, USA
| | - Jin-Young Han
- Department of Pediatrics, New York Presbyterian-Weill Cornell Medicine, New York, New York, USA
| | - Stefan Worgall
- Department of Pediatrics, New York Presbyterian-Weill Cornell Medicine, New York, New York, USA
| | - Charlene Thomas
- Department of Biostatistics, Weill Cornell Medicine, New York, New York, USA
| | - Alan Wu
- Department of Biostatistics, Weill Cornell Medicine, New York, New York, USA
| | - Nivedita Chang
- Information Technologies and Services Department, Weill Cornell Medicine, New York, New York, USA
| | - Linda M Gerber
- Weill Cornell Medicine Graduate School of Medical Sciences, New York, New York, USA
| | - Elizabeth K Fiorino
- Departments of Science Education and Pediatrics, Donald and Barbara Zucker School of Medicine, Hempstead, New York, USA
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Schiff ND, Giacino JT, Butson CR, Choi EY, Baker JL, O'Sullivan KP, Janson AP, Bergin M, Bronte-Stewart HM, Chua J, DeGeorge L, Dikmen S, Fogarty A, Gerber LM, Krel M, Maldonado J, Radovan M, Shah SA, Su J, Temkin N, Tourdias T, Victor JD, Waters A, Kolakowsky-Hayner SA, Fins JJ, Machado AG, Rutt BK, Henderson JM. Thalamic deep brain stimulation in traumatic brain injury: a phase 1, randomized feasibility study. Nat Med 2023; 29:3162-3174. [PMID: 38049620 DOI: 10.1038/s41591-023-02638-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/10/2023] [Indexed: 12/06/2023]
Abstract
Converging evidence indicates that impairments in executive function and information-processing speed limit quality of life and social reentry after moderate-to-severe traumatic brain injury (msTBI). These deficits reflect dysfunction of frontostriatal networks for which the central lateral (CL) nucleus of the thalamus is a critical node. The primary objective of this feasibility study was to test the safety and efficacy of deep brain stimulation within the CL and the associated medial dorsal tegmental (CL/DTTm) tract.Six participants with msTBI, who were between 3 and 18 years post-injury, underwent surgery with electrode placement guided by imaging and subject-specific biophysical modeling to predict activation of the CL/DTTm tract. The primary efficacy measure was improvement in executive control indexed by processing speed on part B of the trail-making test.All six participants were safely implanted. Five participants completed the study and one was withdrawn for protocol non-compliance. Processing speed on part B of the trail-making test improved 15% to 52% from baseline, exceeding the 10% benchmark for improvement in all five cases.CL/DTTm deep brain stimulation can be safely applied and may improve executive control in patients with msTBI who are in the chronic phase of recovery.ClinicalTrials.gov identifier: NCT02881151 .
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Affiliation(s)
- Nicholas D Schiff
- Feil Family Brain Mind Institute, Weill Cornell Medicine, New York, NY, USA.
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA.
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Christopher R Butson
- Scientific Computing and Imaging Institute Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
- Norman Fixel Institute for Neurological Diseases Departments of Neurology and Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Eun Young Choi
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Jonathan L Baker
- Feil Family Brain Mind Institute, Weill Cornell Medicine, New York, NY, USA
| | - Kyle P O'Sullivan
- Scientific Computing and Imaging Institute Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - Andrew P Janson
- Scientific Computing and Imaging Institute Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
- Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA
| | - Michael Bergin
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | | | - Jason Chua
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Laurel DeGeorge
- Feil Family Brain Mind Institute, Weill Cornell Medicine, New York, NY, USA
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Adam Fogarty
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Linda M Gerber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Mark Krel
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Jose Maldonado
- Department of Psychiatry, Stanford University, Stanford, CA, USA
| | - Matthew Radovan
- Department of Computer Science, Stanford University, Stanford, CA, USA
| | - Sudhin A Shah
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Jason Su
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Thomas Tourdias
- Department of Neuroimaging, University of Bordeaux, Nouvelle-Aquitaine, France
| | - Jonathan D Victor
- Feil Family Brain Mind Institute, Weill Cornell Medicine, New York, NY, USA
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Abigail Waters
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | | | - Joseph J Fins
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Andre G Machado
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian K Rutt
- Department of Radiology, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
- Bio-X Program, Stanford University, Stanford, CA, USA
| | - Jaimie M Henderson
- Department of Neurosurgery, Stanford University, Stanford, CA, USA.
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA.
- Bio-X Program, Stanford University, Stanford, CA, USA.
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Nelligan M, Nellis ME, Mauer EA, Gerber LM, Traube C. Association between Platelet Transfusion and Delirium in Critically Ill Children. Children (Basel) 2023; 10:825. [PMID: 37238373 PMCID: PMC10216991 DOI: 10.3390/children10050825] [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] [Received: 02/28/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023]
Abstract
Delirium is a frequent, serious, and preventable complication in critically ill children. Inflammation has been implicated as a mechanism for the development of delirium. Platelet transfusions may potentiate the body's pro-inflammatory responses. We hypothesized that receipt of platelets would be associated with delirium development in a pediatric intensive care unit (PICU). We performed a single-center retrospective cohort analysis including children admitted to the PICU between 2014 and 2018 who were transfused platelets within the first 14 days of admission. Data obtained included severity of illness, level of respiratory support, exposure to medications and blood products, as well as daily cognitive status. To account for time-dependent confounding, a marginal structural model (MSM) was constructed to delineate the relationship between platelet transfusion and next-day delirium. MSM demonstrated a 75% increase in the development of next-day delirium after transfusion of platelets (aOR 1.75, 95% CI 1.03-2.97). For every 1 cc/kg of platelet transfused, odds of next-day delirium increased by 9% (odds ratio 1.09, 95% CI 1.03-1.51). We reported an independent association between platelet transfusion and next-day delirium/coma after accounting for time-dependent confounders, with a dose-response effect. Minimizing platelet transfusions as much as clinically feasible may decrease delirium risk in critically ill children.
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Affiliation(s)
- Matthew Nelligan
- Morgan Stanley Children’s Hospital, NewYork-Presbyterian Columbia University, New York, NY 10032, USA
| | - Marianne E. Nellis
- Department of Pediatrics, Weill Cornell Medical College, New York, NY 10065, USA
| | - Elizabeth A. Mauer
- Department of Pediatrics, Weill Cornell Medical College, New York, NY 10065, USA
| | - Linda M. Gerber
- Department of Pediatrics, Weill Cornell Medical College, New York, NY 10065, USA
| | - Chani Traube
- Department of Pediatrics, Weill Cornell Medical College, New York, NY 10065, USA
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Schenck HE, Joackim P, Lazaro A, Wu X, Gerber LM, Stieg PE, Härtl R, Shabani H, Mangat HS. Affordability impacts therapeutic intensity of acute management of severe traumatic brain injury patients: An exploratory study in Tanzania. Brain Spine 2023; 3:101738. [PMID: 37383438 PMCID: PMC10293321 DOI: 10.1016/j.bas.2023.101738] [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] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 06/30/2023]
Abstract
Introduction Quality health care in low and middle-income countries (LMICs) is constrained by financing of care. Research question What is the effect of ability to pay on critical care management of patients with severe traumatic brain injury (sTBI)? Material and Methods Data on sTBI patients admitted to a tertiary referral hospital in Dar-es-Salaam, Tanzania, were collected between 2016 and 2018, and included payor mechanisms for hospitalization costs. Patients were grouped as those who could afford care and those who were unable to pay. Results Sixty-seven patients with sTBI were included. Of those enrolled, 44 (65.7%) were able to pay and 15 (22.3%) were unable to pay costs of care upfront. Eight (11.9%) patients did not have a documented source of payment (unknown identity or excluded from further analysis). Overall mechanical ventilation rates were 81% (n=36) in the affordable group and 100% (n=15) in the unaffordable group (p=0.08). Computed tomography (CT) rates were 71.6% (n=48) overall, 100% (n=44) and 0% respectively (p<0.01); Surgical rates were 16.4% (n=11) overall, 18.2% (n=8) vs. 13.3% (n=2) (p=0.67) respectively. Two-week mortality was 59.7% overall (n=40), 47.7% (n=21) in the affordable group and 73.3% (n=11) in the unaffordable group (p=0.09) (adjusted OR 0.4; 95% CI: 0.07-2.41, p=0.32). Discussion and Conclusion Ability to pay appears to have a strong association with the use of head CT and a weak association with mechanical ventilation in the management of sTBI. Inability to pay increases redundant or sub-optimal care, and imposes a financial burden on patients and their relatives.
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Affiliation(s)
| | - Pascal Joackim
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Albert Lazaro
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Xian Wu
- Department of Population Health Sciences, Weill Cornell Medicine, New York, USA
| | - Linda M. Gerber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, USA
| | - Philip E. Stieg
- Department of Neurosurgery, Weill Cornell Brain & Spine Institute, USA
| | - Roger Härtl
- Department of Neurosurgery, Weill Cornell Brain & Spine Institute, USA
| | - Hamisi Shabani
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Halinder S. Mangat
- Department of Neurosurgery, Weill Cornell Brain & Spine Institute, USA
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
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Clermont A, Rouzier V, Pierre JL, Sufra R, Dade E, Preval F, St-Preux S, Deschamps MM, Apollon A, Dupnik K, Metz M, Duffus Y, Sabwa S, Yan LD, Lee MH, Palmer LG, Gerber LM, Pecker MS, Mann SJ, Safford MM, Fitzgerald DW, Pape JW, McNairy ML. High Dietary Sodium, Measured Using Spot Urine Samples, is Associated with Higher Blood Pressure among Young Adults in Haiti. Glob Heart 2023; 18:5. [PMID: 36817226 PMCID: PMC9936908 DOI: 10.5334/gh.1187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
Background Hypertension (HTN) is the leading cardiovascular disease (CVD) risk factor in Haiti and is likely driven by poverty-related social and dietary factors. Salt consumption in Haiti is hypothesized to be high but has never been rigorously quantified. Methods We used spot urine samples from a subset of participants in the population-based Haiti Cardiovascular Disease Cohort to estimate population mean daily sodium intake. We compared three previously validated formulas for estimating dietary sodium intake using urine sodium, urine creatinine, age, sex, height, and weight. We explored the association between dietary sodium intake and blood pressure, stratified by age group. Results A total of 1,240 participants had spot urine samples. Median age was 38 years (range 18-93), and 48% were female. The mean dietary sodium intake was 3.5-5.0 g/day across the three estimation methods, with 94.2%-97.9% of participants consuming above the World Health Organization (WHO) recommended maximum of 2 g/day of sodium. Among young adults aged 18-29, increasing salt intake from the lowest quartile of consumption (<3.73 g/day) to the highest quartile (>5.88 g/day) was associated with a mean 8.71 mmHg higher systolic blood pressure (SBP) (95% confidence interval: 3.35, 14.07; p = 0.001). An association was not seen in older age groups. Among participants under age 40, those with SBP ≥120 mmHg consumed 0.5 g/day more sodium than those with SBP <120 mmHg (95% confidence interval: 0.08, 0.69; p = 0.012). Conclusions Nine out of 10 Haitian adults in our study population consumed more than the WHO recommended maximum for daily sodium intake. In young adults, higher sodium consumption was associated with higher SBP. This represents an inflection point for increased HTN risk early in the life course and points to dietary salt intake as a potential modifiable risk factor for primordial and primary CVD prevention in young adults.
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Affiliation(s)
- Adrienne Clermont
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
- MD Program, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA
| | - Vanessa Rouzier
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Jean Lookens Pierre
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Rodney Sufra
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Eliezer Dade
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Fabyola Preval
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Stephano St-Preux
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Marie Marcelle Deschamps
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Alexandra Apollon
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Kathryn Dupnik
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Miranda Metz
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Yanique Duffus
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Shalom Sabwa
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Lily D. Yan
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Myung Hee Lee
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Lawrence G. Palmer
- Department of Physiology and Biophysics, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA
| | - Linda M. Gerber
- Department of Population Health Sciences, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA
| | - Mark S. Pecker
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA
| | - Samuel J. Mann
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA
| | - Monika M. Safford
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Daniel W. Fitzgerald
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Jean W. Pape
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Margaret L. McNairy
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
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10
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Leidinger A, Zuckerman SL, Feng Y, He Y, Chen X, Cheserem B, Gerber LM, Lessing NL, Shabani HK, Härtl R, Mangat HS. Predictors of spinal trauma care and outcomes in a resource-constrained environment: a decision tree analysis of spinal trauma surgery and outcomes in Tanzania. J Neurosurg Spine 2023; 38:503-511. [PMID: 36640104 DOI: 10.3171/2022.11.spine22763] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/29/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The burden of spinal trauma in low- and middle-income countries (LMICs) is immense, and its management is made complex in such resource-restricted settings. Algorithmic evidence-based management is cost-prohibitive, especially with respect to spinal implants, while perioperative care is work-intensive, making overall care dependent on multiple constraints. The objective of this study was to identify determinants of decision-making for surgical intervention, improvement in function, and in-hospital mortality among patients experiencing acute spinal trauma in resource-constrained settings. METHODS This study was a retrospective analysis of prospectively collected data in a cohort of patients with spinal trauma admitted to a tertiary referral hospital center in Dar es Salam, Tanzania. Data on demographic, clinical, and treatment characteristics were collected as part of a quality improvement neurotrauma registry. Outcome measures were surgical intervention, American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade improvement, and in-hospital mortality, based on existing treatment protocols. Univariate analyses of demographic and clinical characteristics were performed for each outcome of interest. Using the variables associated with each outcome, a machine learning algorithm-based regression nonparametric decision tree model utilizing a bootstrapping method was created and the accuracy of the three models was estimated. RESULTS Two hundred eighty-four consecutively admitted patients with acute spinal trauma were included over a period of 33 months. The median age was 34 (IQR 26-43) years, 83.8% were male, and 50.7% had experienced injury in a motor vehicle accident. The median time to hospital admission after injury was 2 (IQR 1-6) days; surgery was performed after a further median delay of 22 (IQR 13-39) days. Cervical spine injury comprised 38.4% of the injuries. Admission AIS grades were A in 48.9%, B in 16.2%, C in 8.5%, D in 9.5%, and E in 16.6%. Nearly half (45.1%) of the patients underwent surgery, 12% had at least one functional improvement in AIS grade, and 11.6% died in the hospital. Determinants of surgical intervention were age ≤ 30 years, spinal injury level, admission AIS grade, delay in arrival to the referral hospital, undergoing MRI, and type of insurance; admission AIS grade, delay to arrival to the hospital, and injury level for functional improvement; and delay to arrival, injury level, delay to surgery, and admission AIS grade for in-hospital mortality. The best accuracies for the decision tree models were 0.62, 0.34, and 0.93 for surgery, AIS grade improvement, and in-hospital mortality, respectively. CONCLUSIONS Operative intervention and functional improvement after acute spinal trauma in this tertiary referral hospital in an LMIC environment were low and inconsistent, which suggests that nonclinical factors exist within complex resource-driven decision-making frameworks. These nonclinical factors are highlighted by the authors' results showing clinical outcomes and in-hospital mortality were determined by natural history, as evidenced by the highest accuracy of the model predicting in-hospital mortality.
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Affiliation(s)
- Andreas Leidinger
- 1Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Scott L Zuckerman
- 2Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yueqi Feng
- 3Biostatistics and Data Science, Cornell University, New York, New York
| | - Yitian He
- 3Biostatistics and Data Science, Cornell University, New York, New York
| | - Xinrui Chen
- 3Biostatistics and Data Science, Cornell University, New York, New York
| | | | | | - Noah L Lessing
- 6School of Medicine, University of Maryland, Baltimore, Maryland
| | - Hamisi K Shabani
- 7Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania; and
| | - Roger Härtl
- 8Neurology and Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Halinder S Mangat
- 9Department of Neurology, Division of Neurocritical Care, University of Kansas Medical Center, Kansas City, Kansas
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11
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Sievert LL, Whitcomb BW, Verjee MA, Gerber LM. Limited evidence of a threshold effect for increasing adiposity on risk of symptoms at midlife. Menopause 2022; 29:1381-1387. [PMID: 36166728 DOI: 10.1097/gme.0000000000002074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the nature of relationships between increasing body mass index (BMI) and the prevalence of midlife symptoms in a population with high adiposity. METHODS In the cross-sectional Study of Women's Health in Qatar, 841 participants aged 40 to 60 years were recruited from nine primary health centers in Doha. Face-to-face interviews collected demographic, menopause, and symptom information. BMI (kg/m 2 ) was categorized as healthy, overweight, or class I, II, or III obesity. Multivariate logistic regression models were used to examine aches/stiffness in joints, trouble sleeping, shortness of breath, urinary incontinence, and hot flashes with BMI categories. Restricted cubic splines (RCSs) were used to estimate relationships between continuous BMI and each symptom and to conduct formal tests of nonlinearity. RESULTS Mean BMI was 34.3 kg/m 2 (SD, 6.0 kg/m 2 ). Women with class II and III obesity had higher odds of reporting aches/stiffness than women with a healthy BMI, and the odds of reporting urinary incontinence were three times higher among women with class III obesity (odds ratio, 3.08; 95% confidence interval, 1.17-8.14). Using restricted cubic spline models, a significant nonlinear association ( P = 0.002) was observed between aches/stiffness and BMI with an apparent threshold of 38 kg/m 2 . Linear relationships were observed with BMI for urinary incontinence ( P < 0.001 for linear trend) and shortness of breath ( P = 0.005 for linear trend). Trouble sleeping and hot flashes were not associated with BMI. CONCLUSIONS Even at very high levels of BMI, likelihood of urinary incontinence and shortness of breath increases with BMI. In contrast, likelihood of aches/stiffness has a nonlinear relationship with BMI, increasing to a threshold level.
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Affiliation(s)
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA
| | | | - Linda M Gerber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
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12
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Gourari I, Gomi R, Young M, Jordan G, Liongson M, Heras A, Gerber LM, Thomas C, Tsirilakis K, Ono J, Narula P, Ketas T, Moore JP, Worgall S, Permaul P. Asthma 17q21 polymorphism associates with decreased risk of COVID-19 in children. Pediatr Pulmonol 2022; 57:2855-2860. [PMID: 35932217 PMCID: PMC9538222 DOI: 10.1002/ppul.26091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/05/2022] [Accepted: 07/31/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Ioulia Gourari
- Division of Pediatric Pulmonology, Allergy & Immunology, Weill Cornell Medicine, New York, NY
| | - Rika Gomi
- Division of Pediatric Pulmonology, Allergy & Immunology, Weill Cornell Medicine, New York, NY
| | - Madeline Young
- Division of Pediatric Pulmonology, Allergy & Immunology, Weill Cornell Medicine, New York, NY
| | - Geancarlo Jordan
- Division of Pediatric Pulmonology, Allergy & Immunology, Weill Cornell Medicine, New York, NY
| | - Madeline Liongson
- Division of Pediatric Pulmonology, Allergy & Immunology, Weill Cornell Medicine, New York, NY
| | - Andrea Heras
- Division of Pediatric Pulmonology, Allergy & Immunology, Weill Cornell Medicine, New York, NY
| | - Linda M. Gerber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Charlene Thomas
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Kalliope Tsirilakis
- Division of Pediatric Pulmonology, Allergy & Immunology, Weill Cornell Medicine, New York, NY
| | - Jennie Ono
- Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Pramod Narula
- Department of Pediatrics, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Thomas Ketas
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY
| | - John P. Moore
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY
| | - Stefan Worgall
- Division of Pediatric Pulmonology, Allergy & Immunology, Weill Cornell Medicine, New York, NY
- Drukier Institute for Children’s Health, Weill Cornell Medicine, New York, NY
- Department of Genetic Medicine, Weill Cornell Medicine, New York, NY
| | - Perdita Permaul
- Division of Pediatric Pulmonology, Allergy & Immunology, Weill Cornell Medicine, New York, NY
- Drukier Institute for Children’s Health, Weill Cornell Medicine, New York, NY
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13
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Bloch AM, Gabbay E, Gerber LM, Dickerman AL, Knowlton S, Fins JJ. Challenges and strategies in the psychiatric care of the ultra-Orthodox Jewish population: A thematic analysis of 18 psychiatrist interviews. Transcult Psychiatry 2022:13634615221126052. [PMID: 36222017 DOI: 10.1177/13634615221126052] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite the importance of accessible psychiatric care for the ultra-Orthodox Jewish community, prior research has characterized how stigma and suspicion of secular institutions limit mental healthcare utilization by this population. No study, however, has interviewed a cohort of psychiatrists to identify commonly encountered challenges or successfully employed strategies in the care of ultra-Orthodox Jewish psychiatric patients who have overcome these barriers to present for care. We recruited by snowball sampling from a sample of convenience 18 psychiatrists affiliated with the Weill Cornell Department of Psychiatry, experienced in the care of ultra-Orthodox Jewish patients. Each participant was engaged in a 20-45-min, semi-structured interview, which was subsequently transcribed, de-identified, and analyzed with combined deductive and inductive thematic analysis. We identified 12 challenges and 11 strategies as particularly significant in psychiatric work with ultra-Orthodox Jewish patients at every phase of treatment, including rapport-building, history-taking, diagnostic formulation, and achieving concordance with patient and family. These challenges and strategies revolved around themes of community stigma, an extended family-patient-community team, cross-cultural communication, culture-related diagnostic complexity, transference/countertransference, and conflicts between Jewish law /community norms and treatment protocol. Psychiatrists caring for ultra-Orthodox Jewish patients face a range of complex challenges stemming from factors unique to ultra-Orthodox Jewish religion, culture, and family/community structure. However, they have also identified strategies to manage these challenges and provide culturally sensitive care. Further research is necessary to directly elicit perspectives from within the ultra-Orthodox Jewish community and validate our initial findings.
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Affiliation(s)
| | - Ezra Gabbay
- Divisions of Medical Ethics, Department of Medicine, 12295Weill Cornell Medicine, New York, NY, USA
- General Internal Medicine, Department of Medicine, 12295Weill Cornell Medicine, New York, NY, USA
| | - Linda M Gerber
- Department of Population Health Sciences, 12295Weill Cornell Medicine, New York, NY, USA
| | | | - Samantha Knowlton
- Divisions of Medical Ethics, Department of Medicine, 12295Weill Cornell Medicine, New York, NY, USA
| | - Joseph J Fins
- Divisions of Medical Ethics, Department of Medicine, 12295Weill Cornell Medicine, New York, NY, USA
- Department of Psychiatry, 12295Weill Cornell Medicine, New York, NY, USA
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Abstract
OBJECTIVES Delirium in critically ill children is associated with increased in-hospital morbidity and mortality. Little is known about the lingering effects of pediatric delirium in survivors after hospital discharge. The primary objective of this study was to determine whether children with delirium would have a higher likelihood of all-cause PICU readmission within 1 calendar year, when compared with children without delirium. DESIGN Retrospective cohort study. SETTING Tertiary care, mixed PICU at an urban academic medical center. PATIENTS Index admissions included all children admitted between September 2014 and August 2015. For each index admission, any readmission occurring within 1 year after PICU discharge was captured. INTERVENTION Every child was screened for delirium daily throughout the PICU stay. MEASUREMENTS AND MAIN RESULTS Among 1,145 index patients, 166 children (14.5%) were readmitted at least once. Bivariate analyses compared patients readmitted within 1 year of discharge with those not readmitted: complex chronic conditions (CCCs), increased severity of illness, longer PICU length of stay, need for mechanical ventilation, age less than 6 months, and a diagnosis of delirium were all associated with subsequent readmission. A multivariable logistic regression model was constructed to describe adjusted odds ratios for readmission. The primary exposure variable was number of delirium days. After controlling for confounders, critically ill children who experienced greater than 2 delirium days on index admission were more than twice as likely to be readmitted (adjusted odds ratio, 2.2; CI, 1.1-4.4; p = 0.023). A dose-response relationship was demonstrated as children with longer duration of delirium had increased odds of readmission. CONCLUSIONS In this cohort, delirium duration was an independent risk factor for readmission in critically ill children. Future research is needed to determine if decreasing prevalence of delirium during hospitalization can decrease need for PICU readmission.
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Affiliation(s)
| | - Elizabeth A Mauer
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY
| | - Linda M Gerber
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY
| | - Chani Traube
- Department of Pediatrics, Weill Cornell Medical College, New York, NY
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15
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Yan LD, McNairy ML, Dévieux JG, Pierre JL, Dade E, Sufra R, Gerber LM, Roberts N, St Preux S, Malebranche R, Metz M, Tymejczyk O, Nash D, Deschamps M, Safford MM, Pape JW, Rouzier V. Neighborhood cohesion and violence in Port-au-Prince, Haiti, and their relationship to stress, depression, and hypertension: Findings from the Haiti cardiovascular disease cohort study. PLOS Glob Public Health 2022; 2:e0000503. [PMID: 36819610 PMCID: PMC9937441 DOI: 10.1371/journal.pgph.0000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022]
Abstract
Neighborhood factors have been associated with health outcomes, but this relationship is underexplored in low-income countries like Haiti. We describe perceived neighborhood cohesion and perceived violence using the Neighborhood Collective Efficacy and the City Stress Inventory scores. We hypothesized lower cohesion and higher violence were associated with higher stress, depression, and hypertension. We collected data from a population-based cohort of adults in Port-au-Prince, Haiti between March 2019 to August 2021, including stress (Perceived Stress Scale), depression (PHQ-9), and blood pressure (BP). Hypertension was defined as systolic BP ≥ 140 mmHg, diastolic BP ≥ 90 mmHg, or on antihypertensive medications. Covariates that were adjusted for included age, sex, body mass index, smoking, alcohol, physical activity, diet, income, and education, multivariable linear and Poisson regressions assessed the relationship between exposures and outcomes. Among 2,961 adults, 58.0% were female and median age was 40 years (IQR:28-55). Participants reported high cohesion (median 15/25, IQR:14-17) and moderate violence (9/20, IQR:7-11). Stress was moderate (8/16) and 12.6% had at least moderate depression (PHQ-9 ≥ 11). Median systolic BP was 118 mmHg, median diastolic BP 72 mmHg, and 29.2% had hypertension. In regressions, higher violence was associated with higher prevalence ratios of moderate-to-severe depression (Tertile3 vs Tertile1: PR 1.12, 95%CI:1.09 to 1.16) and stress (+0.3 score, 95%CI:0.01 to 0.6) but not hypertension. Cohesion was associated with lower stress (Tertile3 vs Tertile1: -0.4 score, 95%CI: -0.7 to -0.2) but not depression or hypertension. In summary, urban Haitians reported high perceived cohesion and moderate violence, with higher violence associated with higher stress and depression.
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Affiliation(s)
- Lily D. Yan
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Margaret L. McNairy
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Jessy G. Dévieux
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, United States of America
| | - Jean Lookens Pierre
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Eliezer Dade
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Rodney Sufra
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Linda M. Gerber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States of America
| | - Nicholas Roberts
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Stephano St Preux
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Rodolphe Malebranche
- Collège Haïtien de Cardiologie, Port-au-Prince, Haiti
- Medicine and Pharmacology, Université d’État d’Haïti, Port-au-Prince, Haiti
| | - Miranda Metz
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Olga Tymejczyk
- City University of New York Institute for Implementation Science in Population Health, New York, New York, United States of America
| | - Denis Nash
- City University of New York Institute for Implementation Science in Population Health, New York, New York, United States of America
| | - Marie Deschamps
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Monica M. Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Jean W. Pape
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa Rouzier
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
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Gupta J, Antal Z, Mauer E, Gerber LM, An A, Censani M. Dysglycemia screening with oral glucose tolerance test in adolescents with polycystic ovary syndrome and relationship with obesity. BMC Endocr Disord 2022; 22:180. [PMID: 35842601 PMCID: PMC9288674 DOI: 10.1186/s12902-022-01098-0] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 07/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents with polycystic ovary syndrome (PCOS) are at increased risk of impaired glucose tolerance (IGT) and type 2 diabetes mellitus. The aim of this study is to evaluate dysglycemia and biochemical differences based on BMI status and assess the prognostic ability of elevated hemoglobin A1c (HbA1c) in predicting an abnormal 2 hour oral glucose tolerance test (OGTT). METHODS Retrospective cohort of female patients aged 11-18 years who underwent 75-g OGTT and were evaluated for PCOS at an urban tertiary care hospital between January 2002 to December 2017. RESULTS In 106 adolescents with PCOS who had OGTT results available, IGT was markedly pronounced in the ≥95th percentile BMI group (17 out of 72; 23.6%) compared with <95th percentile BMI group (4 out of 34; 11.7%). One patient with obesity met the criteria for type 2 diabetes. Patients with obesity had significantly higher homeostasis model assessment (HOMA-IR) and lower whole body insulin sensitivity index (WBISI) (p < 0.001) compared to patients without obesity. Free testosterone levels were also higher in patients with obesity (p< 0.03) and were significantly associated with HOMA-IR when controlling for body mass index (BMI). HbA1c did not demonstrate a strong ability to predict abnormal OGTT on receiver operating characteristic (ROC) curve analysis [Area under the curve (AUC) = 0.572, 95% CI: 0.428, 0.939]). CONCLUSIONS In a study to assess glucose abnormalities in adolescents with PCOS, IGT was found to be markedly increased in patients with obesity, with abnormal glucose metabolism identified in over one-fifth of the patients. HbA1c alone may be a poor test to assess IGT and we recommend that adolescents diagnosed with PCOS and obesity undergo formal oral glucose tolerance testing.
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Affiliation(s)
- Jyotsna Gupta
- Department of Pediatrics, Division of Pediatric Endocrinology, New York Presbyterian Hospital, Weill Cornell Medicine, 505 East 70th Street, New York, NY, USA
| | - Zoltan Antal
- Department of Pediatrics, Division of Pediatric Endocrinology, New York Presbyterian Hospital, Weill Cornell Medicine, 505 East 70th Street, New York, NY, USA
| | - Elizabeth Mauer
- Department of Population Health Sciences, Division of Biostatistics, Weill Cornell Medicine, 1300 York Avenue, New York, NY, USA
| | - Linda M Gerber
- Department of Population Health Sciences, Division of Biostatistics, Weill Cornell Medicine, 1300 York Avenue, New York, NY, USA
| | - Anjile An
- Department of Population Health Sciences, Division of Biostatistics, Weill Cornell Medicine, 1300 York Avenue, New York, NY, USA
| | - Marisa Censani
- Department of Pediatrics, Division of Pediatric Endocrinology, New York Presbyterian Hospital, Weill Cornell Medicine, 505 East 70th Street, New York, NY, USA.
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17
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Shah SA, Gautam R, Lowder R, Mauer EA, Carullo RB, Parlatore DE, Gerber LM, Schiff ND, Traube C. Quantitative Electroencephalographic Markers of Delirium in the Pediatric Intensive Care Unit: Insights From a Heterogenous Convenience Sample. J Neuropsychiatry Clin Neurosci 2022; 33:219-224. [PMID: 33757305 DOI: 10.1176/appi.neuropsych.20070184] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Little is known about the underlying neurophysiology of pediatric delirium. In adult patients, the sensitivity of EEG to clinical symptoms of delirium has been noted, with a slowing of background activity (alpha) and an increase in slow-wave activity (delta-theta). In this pilot study, the authors extended this investigation to a pediatric cohort. METHODS In a convenience sample, 23 critically ill children were screened for delirium, using the Cornell Assessment for Pediatric Delirium (CAPD), every 12 hours throughout their pediatric intensive care unit stay as part of standard intensive care unit procedure, and EEGs were performed as part of their clinical care. After hospital discharge, EEGs were reviewed using quantitative analysis, and the maximum delta-alpha ratio (DAR; eyes closed) was derived for each 12-hour period. DAR values were compared between delirious and nondelirious episodes, and the linear relationship between DAR and CAPD was assessed. RESULTS Higher DARs were associated with episodes of delirium. The DAR also positively correlated with CAPD assessments, with higher DARs relating to higher delirium scores. CONCLUSIONS Future prospective studies may further investigate this relationship in a more homogeneous and larger sample, and the DAR should be considered to track delirium and assess the effectiveness of therapeutic interventions.
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Affiliation(s)
- Sudhin A Shah
- Departments of Rehabilitation Medicine (Shah, Lowder), Pediatrics (Traube), and Population Health Sciences (Mauer, Gerber), Cornell University Joan and Sanford I Weill Medical College, New York; Clinical and Translational Science Center, Cornell University Joan and Sanford I Weill Medical College, New York (Gautam); Department of Pediatrics, New York-Presbyterian Hospital, New York (Carullo, Parlatore, Traube); Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York (Shah, Schiff); Department of Neurology, Weill Cornell Medicine, New York (Schiff); and Rockefeller University Hospital, New York (Schiff)
| | - Richa Gautam
- Departments of Rehabilitation Medicine (Shah, Lowder), Pediatrics (Traube), and Population Health Sciences (Mauer, Gerber), Cornell University Joan and Sanford I Weill Medical College, New York; Clinical and Translational Science Center, Cornell University Joan and Sanford I Weill Medical College, New York (Gautam); Department of Pediatrics, New York-Presbyterian Hospital, New York (Carullo, Parlatore, Traube); Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York (Shah, Schiff); Department of Neurology, Weill Cornell Medicine, New York (Schiff); and Rockefeller University Hospital, New York (Schiff)
| | - Ryan Lowder
- Departments of Rehabilitation Medicine (Shah, Lowder), Pediatrics (Traube), and Population Health Sciences (Mauer, Gerber), Cornell University Joan and Sanford I Weill Medical College, New York; Clinical and Translational Science Center, Cornell University Joan and Sanford I Weill Medical College, New York (Gautam); Department of Pediatrics, New York-Presbyterian Hospital, New York (Carullo, Parlatore, Traube); Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York (Shah, Schiff); Department of Neurology, Weill Cornell Medicine, New York (Schiff); and Rockefeller University Hospital, New York (Schiff)
| | - Elizabeth A Mauer
- Departments of Rehabilitation Medicine (Shah, Lowder), Pediatrics (Traube), and Population Health Sciences (Mauer, Gerber), Cornell University Joan and Sanford I Weill Medical College, New York; Clinical and Translational Science Center, Cornell University Joan and Sanford I Weill Medical College, New York (Gautam); Department of Pediatrics, New York-Presbyterian Hospital, New York (Carullo, Parlatore, Traube); Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York (Shah, Schiff); Department of Neurology, Weill Cornell Medicine, New York (Schiff); and Rockefeller University Hospital, New York (Schiff)
| | - Renata B Carullo
- Departments of Rehabilitation Medicine (Shah, Lowder), Pediatrics (Traube), and Population Health Sciences (Mauer, Gerber), Cornell University Joan and Sanford I Weill Medical College, New York; Clinical and Translational Science Center, Cornell University Joan and Sanford I Weill Medical College, New York (Gautam); Department of Pediatrics, New York-Presbyterian Hospital, New York (Carullo, Parlatore, Traube); Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York (Shah, Schiff); Department of Neurology, Weill Cornell Medicine, New York (Schiff); and Rockefeller University Hospital, New York (Schiff)
| | - Dorin E Parlatore
- Departments of Rehabilitation Medicine (Shah, Lowder), Pediatrics (Traube), and Population Health Sciences (Mauer, Gerber), Cornell University Joan and Sanford I Weill Medical College, New York; Clinical and Translational Science Center, Cornell University Joan and Sanford I Weill Medical College, New York (Gautam); Department of Pediatrics, New York-Presbyterian Hospital, New York (Carullo, Parlatore, Traube); Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York (Shah, Schiff); Department of Neurology, Weill Cornell Medicine, New York (Schiff); and Rockefeller University Hospital, New York (Schiff)
| | - Linda M Gerber
- Departments of Rehabilitation Medicine (Shah, Lowder), Pediatrics (Traube), and Population Health Sciences (Mauer, Gerber), Cornell University Joan and Sanford I Weill Medical College, New York; Clinical and Translational Science Center, Cornell University Joan and Sanford I Weill Medical College, New York (Gautam); Department of Pediatrics, New York-Presbyterian Hospital, New York (Carullo, Parlatore, Traube); Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York (Shah, Schiff); Department of Neurology, Weill Cornell Medicine, New York (Schiff); and Rockefeller University Hospital, New York (Schiff)
| | - Nicholas D Schiff
- Departments of Rehabilitation Medicine (Shah, Lowder), Pediatrics (Traube), and Population Health Sciences (Mauer, Gerber), Cornell University Joan and Sanford I Weill Medical College, New York; Clinical and Translational Science Center, Cornell University Joan and Sanford I Weill Medical College, New York (Gautam); Department of Pediatrics, New York-Presbyterian Hospital, New York (Carullo, Parlatore, Traube); Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York (Shah, Schiff); Department of Neurology, Weill Cornell Medicine, New York (Schiff); and Rockefeller University Hospital, New York (Schiff)
| | - Chani Traube
- Departments of Rehabilitation Medicine (Shah, Lowder), Pediatrics (Traube), and Population Health Sciences (Mauer, Gerber), Cornell University Joan and Sanford I Weill Medical College, New York; Clinical and Translational Science Center, Cornell University Joan and Sanford I Weill Medical College, New York (Gautam); Department of Pediatrics, New York-Presbyterian Hospital, New York (Carullo, Parlatore, Traube); Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York (Shah, Schiff); Department of Neurology, Weill Cornell Medicine, New York (Schiff); and Rockefeller University Hospital, New York (Schiff)
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Weiss P, Rama J, Gerber LM, Qiu Y, Li STT, Duncan JG, Naifeh MM, Stevenson MD, Mauer E, Abramson EL. Scholarly activity training in pediatric pulmonology fellowship programs. Pediatr Pulmonol 2022; 57:982-990. [PMID: 35018735 DOI: 10.1002/ppul.25815] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/12/2021] [Accepted: 01/02/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Scholarly activity training is a required component of pediatric pulmonology fellowship programs. However, there are no data on resources and barriers to training and factors associated with fellow productivity. METHODS We surveyed US pediatric pulmonology fellowship program directors (FPDs) between March and October 2019. Our primary outcome was fellow productivity (>75% of fellows in the past 5 years had a manuscript accepted in a peer-reviewed journal). Analyses included descriptive statistics, χ2 and Fisher's exact tests for categorical values, and t-test or Wilcoxon rank-sum test for numerical values. RESULTS Sixty-one percent (33/54) of FPDs completed the survey. Seventy-nine percent reported that most fellows completed clinical, basic science, or translational research. However, only 21% reported that most fellows pursued research positions after graduation; academic clinical positions were more common. For 21%, lack of funding and competing clinical responsibilities were barriers to completing the scholarly activity. Only 39% had highly productive programs; those FPDs were more likely to be highly satisfied with fellow scholarly activity products (p = 0.049) and have >6 publications in the previous 3 years (p = 0.03). Fifty-two percent of FPDs believed that pediatric pulmonary training should be shortened to 2 years for those pursuing clinical or clinician-educator careers. CONCLUSIONS Barriers to scholarly activity training in pediatric pulmonology programs threaten the pipeline of academic pediatric pulmonologists and physician-investigators. Aligning fellow scholarly activity and clinical training with the skills required in their postgraduate positions could optimize the utilization of limited resources and better support career development.
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Affiliation(s)
- Pnina Weiss
- Section of Pulmonology, Allergy, Immunology and Sleep Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jennifer Rama
- Section of Pulmonary Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Linda M Gerber
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Yuqing Qiu
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Su-Ting T Li
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Jennifer G Duncan
- Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Monique M Naifeh
- Section of Hospital Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Michelle D Stevenson
- Division of Emergency Medicine, Department of Pediatrics, Norton Children's and University of Louisville, Louisville, Kentucky, USA
| | - Elizabeth Mauer
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Erika L Abramson
- Division of General Pediatrics, Department of Pediatrics and Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
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19
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Kochhar R, Modi V, Silva ND, Gueye-Ndiaye S, Neugarten JM, Ward MJ, Gerber LM, An A, Mauer E, Veler H. Polysomnography-guided mandibular distraction osteogenesis in Pierre Robin sequence patients. J Clin Sleep Med 2022; 18:1749-1755. [PMID: 35332870 DOI: 10.5664/jcsm.9960] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Craniofacial malformations with micrognathia cause high grades of obstructive sleep apnea (OSA) measured by polysomnography (PSG). Mandibular Distraction Osteogenesis (MDO) is a novel procedure for upper airway obstruction (UAO) relief. Our primary objective was to describe the utilization of PSGs to improve obstruction in patients undergoing mandibular distraction. METHODS This is a retrospective study. Patients with micrognathia and severe UAO, presenting with severe OSA diagnosed by PSG, were included from a single tertiary care center between 2015-2019. PSGs were done: (1) prior to surgery, (2) once cosmetic goal was achieved (Post-Op 1) (3) if residual moderate-to-severe OSA was seen, every 2 nights until mild or no OSA was achieved (Post-Op 2). RESULTS Thirteen patients were included. The median age at surgery was 1.1months (10 days-3 months). All thirteen patients had baseline severe OSA, with a median obstructive apnea-hypopnea index (OAHI) of 33 events/h and a median O2 nadir of 73%. Post-Op 1 PSG was done at a median of 6 days after surgery. Median first post-operative OAHI in all 13 patients was 6.8 events/h, with a median O2 nadir of 87%. A median additional distraction of 3 mm was needed beyond the traditionally recommended advancement. Long term follow-up studies at or after 1year were done in 5 patients, all showing persistent non-severe OSA. CONCLUSIONS This is the first case-series utilizing PSGs as a guide for MDO in patients with micrognathia showing the need for jaw over-correction to achieve resolution of OSA.
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Affiliation(s)
- Rashi Kochhar
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, CT
| | - Vikash Modi
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, NY
| | - Neranjan de Silva
- Department of Pediatrics, Division of Pulmonology, Allergy & Immunology, Weill Cornell Medicine, NY
| | | | - Jay M Neugarten
- The New York Center for Orthognathic and Maxillofacial Surgery, Weill Cornell Medicine, NY
| | - Mary J Ward
- Department of Pediatrics, Division of Pulmonology, Allergy & Immunology, Weill Cornell Medicine, NY
| | - Linda M Gerber
- Department of Population Health Sciences, Weill Cornell Medicine, NY
| | - Anjile An
- Department of Population Health Sciences, Weill Cornell Medicine, NY
| | - Elizabeth Mauer
- Department of Population Health Sciences, Weill Cornell Medicine, NY
| | - Haviva Veler
- Department of Pediatrics, Division of Pulmonology, Allergy & Immunology, Weill Cornell Medicine, NY
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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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Vien A, Shyh G, Jannat-Khah D, Chen S, Kuang X, Gerber LM, Lee JI. Impact of a Novel Hospital-Based Opioid Stewardship Program on Nonsurgical Acute Pain Management in the Hospital. J Gen Intern Med 2021; 36:3608-3610. [PMID: 33469760 PMCID: PMC8606386 DOI: 10.1007/s11606-020-06404-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Alexis Vien
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA. .,New York-Presbyterian Weill Cornell Medical Center, New York, NY, USA.
| | - Grace Shyh
- Clinical Pharmacy, New York-Presbyterian Lower Manhattan Hospital, New York, NY, USA
| | - Deanna Jannat-Khah
- Division of General Internal Medicine, Department of Rheumatology, Weill Cornell Medicine and Hospital for Special Surgery, New York, NY, USA
| | - Stephanie Chen
- New York-Presbyterian Weill Cornell Medical Center, New York, NY, USA.,Department of Anesthesiology, Columbia University School of Medicine, New York, NY, USA
| | - Xiao Kuang
- Department of Nursing, New York-Presbyterian Lower Manhattan Hospital, New York, NY, USA
| | - Linda M Gerber
- Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.,Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
| | - Jennifer I Lee
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA.,New York-Presbyterian Weill Cornell Medical Center, New York, NY, USA
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Forgacs PB, Allen BB, Wu X, Gerber LM, Boddu S, Fakhar M, Stieg PE, Schiff ND, Mangat HS. Corticothalamic Connectivity in Aneurysmal Subarachnoid Hemorrhage: Relationship with Disordered Consciousness and Clinical Outcomes. Neurocrit Care 2021; 36:760-771. [PMID: 34669180 DOI: 10.1007/s12028-021-01354-6] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND We present an exploratory analysis of the occurrence of early corticothalamic connectivity disruption after aneurysmal subarachnoid hemorrhage (SAH) and its correlation with clinical outcomes. METHODS We conducted a retrospective study of patients with acute SAH who underwent continuous electroencephalography (EEG) for impairment of consciousness. Only patients undergoing endovascular aneurysm treatment were included. Continuous EEG tracings were reviewed to obtain artifact-free segments. Power spectral analyses were performed, and segments were classified as A (only delta power), B (predominant delta and theta), C (predominant theta and beta), or D (predominant alpha and beta). Each incremental category from A to D implies greater preservation of corticothalamic connectivity. We dichotomized categories as AB for poor connectivity and CD for good connectivity. The modified Rankin Scale score at follow-up and in-hospital mortality were used as outcome measures. RESULTS Sixty-nine patients were included, of whom 58 had good quality EEG segments for classification: 28 were AB and 30 were CD. Hunt and Hess and World Federation of Neurological Surgeons grades were higher and the initial Glasgow Coma Scale score was lower in the AB group compared with the CD group. AB classification was associated with an adjusted odds ratio of 5.71 (95% confidence interval 1.61-20.30; p < 0.01) for poor outcome (modified Rankin Scale score 4-6) at a median follow-up of 4 months (interquartile range 2-6) and an odds ratio of 5.6 (95% confidence interval 0.98-31.95; p = 0.03) for in-hospital mortality, compared with CD. CONCLUSIONS EEG spectral-power-based classification demonstrates early corticothalamic connectivity disruption following aneurysmal SAH and may be a mechanism involved in early brain injury. Furthermore, the extent of this disruption appears to be associated with functional outcome and in-hospital mortality in patients with aneurysmal SAH and appears to be a potentially useful predictive tool that must be validated prospectively.
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Affiliation(s)
- Peter B Forgacs
- Department of Neurology, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, 525 E 68 Street, 610, New York, NY, 10065, USA
| | - Baxter B Allen
- Department of Neurology, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, 525 E 68 Street, 610, New York, NY, 10065, USA
| | - Xian Wu
- Department of Population Health Sciences, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, NY, USA
| | - Linda M Gerber
- Department of Population Health Sciences, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, NY, USA
| | - Srikanth Boddu
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, NY, USA
| | - Malik Fakhar
- Department of Neurology, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, 525 E 68 Street, 610, New York, NY, 10065, USA.,Department of Neurology, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Philip E Stieg
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, NY, USA
| | - Nicholas D Schiff
- Department of Neurology, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, 525 E 68 Street, 610, New York, NY, 10065, USA
| | - Halinder S Mangat
- Department of Neurology, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, 525 E 68 Street, 610, New York, NY, 10065, USA. .,Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, NY, USA.
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23
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Traube C, Rosenberg L, Thau F, Gerber LM, Mauer EA, Seghini T, Gulati N, Taylor D, Silver G, Kudchadkar SR. Sleep in Hospitalized Children With Cancer: A Cross-Sectional Study. Hosp Pediatr 2021; 10:969-976. [PMID: 33122175 DOI: 10.1542/hpeds.2020-0101] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Many children with cancer have repeated and prolonged hospitalizations, and in-hospital sleep disruption may negatively affect outcomes. Our objective for this study was to characterize sleep quality and quantity in hospitalized children with cancer by using parental surveys and actigraphy, to evaluate the association between subjective and objective sleep measures, and to describe hospital-associated risk factors related to poor sleep. METHODS Cross-sectional study of children aged 0 to 18 years old admitted to a pediatric oncology ward. Parents completed a baseline sleep questionnaire describing their child's sleep at home before hospitalization, followed by daily questionnaires describing their child's sleep for up to 3 nights while in the hospital. A subgroup of children aged 5 to 18 years wore actigraphs during the same time period. Demographic and clinical data were extracted from the electronic medical record. The primary outcome was inadequate sleep, defined by the total sleep duration adjusted for age. RESULTS Among 56 participants over 135 hospital nights, 66% (n = 37) reported inadequate sleep. Actigraphy was completed on 39 nights (29%), with a median total sleep time of 477 (interquartile range 407-557) minutes. There was a strong correlation between subjective questionnaire measures and actigraphic measures (r = 0.76). No patient-specific demographic factors were related to inadequate sleep. A multivariable model indicated the following hospital-related factors were associated with inadequate sleep: noise (adjusted odds ratio [aOR] 3.0; confidence interval [CI] 1.2-7.7), alarms (aOR 3.1; CI 1.2-8.3), child's worries (aOR 2.8; CI 1.1-7.2), and receipt of benzodiazepines (aOR 2.9; CI 1.2-7.5). CONCLUSIONS A majority of children experienced inadequate sleep during hospitalization. Subjective report of sleep duration correlated well with objective measures of sleep by actigraphy. Several potentially modifiable factors were independently associated with poor sleep. Further interventional studies are required to test approaches to optimize sleep in hospitalized children with cancer.
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Affiliation(s)
- Chani Traube
- Departments of Pediatrics, .,Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | | | | | | | | | - Thomas Seghini
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Nitya Gulati
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Damani Taylor
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | | | - Sapna R Kudchadkar
- Departments of Anesthesiology and Critical Care Medicine, Pediatrics, and Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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24
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Caliendo ET, Kim N, Edasery D, Askin G, Nowak S, Gerber LM, Baum KT, Blackwell LS, Koterba CH, Hoskinson KR, Kurowski BG, McLaughlin M, Tlustos SJ, Watson WD, Niogi SN, Suskauer SJ, Shah SA. Acute Imaging Findings Predict Recovery of Cognitive and Motor Function after Inpatient Rehabilitation for Pediatric Traumatic Brain Injury: A Pediatric Brain Injury Consortium Study. J Neurotrauma 2021; 38:1961-1968. [PMID: 33504256 PMCID: PMC8418527 DOI: 10.1089/neu.2020.7437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Traumatic brain injury (TBI) is a major cause of morbidity and mortality in children; survivors experience long-term cognitive and motor deficits. To date, studies predicting outcome following pediatric TBI have primarily focused on acute behavioral responses and proxy measures of injury severity; unsurprisingly, these measures explain very little of the variance following heterogenous injury. In adults, certain acute imaging biomarkers help predict cognitive and motor recovery following moderate to severe TBI. This multi-center, retrospective study, characterizes the day-of-injury computed tomographic (CT) reports of pediatric, adolescent, and young adult patients (2 months to 21 years old) who received inpatient rehabilitation services for TBI (n = 247). The study also determines the prognostic utility of CT findings for cognitive and motor outcomes assessed by the Pediatric Functional Independence Measure, converted to age-appropriate developmental functional quotient (DFQ), at discharge from rehabilitation. Subdural hematomas (66%), contusions (63%), and subarachnoid hemorrhages (59%) were the most common lesions; the majority of subjects had less severe Rotterdam CT scores (88%, ≤ 3). After controlling for age, gender, mechanism of injury, length of acute hospital stay, and admission DFQ in multivariate regression analyses, the highest Rotterdam score (β = -25.2, p < 0.01) and complete cisternal effacement (β = -19.4, p < 0.05) were associated with lower motor DFQ, and intraventricular hemorrhage was associated with lower motor (β = -3.7, p < 0.05) and cognitive DFQ (β = -4.9, p < 0.05). These results suggest that direct detection of intracranial injury provides valuable information to aid in prediction of recovery after pediatric TBI, and needs to be accounted for in future studies of prognosis and intervention.
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Affiliation(s)
| | - Nayoung Kim
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York, USA
- Blythedale Children's Hospital, Valhalla, New York, USA
| | - David Edasery
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Gulce Askin
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Sophie Nowak
- Blythedale Children's Hospital, Valhalla, New York, USA
| | - Linda M. Gerber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Katherine T. Baum
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Laura S. Blackwell
- Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Christine H. Koterba
- Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Kristen R. Hoskinson
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Brad G. Kurowski
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Departments of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Matthew McLaughlin
- Division of Pediatric Rehabilitation Medicine, Children's Mercy, Kansas City, Missouri, USA
- University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Sarah J. Tlustos
- Department of Rehabilitation, Children's Hospital Colorado and Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - William D. Watson
- Blythedale Children's Hospital, Valhalla, New York, USA
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Sumit N. Niogi
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Stacy J. Suskauer
- Kennedy Krieger Institute, Baltimore, Maryland, USA
- Departments of Physical Medicine & Rehabilitation and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sudhin A. Shah
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York, USA
- Blythedale Children's Hospital, Valhalla, New York, USA
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25
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Watson WD, Suskauer SJ, Askin G, Nowak S, Baum KT, Gerber LM, Blackwell LS, Koterba CH, Hoskinson KR, Kurowski BG, Mclaughlin MJ, Tlustos SJ, Zimmerman KO, Shah SA. Cognitive Recovery During Inpatient Rehabilitation Following Pediatric Traumatic Brain Injury: A Pediatric Brain Injury Consortium Study. J Head Trauma Rehabil 2021; 36:253-263. [PMID: 33656473 DOI: 10.1097/htr.0000000000000650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To characterize the demographics, clinical course, and predictors of cognitive recovery among children and young adults receiving inpatient rehabilitation following pediatric traumatic brain injury (TBI). DESIGN Retrospective observational, multicenter study. SETTING Eight acute pediatric inpatient rehabilitation facilities in the United States with specialized programs for treating patients with TBI. PARTICIPANTS Children and young adults (0-21 years) with TBI (n = 234) receiving inpatient rehabilitation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Admission and discharge status assessed by the WeeFIM Cognitive Developmental Functional Quotient (DFQ) and Cognitive and Linguistic Scale (CALS). RESULTS Patients admitted to pediatric inpatient rehabilitation are diverse in cognitive functioning. While the majority of patients make improvements, cognitive recovery is constrained for those admitted with the most severe cognitive impairments. Age, time since injury to rehabilitation admission, and admission WeeFIM Cognitive DFQ are significant predictors of cognitive functioning at discharge from inpatient rehabilitation. CONCLUSIONS This work establishes a multicenter Pediatric Brain Injury Consortium and characterized the demographics and clinical course of cognitive recovery during inpatient rehabilitation of pediatric patients with TBI to aid in prospective study design.
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Affiliation(s)
- William D Watson
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York (Dr Watson); Blythedale Children's Hospital, Valhalla, New York (Drs Watson and Shah and Ms Nowak); Kennedy Krieger Institute, and Departments of Physical Medicine and Rehabilitation and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Suskauer); Departments of Population Health Sciences (Ms Askin and Dr Gerber) and Rehabilitation Medicine (Dr Shah), Weill Cornell Medicine, New York, New York; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Dr Baum); Department of Neuropsychology, Children's Hospital of Atlanta, Atlanta, Georgia (Dr Blackwell); Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio (Drs Koterba and Hoskinson); Department of Pediatrics, The Ohio State University College of Medicine, Columbus (Dr Hoskinson); Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, and Departments of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Ohio (Dr Kurowski); Division of Pediatric Rehabilitation Medicine, Children's Mercy-Kansas City, Kansas City, Missouri, and Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri (Dr Mclaughlin); Department of Rehabilitation, Children's Hospital Colorado, and Department of Physical Medicine and Rehabilitation, University of Colorado Anshutz Medical Campus, Aurora (Dr Tlustos); and Division of Critical Care Medicine, Department of Pediatrics, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina (Dr Zimmerman)
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26
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Traube C, Gerber LM, Mauer EA, Small K, Broglie L, Chopra YR, Duncan CN, Ebens CL, Fitzgerald JC, Freedman JL, Hudspeth MP, Hurley C, Mahadeo KM, McArthur J, Shapiro MC, Sharron MP, Wall DA, Zinter MS, Greenwald BM, Silver G, Boulad F. Delirium in Children Undergoing Hematopoietic Cell Transplantation: A Multi-Institutional Point Prevalence Study. Front Oncol 2021; 11:627726. [PMID: 33968727 PMCID: PMC8100670 DOI: 10.3389/fonc.2021.627726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/19/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Delirium occurs frequently in adults undergoing hematopoietic cell transplantation, with significant associated morbidity. Little is known about the burden of delirium in children in the peri-transplant period. This study was designed to determine delirium rates, define risk factors (demographic and treatment related), and establish feasibility of multi-institutional bedside screening for delirium in children undergoing hematopoietic cell transplant. Methods: This is a multi-institutional point prevalence study. All subjects were prospectively screened for delirium twice daily using the Cornell Assessment of Pediatric Delirium over a 10-day period. De-identified data, including basic demographics and daily characteristics, were extracted from the electronic medical record. Results: Eleven North American institutions were included, 106 children were enrolled, and 883 hospital days were captured. Delirium screening was successfully completed on more than 98% of the study days. Forty-eight children (45%) developed delirium over the course of the 10-day study. Children were diagnosed with delirium on 161/883 study days, for an overall delirium rate of 18% per day. Higher delirium rates were noted in children <5 years old (aOR 0.41 for children over 5 years), and in association with specific medications (melatonin, steroids, and tacrolimus). Conclusion: Delirium was a frequent occurrence in our study cohort, with identifiable risk factors. Delirium screening is highly feasible in the pediatric hematopoietic cell transplant patient population. A large-scale prospective longitudinal study following children throughout their transplant course is urgently needed to fully describe the epidemiology of pediatric delirium, explore the effects of delirium on patient outcomes, and establish guidelines to prevent and treat delirium in the peri-transplant period.
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Affiliation(s)
- Chani Traube
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, United States.,Department of Pediatrics, MSK Kids at Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Linda M Gerber
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States.,Department of Medicine, Weill Cornell Medical College, New York, NY, United States
| | - Elizabeth A Mauer
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States
| | - Keshia Small
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, United States
| | - Larisa Broglie
- Department of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University Medical Center, New York, NY, United States
| | - Yogi Raj Chopra
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Christine N Duncan
- Department of Pediatric Hematology/Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Christen L Ebens
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Julie C Fitzgerald
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Jason L Freedman
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Michelle P Hudspeth
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Caitlin Hurley
- Department of Bone Marrow Transplant & Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, United States
| | - Kris M Mahadeo
- Department of Stem Cell Transplantation and Cellular Therapy, Children's Cancer Hospital, University of Texas at MD Anderson Cancer Center, Houston, TX, United States
| | - Jennifer McArthur
- Department of Bone Marrow Transplant & Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, United States
| | - Miriam C Shapiro
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Matthew P Sharron
- Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC, United States
| | - Donna A Wall
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Matt S Zinter
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | - Bruce M Greenwald
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, United States.,Department of Pediatrics, MSK Kids at Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Gabrielle Silver
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, United States
| | - Farid Boulad
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, United States.,Department of Pediatrics, MSK Kids at Memorial Sloan Kettering Cancer Center, New York, NY, United States
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27
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Mangat HS, Wu X, Gerber LM, Shabani HK, Lazaro A, Leidinger A, Santos MM, McClelland PH, Schenck H, Joackim P, Ngerageza JG, Schmidt F, Stieg PE, Hartl R. Severe traumatic brain injury management in Tanzania: analysis of a prospective cohort. J Neurosurg 2021; 135:1190-1202. [PMID: 33482641 PMCID: PMC8295409 DOI: 10.3171/2020.8.jns201243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Given the high burden of neurotrauma in low- and middle-income countries (LMICs), in this observational study, the authors evaluated the treatment and outcomes of patients with severe traumatic brain injury (TBI) accessing care at the national neurosurgical institute in Tanzania. METHODS A neurotrauma registry was established at Muhimbili Orthopaedic Institute, Dar-es-Salaam, and patients with severe TBI admitted within 24 hours of injury were included. Detailed emergency department and subsequent medical and surgical management of patients was recorded. Two-week mortality was measured and compared with estimates of predicted mortality computed with admission clinical variables using the Corticoid Randomisation After Significant Head Injury (CRASH) core model. RESULTS In total, 462 patients (mean age 33.9 years) with severe TBI were enrolled over 4.5 years; 89% of patients were male. The mean time to arrival to the hospital after injury was 8 hours; 48.7% of patients had advanced airway management in the emergency department, 55% underwent cranial CT scanning, and 19.9% underwent surgical intervention. Tiered medical therapies for intracranial hypertension were used in less than 50% of patients. The observed 2-week mortality was 67%, which was 24% higher than expected based on the CRASH core model. CONCLUSIONS The 2-week mortality from severe TBI at a tertiary referral center in Tanzania was 67%, which was significantly higher than the predicted estimates. The higher mortality was related to gaps in the continuum of care of patients with severe TBI, including cardiorespiratory monitoring, resuscitation, neuroimaging, and surgical rates, along with lower rates of utilization of available medical therapies. In ongoing work, the authors are attempting to identify reasons associated with the gaps in care to implement programmatic improvements. Capacity building by twinning provides an avenue for acquiring data to accurately estimate local needs and direct programmatic education and interventions to reduce excess in-hospital mortality from TBI.
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Affiliation(s)
- Halinder S. Mangat
- Department of Neurology, Weill Cornell Brain and Spine Institute, New York
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, New York
| | - Xian Wu
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Linda M. Gerber
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Hamisi K. Shabani
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute, Dar-es-Salaam, Tanzania
| | - Albert Lazaro
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute, Dar-es-Salaam, Tanzania
| | - Andreas Leidinger
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, New York
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute, Dar-es-Salaam, Tanzania
| | - Maria M. Santos
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, New York
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute, Dar-es-Salaam, Tanzania
| | - Paul H. McClelland
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, New York
| | | | - Pascal Joackim
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute, Dar-es-Salaam, Tanzania
| | - Japhet G. Ngerageza
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute, Dar-es-Salaam, Tanzania
| | - Franziska Schmidt
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, New York
| | - Philip E. Stieg
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, New York
| | - Roger Hartl
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, New York
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28
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Abramson EL, Weiss P, Naifeh M, Stevenson MD, Duncan JG, Rama JA, Mauer E, Gerber LM, Li STT. Scholarly Activity During Pediatric Fellowship. Pediatrics 2021; 147:peds.2020-013953. [PMID: 33262266 DOI: 10.1542/peds.2020-013953] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/21/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The educational requirements for pediatric fellows include at least 12 months of scholarly activity and generation of a work product. Yet there lacks detailed guidance on how programs can best integrate scholarly activity training into fellowships. Our objectives were to understand the resources and barriers to training and identify factors associated with productivity. METHODS We surveyed pediatric fellowship program directors (FPDs) nationally in 2019. Data analysis included descriptive statistics, χ2 and Fisher's exact tests, and multivariable modeling to identify factors associated with high productivity (>75% of fellows in the past 5 years had an article from their fellowship accepted). RESULTS A total of 499 of 770 FPDs responded (65%). A total of 174 programs (35%) were highly productive. The most frequent major barriers were a lack of funding for fellows to conduct scholarship (21%, n = 105) and lack of sufficient divisional faculty mentorship (16%, n = 79). The median number of months for scholarship with reduced clinical obligations scholarship was 17. A total of 40% (n = 202) of FPDs believed training should be shortened to 2 years for clinically oriented fellows. Programs with a T32 and a FPD with >5 publications in the past 3 years were twice as likely to be productive. Not endorsing lack of adequate Scholarship Oversight Committee expertise and a research curriculum as barriers was associated with increased productivity (odds ratio = 1.83-1.65). CONCLUSIONS Despite significant protected fellow research time, most fellows do not publish. Ensuring a program culture of research may provide the support needed to take projects to publication. The fellowship community may consider reevaluating the fellowship duration, particularly for those pursing nonresearch focused careers.
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Affiliation(s)
- Erika L Abramson
- Division of General Pediatrics, Department of Pediatrics and .,Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Pnina Weiss
- Department of Pediatrics, Section of Respiratory Medicine, Allergy Immunology and Sleep Medicine, Yale University School of Medicine, Yale University, New Haven, Connecticut
| | - Monique Naifeh
- Department of Pediatrics, Section of Pediatric Hospital Medicine, University of Oklahoma Health Sciences Center and University of Oklahoma, Oklahoma City, Oklahoma
| | - Michelle D Stevenson
- Division of Emergency Medicine, Department of Pediatrics, Norton Children's and University of Louisville, Louisville, Kentucky
| | - Jennifer G Duncan
- Division of Critical Care Medicine, Department of Pediatrics, School of Medicine, Washington University, St Louis, Missouri
| | - Jennifer A Rama
- Section of Pulmonary Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas; and
| | - Elizabeth Mauer
- Divison of Biostatistics.,Division of General Pediatrics, Department of Pediatrics and
| | - Linda M Gerber
- Divison of Biostatistics.,Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Su-Ting T Li
- University of California, Davis, Sacramento, California
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29
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Reed R, Grossman T, Askin G, Gerber LM, Kasdorf E. Joint periviability counseling between neonatology and obstetrics is a rare occurrence. J Perinatol 2020; 40:1789-1796. [PMID: 32859941 DOI: 10.1038/s41372-020-00796-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/28/2020] [Accepted: 08/14/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the frequency with which neonatal and maternal-fetal medicine (MFM) providers perform joint periviability counseling (JPC), compare content of counseling, and identify perceived barriers to JPC. STUDY DESIGN An anonymous REDCap survey was e-mailed to members of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine and to members of the Society for MFM. RESULTS There were 424 neonatal and 115 MFM participants. Fifty-two percent of neonatal and 35% of MFM respondents reported rarely/never performing JPC (p < 0.001), while 80% and 82%, respectively felt it would improve counseling. Content of counseling was similar, except for length of stay with 93% of neonatal vs. 85% of MFM respondents addressing this (p = 0.03). The majority (>60%) of respondents in both groups reported that clinical duties posed a significant/great barrier to JPC. CONCLUSION JPC is recommended but infrequently performed, with both specialties interested in further collaboration to strengthen the counseling provided.
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Affiliation(s)
- Rachel Reed
- Division of Newborn Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA. .,Division of Newborn Medicine, Mount Sinai Health System, New York, NY, USA.
| | - Tracy Grossman
- Division of Maternal-Fetal Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA.,Division of Maternal-Fetal Medicine, New York University Langone Medical Center, New York, NY, USA
| | - Gulce Askin
- Department of Population Health Sciences, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Linda M Gerber
- Department of Population Health Sciences, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Ericalyn Kasdorf
- Division of Newborn Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
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Grossman A, Mauer E, Gerber LM, Long MD, Kappelman MD, Gupta N. Black/African American Patients with Pediatric Crohn's Disease Report Less Anxiety and Fatigue than White Patients. J Pediatr 2020; 225:146-151. [PMID: 32544479 DOI: 10.1016/j.jpeds.2020.05.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To compare patient-reported outcomes in black/African American patients with white patients participating in IBD Partners Kids & Teens, in order to identify possible racial healthcare disparities in pediatric inflammatory bowel disease (IBD) as future targets for improvement. STUDY DESIGN This was a cross-sectional analysis comparing patient-reported outcomes in black/African American patients with white patients, aged 9-18 years, with IBD participating in the IBD Partners Kids & Teens cohort from August 2013 to April 2018. Secondary outcomes included number of IBD-related hospitalizations and surgeries, current medication use, and disease activity. RESULTS We included 401 patients with Crohn's disease (white = 378 [94%]; black/African American = 23 [6%]). For children with Crohn's disease, black/African American patients compared with white patients reported less anxiety (40.7 vs 47.5, P = .001) and fatigue (44.3 vs 48.4, P = .047) despite more frequently reported treatment with biologics (91% vs 61%, P = .006) and antibiotics (17% vs 5%, P = .03) and history of hospitalizations (81% vs 52%, P = .02). CONCLUSIONS Black/African American children with Crohn's disease were less likely to report anxiety or fatigue than white patients, despite an apparent more severe disease course reflected by greater reported frequency of treatment with biologics and antibiotics and history of hospitalizations.
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Affiliation(s)
| | - Elizabeth Mauer
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY
| | - Linda M Gerber
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY
| | - Millie D Long
- Department of Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Center for Gastrointestinal Biology and Disease, Chapel Hill, NC
| | - Michael D Kappelman
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC; Center for Gastrointestinal Biology and Disease, Chapel Hill, NC
| | - Neera Gupta
- Department of Pediatrics, Weill Cornell Medicine, New York, NY.
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31
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Mangat HS, Wu X, Gerber LM, Schwarz JT, Fakhar M, Murthy SB, Stieg PE, Ghajar J, Härtl R. Hypertonic Saline is Superior to Mannitol for the Combined Effect on Intracranial Pressure and Cerebral Perfusion Pressure Burdens in Patients With Severe Traumatic Brain Injury. Neurosurgery 2020; 86:221-230. [PMID: 30877299 DOI: 10.1093/neuros/nyz046] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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: 03/31/2018] [Accepted: 01/31/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hypertonic saline (HTS) and mannitol are effective in reducing intracranial pressure (ICP) after severe traumatic brain injury (TBI). However, their simultaneous effect on the cerebral perfusion pressure (CPP) and ICP has not been studied rigorously. OBJECTIVE To determine the difference in effects of HTS and mannitol on the combined burden of high ICP and low CPP in patients with severe TBI. METHODS We performed a case-control study using prospectively collected data from the New York State TBI-trac® database (Brain Trauma Foundation, New York, New York). Patients who received only 1 hyperosmotic agent, either mannitol or HTS for raised ICP, were included. Patients in the 2 groups were matched (1:1 and 1:2) for factors associated with 2-wk mortality: age, Glasgow Coma Scale score, pupillary reactivity, hypotension, abnormal computed tomography scans, and craniotomy. Primary endpoint was the combined burden of ICPhigh (> 25 mm Hg) and CPPlow (< 60 mm Hg). RESULTS There were 25 matched pairs for 1:1 comparison and 24 HTS patients matched to 48 mannitol patients in 1:2 comparisons. Cumulative median osmolar doses in the 2 groups were similar. In patients treated with HTS compared to mannitol, total number of days (0.6 ± 0.8 vs 2.4 ± 2.3 d, P < .01), percentage of days with (8.8 ± 10.6 vs 28.1 ± 26.9%, P < .01), and the total duration of ICPhigh + CPPlow (11.12 ± 14.11 vs 30.56 ± 31.89 h, P = .01) were significantly lower. These results were replicated in the 1:2 match comparisons. CONCLUSION HTS bolus therapy appears to be superior to mannitol in reduction of the combined burden of intracranial hypertension and associated hypoperfusion in severe TBI patients.
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Affiliation(s)
- Halinder S Mangat
- Department of Neurology, Weill Cornell Medicine, New York, New York.,Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, New York
| | - Xian Wu
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York
| | - Linda M Gerber
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York
| | - Justin T Schwarz
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, New York.,NewYork-Presbyterian Hospital, New York, New York
| | - Malik Fakhar
- Department of Neurology, Weill Cornell Medicine, New York, New York
| | - Santosh B Murthy
- Department of Neurology, Weill Cornell Medicine, New York, New York
| | - Philip E Stieg
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, New York
| | - Jamshid Ghajar
- Department of Neurological Surgery, Stanford University, Palo Alto, California.,Brain Trauma Foundation, New York, New York
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, New York
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32
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Wuennemann MJ, Mackenzie SW, Lane HP, Peltz AR, Ma X, Gerber LM, Edwards DJ, Kitago T. Dose and staffing comparison study of upper limb device-assisted therapy. NeuroRehabilitation 2020; 46:287-297. [DOI: 10.3233/nre-192993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Marissa J. Wuennemann
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, USA
| | - Stuart W. Mackenzie
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, USA
| | - Heather Pepper Lane
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, USA
| | - Avrielle R. Peltz
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, USA
| | - Xiaoyue Ma
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA
| | - Linda M. Gerber
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA
| | - Dylan J. Edwards
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
- Edith Cown University, Joondalup, Australia
| | - Tomoko Kitago
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, USA
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
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33
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Ennamuri S, Abramson E, Mauer E, Gerber LM, Nellis ME. Changes in Clinical Course Before and After Do-Not-Resuscitate Order Placement in a Pediatric Intensive Care Unit Setting. J Palliat Med 2020; 24:107-111. [PMID: 32250188 DOI: 10.1089/jpm.2019.0572] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The relationship between clinical course and do-not-resuscitate (DNR) status has not been well studied in the pediatric intensive care unit (PICU) setting. Objective: To describe the relationship between DNR order placement and clinical course. Design: Single center retrospective cohort study. Setting/Subjects: Patients, ages 0-18 years, who have died in the PICU from 2008 to 2016. Measurements: Retrospective chart review of DNR status, patient characteristics, and clinical course. We compared length of stay and number of consults/procedures/imaging studies done on patients with early DNR (>48 hours before death), late DNR (within 48 hours of death), and no DNR order placement. Results: One-hundred and sixty-one children were included. Nearly half (48%) were male with median (interquartile range) age of 3 years (0-12). One-third (58) had an underlying oncologic diagnosis. Eighteen percent (29/161) were classified as early DNR, 33% (53/161) as late DNR, and 49% (79/161) as no DNR. We found no differences in patient characteristics or risk of mortality at admission among the groups. The early DNR group showed decreased number of invasive procedures (0.68), imaging studies (1), and consults (0.21) per day when compared with the late (2, 1.53, 0.50) and no DNR groups (2.09, 1.73, 0.43). Conclusion: Our results suggest that early DNR placement in the PICU is associated with a change in clinical course centered around less invasive care. Earlier DNR placement can potentially trigger a shift in care goals that could improve the quality of life for patients and mitigate emotional and physical toll on patients and their families during the highly stressful end-of-life time period.
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Affiliation(s)
- Sravya Ennamuri
- Department of Pediatric Critical Care Medicine, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Erika Abramson
- Department of Pediatrics and Weill Cornell Medicine, New York, New York, USA.,Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
| | - Elizabeth Mauer
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, New York, USA
| | - Linda M Gerber
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
| | - Marianne E Nellis
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA
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Mann SJ, Gerber LM. Response to: Measurement of sodium intake or measurement of the detrimental effects of sodium on health in individual subjects? J Clin Hypertens (Greenwich) 2020; 22:304. [PMID: 31913565 DOI: 10.1111/jch.13788] [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] [Received: 12/05/2019] [Accepted: 12/07/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Samuel J Mann
- Department of Medicine, Division of Nephrology and Hypertension, Hypertension Center, Weill Cornell Medicine, New York, New York
| | - Linda M Gerber
- Department of Medicine, Division of Nephrology and Hypertension, Hypertension Center, Weill Cornell Medicine, New York, New York.,Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, New York
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35
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Gibson GE, Luchsinger JA, Cirio R, Chen H, Franchino-Elder J, Hirsch JA, Bettendorff L, Chen Z, Flowers SA, Gerber LM, Grandville T, Schupf N, Xu H, Stern Y, Habeck C, Jordan B, Fonzetti P. Benfotiamine and Cognitive Decline in Alzheimer's Disease: Results of a Randomized Placebo-Controlled Phase IIa Clinical Trial. J Alzheimers Dis 2020; 78:989-1010. [PMID: 33074237 PMCID: PMC7880246 DOI: 10.3233/jad-200896] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND In preclinical models, benfotiamine efficiently ameliorates the clinical and biological pathologies that define Alzheimer's disease (AD) including impaired cognition, amyloid-β plaques, neurofibrillary tangles, diminished glucose metabolism, oxidative stress, increased advanced glycation end products (AGE), and inflammation. OBJECTIVE To collect preliminary data on feasibility, safety, and efficacy in individuals with amnestic mild cognitive impairment (aMCI) or mild dementia due to AD in a placebo-controlled trial of benfotiamine. METHODS A twelve-month treatment with benfotiamine tested whether clinical decline would be delayed in the benfotiamine group compared to the placebo group. The primary clinical outcome was the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog). Secondary outcomes were the clinical dementia rating (CDR) score and fluorodeoxyglucose (FDG) uptake, measured with brain positron emission tomography (PET). Blood AGE were examined as an exploratory outcome. RESULTS Participants were treated with benfotiamine (34) or placebo (36). Benfotiamine treatment was safe. The increase in ADAS-Cog was 43% lower in the benfotiamine group than in the placebo group, indicating less cognitive decline, and this effect was nearly statistically significant (p = 0.125). Worsening in CDR was 77% lower (p = 0.034) in the benfotiamine group compared to the placebo group, and this effect was stronger in the APOEɛ4 non-carriers. Benfotiamine significantly reduced increases in AGE (p = 0.044), and this effect was stronger in the APOEɛ4 non-carriers. Exploratory analysis derivation of an FDG PET pattern score showed a treatment effect at one year (p = 0.002). CONCLUSION Oral benfotiamine is safe and potentially efficacious in improving cognitive outcomes among persons with MCI and mild AD.
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Affiliation(s)
- Gary E. Gibson
- Brain and Mind Research Institute, Weil Cornell Medicine, New York, NY, USA
- Burke Neurological Institute, White Plains, NY, USA
| | - José A. Luchsinger
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | | | | | | | - Joseph A. Hirsch
- Burke Neurological Institute, White Plains, NY, USA
- Burke Rehabilitation Hospital, White Plains, NY, USA
- Lenox Hill Hospital, New York, NY, USA
| | - Lucien Bettendorff
- Laboratory of Neurophysiology, GIGA-Neurosciences, University of Liege, Belgium
| | - Zhengming Chen
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Sarah A. Flowers
- Department of Neuroscience, Georgetown University, Washington, DC, USA
| | - Linda M. Gerber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | | | - Nicole Schupf
- Mailman School of Public Health, The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
| | - Hui Xu
- Burke Neurological Institute, White Plains, NY, USA
| | - Yaakov Stern
- Departments of Neurology, Psychiatry, GH Sergievsky Center, the Taub Institute for the Research on Alzheimer’s Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
| | - Christian Habeck
- Department of Neurology and the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
| | - Barry Jordan
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
- Department of Neurology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Pasquale Fonzetti
- Einstein College of Medicine, Bronx NY; Westmed Medical Group White Plains NY
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36
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Weiss P, Mauer E, Gerber LM, Boyer D, Abramson EL. Funding sources and effects of limited funding in pediatric pulmonology fellowship programs. Pediatr Pulmonol 2020; 55:221-225. [PMID: 31578809 DOI: 10.1002/ppul.24536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/19/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND The pediatric pulmonology workforce is at risk. Access to pediatric pulmonologists to meet patient needs is limited and recruitment of new trainees to replace the aging, retiring physician population may be inadequate. Furthermore, sources of funding for graduate medical education are insecure. However, no prior studies have identified the funding sources of pediatric pulmonology fellowships or the effects of funding constraints. METHODS We conducted a national survey of pediatric pulmonology training directors (PPTD) in the United States between 1 November, 2016 and 9 February, 2017 to examine the sources of funding for pediatric pulmonary fellows and the effect of funding limitations. RESULTS We obtained data from 48 PPTD, representing 89% of pediatric pulmonology programs (N = 54). Limitations in funding restricted program size in 31% of programs. A significant number of programs had no funding to cover educational resources such as advanced degrees (38%), courses (23%), society membership (25%), and journals and books (15%). Twenty seven percent of PPTD perceived their program as financially insecure for academic year 2019 and beyond. CONCLUSIONS Insufficient funding has limited the size of pediatric pulmonology programs and access to important educational resources. It is critical to ensure that there is adequate funding for pediatric pulmonology fellowship programs, as insecurity further endangers the pediatric pulmonology workforce and future provision of care for children with respiratory diseases.
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Affiliation(s)
- Pnina Weiss
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Elizabeth Mauer
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Linda M Gerber
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Debra Boyer
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Erika L Abramson
- Departments of Pediatrics and Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
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37
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Mann SJ, Gerber LM. Addressing the problem of inaccuracy of measured 24-hour urine collections due to incomplete collection. J Clin Hypertens (Greenwich) 2019; 21:1626-1634. [PMID: 31631523 DOI: 10.1111/jch.13696] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/11/2019] [Accepted: 07/22/2019] [Indexed: 11/27/2022]
Abstract
The 24-hour urine collection is widely considered the gold standard for assessing 24-hour excretion of various analytes. Yet, studies show that >30% of collections are incomplete and hence understate the true 24-hour excretion. We previously validated an equation for estimating an individual's 24-hour creatinine excretion, based on weight, sex, race, and age. The present study examines whether routinely correcting measured 24-hour excretion of an analyte using the ratio of estimated to measured 24-hour urine creatinine mitigates the misleadingly low values that result from undercollection. Ninety-nine participants, recruited from an outpatient hypertension clinic, submitted a 24-hour urine collection for measurement of creatinine and sodium excretion. The urine collections were dichotomized into complete (n = 63) and incomplete (n = 36) collections based on previously described criteria for expected 24-hour creatinine excretion. To adjust for possible incompleteness of collections, the measured 24-hour values were then corrected by multiplying them by the ratio of estimated to measured 24-hour urine creatinine. The mean 24-hour creatinine excretion was 1682 mg/d among complete collectors. Among incomplete collectors, the mean was 1211 mg/d before and 1695 mg/d after, adjustment. Similarly, mean 24-hour sodium excretion was 156 mEq/d among complete collectors, whereas among incomplete collectors it was 121 mEq/d before and 171 mEq/d after, adjustment. Undercollection of 24-hour urines is a common problem and results in misleadingly low values for excretion of analytes being measured. Routine adjustment of 24-hour urine values using estimated values for 24-hour creatinine excretion can greatly mitigate artifactually low 24-hour excretion results.
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Affiliation(s)
- Samuel J Mann
- Division of Nephrology and Hypertension, Department of Medicine, Hypertension Center, Weill Cornell Medicine, New York, NY, USA
| | - Linda M Gerber
- Division of Nephrology and Hypertension, Department of Medicine, Hypertension Center, Weill Cornell Medicine, New York, NY, USA.,Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
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Toglia J, Askin G, Gerber LM, Jaywant A, O'Dell MW. Participation in Younger and Older Adults Post-stroke: Frequency, Importance, and Desirability of Engagement in Activities. Front Neurol 2019; 10:1108. [PMID: 31681161 PMCID: PMC6813672 DOI: 10.3389/fneur.2019.01108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 07/15/2019] [Accepted: 10/03/2019] [Indexed: 01/16/2023] Open
Abstract
Purpose: To characterize and compare frequency and subjective dimensions of post-stroke participation in younger (<65) and older adults (>age 65), in social, productivity and leisure activities, 6 months post-inpatient rehabilitation. Secondary aims included exploration of demographic and clinical factors influencing desire for increased participation and comparison of two measures of participation. Methods: A prospective cohort study of people with stroke (n = 99) who were identified during their inpatient rehabilitation stay and followed-up 6 months post-discharge with telephone interviews using two self-report participation measures. The Stroke Impact Participation subscale (SIS-P) measured the frequency of perceived limitations in social, leisure, productive activities and extent of stroke recovery. The Community Participation Indicators (CPI) examined activity frequency, importance, and desire for increased activity engagement. Descriptive statistics were used to summarize demographic variables and characterize SIS-P and CPI items. Differences between age groups on individual items were examined. Associations between measures and demographic variables were explored. Results: Both groups reported a wide variation in participation restrictions that was not associated with stroke severity and weakly associated with discharge functional status (rho = 0.20-0.35). There were no significant differences between age groups in CPI frequency (for 18/19 items), or the SIS-P. However, there was a trend toward more participation restrictions on the SIS-P among those <65 (p = 0.07). Younger adults (n = 46; median age = 53) were significantly more likely to indicate that they were not doing selected activities enough on the CPI, compared with older adults (n = 56; median age = 76). While age and ethnicity were independently associated with some activities, it was not associated with other activities. The CPI and SIS-P were moderately related at a correlation of rho = 0.54, p < 0.001. Conclusion: The CPI demonstrated value and utility in examining subjective perspectives of activity importance and desire for change for people who are 6 months post-stroke. Although the CPI and SIS-P are moderately related, subjective appraisal of participation in selected individual activities (CPI) better distinguished between age groups and provided unique and distinct information from the SIS-P.
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Affiliation(s)
- Joan Toglia
- Mercy College, Dobbs Ferry, NY, United States.,Rehabilitation Medicine Department, Weill Cornell Medicine, New York, NY, United States
| | - Gulce Askin
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, United States
| | - Linda M Gerber
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, United States
| | - Abhishek Jaywant
- Rehabilitation Medicine Department, Weill Cornell Medicine, New York, NY, United States.,NewYork-Presbyterian Hospital, New York, NY, United States.,Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States
| | - Michael W O'Dell
- Rehabilitation Medicine Department, Weill Cornell Medicine, New York, NY, United States
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Allen BB, Forgacs PB, Fakhar MA, Wu X, Gerber LM, Boddu S, Murthy SB, Stieg PE, Mangat HS. Association of Seizure Occurrence with Aneurysm Treatment Modality in Aneurysmal Subarachnoid Hemorrhage Patients. Neurocrit Care 2019; 29:62-68. [PMID: 29484583 DOI: 10.1007/s12028-018-0506-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Data on new-onset seizures after treatment of aneurysmal subarachnoid hemorrhage (aSAH) patients are limited and variable. We examined the association between new-onset seizures after aSAH and aneurysm treatment modality, as well their relationship with initial clinical severity of aSAH and outcomes. METHODS This is a retrospective cohort study of all aSAH patients admitted to our institution over a 6-year period. 'Seizures' were defined as any observed clinical seizure or electrographic seizure on continuous electroencephalogram (cEEG) recordings, as determined by the reviewing neurophysiologist. Subgroup analyses were performed in low-grade (Hunt-Hess 1-3) and high-grade (Hunt-Hess 4-5) patients. Outcomes measures were Glasgow Coma Score (GCS) at intensive care unit (ICU) discharge and modified Rankin Scale (mRS) at outpatient follow-up. RESULTS There were 282 patients with aSAH; 203 (72.0%) suffered low-grade and 79 (28%) high-grade aSAH. Patients were treated with endovascular coiling (N = 194, 68.8%) or surgical clipping (N = 66, 23.4%). Eighteen (6.4%) patients had seizures, of whom 10 (5.5%) had aneurysm coiling and 7 (10.6%) underwent clipping (p = 0.15). In low-grade patients, seizures occurred less frequently (p = 0.016) and were more common after surgical clipping (p = 0.0089). Seizures correlated with lower GCS upon ICU discharge (p < 0.001), in clipped (p = 0.011) and coiled (p < 0.001) patients and in low-grade aSAH (p < 0.001). Seizures correlated with higher mRS on follow-up (p < 0.001), in clipped (p = 0.032) and coiled (p = 0.004) patients and in low-grade aSAH (p = 0.003). CONCLUSIONS New-onset seizures after aSAH occurred infrequently, and their incidence after aneurysm clipping versus coiling was not significantly different. However, in low-grade patients, new seizures were more frequently associated with clipping than coiling. Additionally, non-convulsive seizures did not occur in low-grade patients treated with coiling. These findings may explain, in part, previous work suggesting better outcomes in coiled patients and encourage physicians to have a lower threshold for cEEG utilization in low-grade patients suspected to have acute seizures after surgical clipping.
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Affiliation(s)
- Baxter B Allen
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Department of Neurology, Weill Cornell Medicine, 525 East 68 Street, F-610, New York, NY, 10065, USA
| | - Peter B Forgacs
- Department of Neurology, Weill Cornell Medicine, 525 East 68 Street, F-610, New York, NY, 10065, USA.,Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.,The Rockefeller University, New York, NY, USA
| | - Malik A Fakhar
- Department of Neurology, Weill Cornell Medicine, 525 East 68 Street, F-610, New York, NY, 10065, USA.,Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Xian Wu
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - Linda M Gerber
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - Srikanth Boddu
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York, NY, USA
| | - Santosh B Murthy
- Department of Neurology, Weill Cornell Medicine, 525 East 68 Street, F-610, New York, NY, 10065, USA.,Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Philip E Stieg
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York, NY, USA
| | - Halinder S Mangat
- Department of Neurology, Weill Cornell Medicine, 525 East 68 Street, F-610, New York, NY, 10065, USA. .,Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York, NY, USA.
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40
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Bao GC, Dillon J, Jannat-Khah D, Besada M, Marianova A, Mathewos A, Dargar S, Gerber LM, Tung J, Lee JI. Tai chi for enhanced inpatient mobilization: A feasibility study. Complement Ther Med 2019; 46:109-115. [PMID: 31519266 DOI: 10.1016/j.ctim.2019.07.020] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/13/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To determine whether utilizing beginner, video-guided tai chi and qigong classes as an adjunct to physical therapy to enhance mobilization among hospitalized patients is feasible and acceptable. DESIGN Single-arm feasibility study over a 15½-week period. SETTING Three medical-surgical units at one hospital. INTERVENTIONS Small-group video-guided beginner-level tai chi and qigong classes supervised by physical therapists occurred three times a week. MAIN OUTCOME MEASURES The primary outcome was weekly class attendance. Secondary outcomes included patient and staff satisfaction, collected by surveys and semi-structured interviews. Process measures included class duration. Balancing measures included falls. RESULTS One-hundred and fifty-seven patients were referred for recruitment, 45 gave informed consent, and 38 patients attended at least one class. The number of weekly class attendees increased during the study period. Based on first-class experience, 68% (26/38) of patients reported enjoying the class "quite a bit" or "extremely," 66% (25/38) of patients reported feeling "more mobile" afterward, and 76% (29/38) of patients agreed that the class made them more comfortable going home. Average class duration was 29 minutes. Zero falls occurred during or immediately following class. CONCLUSIONS Video-guided tai chi and qigong classes are feasible and well-received at our hospital. Future studies of the impact on preserving mobility and function or reducing length of stay are of interest.
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Affiliation(s)
| | | | | | - Melissa Besada
- NewYork-Presbyterian/Lower Manhattan Hospital, New York, NY, USA
| | | | - Ama Mathewos
- NewYork-Presbyterian/Lower Manhattan Hospital, New York, NY, USA
| | | | | | - Judy Tung
- Weill Cornell Medicine, New York, NY, USA
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Weiss P, Myers AL, McGann KA, Mason KE, Kesselheim JC, Fleming G, Barron C, Klasner A, Heyman MB, Weiss DL, Mauer E, Gerber LM, Abramson EL. Funding Sources and Perceived Financial Insecurity in Pediatric Subspecialty Fellowship Programs. Acad Pediatr 2019; 19:815-821. [PMID: 31200029 DOI: 10.1016/j.acap.2019.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 05/24/2019] [Accepted: 06/01/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Shortages of pediatric subspecialists exist in many fields with insufficient recruitment of new fellows. The current system of funding graduate medical education is inadequate. We examined funding sources for trainee salary and educational expenses in pediatric fellowship programs, effects of funding constraints, and program characteristics associated with financial insecurity as reported by fellowship program directors (FPD). METHODS We conducted a national survey of FPD between November 1, 2016 and February 9, 2017. We used multivariable logistic regression to examine the association between perceived financial insecurity, program characteristics, and funding sources for fellow salary. RESULTS We obtained data from 519 FPD, representing 14 different pediatric subspecialties. FPD reported that funding limitations restricted program size and educational resources in 22% and 36% of programs, respectively. Nineteen percent of FPD perceived funding of their program to be insecure. Programs with 7 or more fellows (OR .50 [95% CI .27-.90], P = .03) or hospital or graduate medical education/Children's Hospital graduate medical education funding (OR .58 [95% CI .35-.96], P = .04) were less likely to be perceived as insecure. Conversely, programs with extramural (OR 1.74 [95% CI 1.07-2.81], P = .03) or division funding (OR 1.70 [95% CI 1.02-2.82], P = .04) or in subspecialties with more than 25% unfilled positions or programs (OR 1.86 [95% CI 1.11-3.09], P = .02) were more likely to be perceived as insecure. CONCLUSIONS Perceived financial insecurity of fellowship programs was strongly associated with program size, funding source, and unfilled positions, limiting recruitment and resources. Stable funding of fellowship programs is critical to maintain an adequate pediatric subspecialty workforce.
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Affiliation(s)
- Pnina Weiss
- Yale University School of Medicine (P Weiss), New Haven, Conn.
| | - Angela L Myers
- Children's Mercy Kansas City (AL Myers), Kansas City, Mo
| | | | - Katherine E Mason
- The Warren Alpert Medical School at Brown University (KE Mason and C Barron), Providence, RI
| | | | - Geoffrey Fleming
- Vanderbilt University School of Medicine (G Fleming), Nashville, Tenn
| | - Christine Barron
- The Warren Alpert Medical School at Brown University (KE Mason and C Barron), Providence, RI
| | - Ann Klasner
- University of Alabama at Birmingham (A Klasner), Birmingham, Ala
| | - Melvin B Heyman
- University of California at San Francisco (MB Heyman), San Francisco, Calif
| | | | - Elizabeth Mauer
- Weill Cornell Medicine (E Mauer, LM Gerber, and EL Abramson), New York, NY
| | - Linda M Gerber
- Weill Cornell Medicine (E Mauer, LM Gerber, and EL Abramson), New York, NY
| | - Erika L Abramson
- Weill Cornell Medicine (E Mauer, LM Gerber, and EL Abramson), New York, NY
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Silverstein J, Cortes M, Tsagaris KZ, Climent A, Gerber LM, Oromendia C, Fonzetti P, Ratan RR, Kitago T, Iacoboni M, Wu A, Dobkin B, Edwards DJ. Paired Associative Stimulation as a Tool to Assess Plasticity Enhancers in Chronic Stroke. Front Neurosci 2019; 13:792. [PMID: 31427918 PMCID: PMC6687765 DOI: 10.3389/fnins.2019.00792] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 07/15/2019] [Indexed: 01/08/2023] Open
Abstract
Background and Purpose The potential for adaptive plasticity in the post-stroke brain is difficult to estimate, as is the demonstration of central nervous system (CNS) target engagement of drugs that show promise in facilitating stroke recovery. We set out to determine if paired associative stimulation (PAS) can be used (a) as an assay of CNS plasticity in patients with chronic stroke, and (b) to demonstrate CNS engagement by memantine, a drug which has potential plasticity-modulating effects for use in motor recovery following stroke. Methods We examined the effect of PAS in fourteen participants with chronic hemiparetic stroke at five time-points in a within-subjects repeated measures design study: baseline off-drug, and following a week of orally administered memantine at doses of 5, 10, 15, and 20 mg, comprising a total of seventy sessions. Each week, MEP amplitude pre and post-PAS was assessed in the contralesional hemisphere as a marker of enhanced or diminished plasticity. Strength and dexterity were recorded each week to monitor motor-specific clinical status across the study period. Results We found that MEP amplitude was significantly larger after PAS in baseline sessions off-drug, and responsiveness to PAS in these sessions was associated with increased clinical severity. There was no observed increase in MEP amplitude after PAS with memantine at any dose. Motor threshold (MT), strength, and dexterity remained unchanged during the study. Conclusion Paired associative stimulation successfully induced corticospinal excitability enhancement in chronic stroke subjects at the group level. However, this response did not occur in all participants, and was associated with increased clinical severity. This could be an important way to stratify patients for future PAS-drug studies. PAS was suppressed by memantine at all doses, regardless of responsiveness to PAS off-drug, indicating CNS engagement.
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Affiliation(s)
- Joshua Silverstein
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, United States
| | - Mar Cortes
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Katherine Zoe Tsagaris
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, United States
| | - Alejandra Climent
- Sant Joan de Deu Hospital, Department of Neurology, University of Barcelona, Barcelona, Spain
| | - Linda M Gerber
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, United States
| | - Clara Oromendia
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, United States
| | - Pasquale Fonzetti
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States.,Memory Evaluation and Treatment Service, Burke Rehabilitation Hospital, White Plains, NY, United States
| | - Rajiv R Ratan
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States.,Burke Neurological Institute, White Plains, NY, United States.,Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, United States
| | - Tomoko Kitago
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, United States.,Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Marco Iacoboni
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States.,Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, Los Angeles, CA, United States
| | - Allan Wu
- Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Bruce Dobkin
- Department of Neurology, Geffen School of Medicine, Reed Neurologic Research Center, University of California, Los Angeles, Los Angeles, CA, United States
| | - Dylan J Edwards
- Moss Rehabilitation Research Institute, Elkins Park, PA, United States.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
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Edwards DJ, Cortes M, Rykman-Peltz A, Chang J, Elder J, Thickbroom G, Mariman JJ, Gerber LM, Oromendia C, Krebs HI, Fregni F, Volpe BT, Pascual-Leone A. Clinical improvement with intensive robot-assisted arm training in chronic stroke is unchanged by supplementary tDCS. Restor Neurol Neurosci 2019; 37:167-180. [DOI: 10.3233/rnn-180869] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Dylan J. Edwards
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
- Burke Neurological Institute, White Plains, NY, USA
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
- Edith Cowan University, School of Medical and Health Sciences, Joondalup, Australia
| | - Mar Cortes
- Burke Neurological Institute, White Plains, NY, USA
- Department of PM&R, Weill Cornell Medicine, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Avrielle Rykman-Peltz
- Burke Neurological Institute, White Plains, NY, USA
- Department of PM&R, Weill Cornell Medicine, New York, NY, USA
| | - Johanna Chang
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Jessica Elder
- Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, CT, USA
| | - Gary Thickbroom
- Burke Neurological Institute, White Plains, NY, USA
- Department of PM&R, Weill Cornell Medicine, New York, NY, USA
| | - Juan J. Mariman
- Metropolitan University of Educational Sciences, Santiago, Chile
- University of Chile, Neurosystems Laboratory, Santiago, Chile
| | - Linda M. Gerber
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Division of Biostatistics and Epidemiology, New York, NY, USA
| | - Clara Oromendia
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Division of Biostatistics and Epidemiology, New York, NY, USA
| | - Hermano I Krebs
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Boston, MA, USA
| | - Felipe Fregni
- Department of PM&R, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Bruce T. Volpe
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Alvaro Pascual-Leone
- Department of Neurology, Beth Israel Deaconess Medical Center, Berenson-Allen Center for Noninvasive Brain Stimulation, and Harvard Medical School, Boston, MA, USA
- Institut de Neurorehabilitacio Guttmann, Universitat Autonoma Barcelona, Barcelona, Spain
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Clapper TC, Ching K, Lee JG, Mauer E, Gerber LM, Sobin B, Osorio SN, DiPace JI. A TeamSTEPPS® implementation plan for recently assigned interns and nurses. J Interprof Care 2019; 33:823-827. [PMID: 30628509 DOI: 10.1080/13561820.2019.1566217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Interns and newly assigned nurses are expected to assimilate rapidly and begin functioning as members of interprofessional teams. This mixed-method pilot research assessed the impact of a Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) implementation plan in an urban academic teaching hospital that included a cohort of newly assigned pediatric interns and nurses (N = 23). We collected pre- and post-intervention course knowledge and team performance data from two teams in two separate simulation cases. We also surveyed the learners using an open-ended survey to ask about the value of their interprofessional learning experience. TeamSTEPPS® course knowledge improved from pre- to post-intervention (p < 0.001). Team performance scores were tallied and descriptively compared between pre- and post-intervention. Teams performed higher in both post-intervention simulation cases than in the pre-assessments. Post-intervention groups were assessed scores of 4 and 5 in more areas of the team performance checklist. Knowledge scores were compared between pre- and post- intervention by a Wilcoxon rank-sum test. Median scores improved from 17 to 20 following the intervention. Six themes emerged from the coding process that expressed a learned appreciation for contributing to a culture where the expectation is that team members speak up to support patient safety and other team members. As shown by this pilot research, TeamSTEPPS® training approaches that follow the 4-phase brain-based lesson plan for simulation and include interprofessional membership can be promising for integrating newly assigned members into existing clinical teams.
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Affiliation(s)
- Timothy C Clapper
- Department of Pediatrics, Weill Cornell Medical College, New York, N.Y. USA
| | - Kevin Ching
- Department of Pediatrics, Weill Cornell Medical College, New York, N.Y. USA
| | - Joanna G Lee
- Department of Pediatrics, Weill Cornell Medical College, New York, N.Y. USA
| | - Elizabeth Mauer
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, N.Y. USA
| | - Linda M Gerber
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, N.Y. USA
| | - Brittany Sobin
- W&C Health-PICU, New York-Presbyterian Hospital, New York, N.Y. USA
| | | | - Jennifer I DiPace
- Department of Pediatrics, Weill Cornell Medical College, New York, N.Y. USA
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Buchwald A, Falconer C, Rykman-Peltz A, Cortes M, Pascual-Leone A, Thickbroom GW, Krebs HI, Fregni F, Gerber LM, Oromendia C, Chang J, Volpe BT, Edwards DJ. Robotic Arm Rehabilitation in Chronic Stroke Patients With Aphasia May Promote Speech and Language Recovery (but Effect Is Not Enhanced by Supplementary tDCS). Front Neurol 2018; 9:853. [PMID: 30405512 PMCID: PMC6207995 DOI: 10.3389/fneur.2018.00853] [Citation(s) in RCA: 6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 09/21/2018] [Indexed: 11/17/2022] Open
Abstract
Objective: This study aimed to determine the extent to which robotic arm rehabilitation for chronic stroke may promote recovery of speech and language function in individuals with aphasia. Methods: We prospectively enrolled 17 individuals from a hemiparesis rehabilitation study pairing intensive robot assisted therapy with sham or active tDCS and evaluated their speech (N = 17) and language (N = 9) performance before and after a 12-week (36 session) treatment regimen. Performance changes were evaluated with paired t-tests comparing pre- and post-test measures. There was no speech therapy included in the treatment protocol. Results: Overall, the individuals significantly improved on measures of motor speech production from pre-test to post-test. Of the subset who performed language testing (N = 9), overall aphasia severity on a standardized aphasia battery improved from pre-test baseline to post-test. Active tDCS was not associated with greater gains than sham tDCS. Conclusions: This work indicates the importance of considering approaches to stroke rehabilitation across different domains of impairment, and warrants additional exploration of the possibility that robotic arm motor treatment may enhance rehabilitation for speech and language outcomes. Further investigation into the role of tDCS in the relationship of limb and speech/language rehabilitation is required, as active tDCS did not increase improvements over sham tDCS.
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Affiliation(s)
- Adam Buchwald
- Department of Communicative Sciences and Disorders, New York University, New York, NY, United States
| | - Carolyn Falconer
- Department of Communicative Sciences and Disorders, New York University, New York, NY, United States
| | - Avrielle Rykman-Peltz
- Restorative Neurology Clinic, Burke Neurological Institute, White Plains, NY, United States.,Weill Cornell Medicine, New York City, NY, United States
| | - Mar Cortes
- Restorative Neurology Clinic, Burke Neurological Institute, White Plains, NY, United States.,Weill Cornell Medicine, New York City, NY, United States.,Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Barcelona, Spain
| | - Gary W Thickbroom
- Restorative Neurology Clinic, Burke Neurological Institute, White Plains, NY, United States.,Weill Cornell Medicine, New York City, NY, United States
| | - Hermano Igo Krebs
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Felipe Fregni
- Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, MA, United States
| | - Linda M Gerber
- Weill Cornell Medicine, New York City, NY, United States
| | | | - Johanna Chang
- Center for Biomedical Science, Feinstein Institute for Medical Research, Manhasset, NY, United States
| | - Bruce T Volpe
- Center for Biomedical Science, Feinstein Institute for Medical Research, Manhasset, NY, United States
| | - Dylan J Edwards
- Restorative Neurology Clinic, Burke Neurological Institute, White Plains, NY, United States.,Weill Cornell Medicine, New York City, NY, United States.,Moss Rehabilitation Research Institute, Elkins Park, PA, United States.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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Gerber LM, Sievert LL. Neighborhood disorder, exposure to violence, and perceived discrimination in relation to symptoms in midlife women. Womens Midlife Health 2018; 4:14. [PMID: 30766724 PMCID: PMC6297945 DOI: 10.1186/s40695-018-0043-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 09/21/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Some symptoms at midlife are associated with stress, such as hot flashes, trouble sleeping, headaches, or depressed mood. Hot flashes have been studied in relation to laboratory stressors, physiological biomarkers, and self-reported stress, but less is known about hot flashes in relation to the larger context of women's lives. This study examined the risk of symptoms in relation to neighborhood disorder, exposure to neighborhood violence, social cohesion and perceived discrimination. We hypothesized that women exposed to more negative neighborhood characteristics and discrimination would be more likely to report hot flashes and other midlife symptoms. METHODS Participants were black and white women, aged 40 to 60, drawn from a cross-sectional investigation of race/ethnicity, socioeconomic status, and blood pressure in New York City (n = 139). Demographic information, medical history, menopausal status, and symptoms were measured by questionnaire. Likert scales were used to measure neighborhood characteristics, specifically, the Neighborhood Disorder Scale, the Exposure to Violence Scale, the Perceived Violence Subscale, the Neighborhood Social Cohesion and Trust Scale, and the Everyday Discrimination Scale. Ten symptoms were included in analyses: lack of energy, feeling blue/depressed, backaches, headaches, aches/stiffness in joints, shortness of breath, hot flashes, trouble sleeping, nervous tension, and pins/needles in hands/feet. Each scale with each symptom outcome was examined using logistic regression analyses adjusting for significant covariates. RESULTS Black women reported higher scores on all negative neighborhood characteristics and discrimination, and a lower score on the positive Neighborhood Social Cohesion and Trust. Neighborhood Disorder was associated with feeling blue/depressed, aches/stiffness in joints, and hot flashes, and Perceived Violence was associated with aches/stiffness in joints, after controlling for model-specific covariates. There was a lower risk of backaches with increasing Neighborhood Social Cohesion and Trust score. The Everyday Discrimination Scale was associated with lack of energy. Lack of energy, feeling blue/depressed, aches/stiffness in joints, and hot flashes appeared to be most vulnerable to negative neighborhood context and discrimination. CONCLUSIONS This study adds to the literature linking neighborhood environments to health outcomes. The associations between negative neighborhood contexts and discrimination with diverse symptoms, and the association between social cohesion and back pain, point to the need to expand analyses of stress to multiple physiological systems.
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Affiliation(s)
- Linda M Gerber
- Department of Healthcare Policy & Research, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, 402 E. 67th St., LA-231, New York, NY 10065 USA
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medical College, New York City, NY USA
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Abramson EL, Naifeh MM, Stevenson MD, Mauer E, Hammad HT, Gerber LM, Li STT. Scholarly Activity Training During Residency: Are We Hitting the Mark? A National Assessment of Pediatric Residents. Acad Pediatr 2018; 18:542-549. [PMID: 29448048 DOI: 10.1016/j.acap.2018.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/31/2018] [Accepted: 02/03/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Participation in scholarly activity (SA) is an Accreditation Council for Graduate Medical Education requirement. Our previous research with program directors (PDs) suggests that pediatric SA training is variable and suboptimal. To help programs better meet requirements, our objective was to understand the resident perspective regarding SA training, including factors associated with satisfaction and productivity. METHODS We conducted cross-sectional surveys of second- and third-year pediatric residents and PDs at 22 diverse programs in 2016. Surveys assessed resident demographics, career intentions, program characteristics, beliefs, barriers, satisfaction, and productivity, defined as SA accepted at a regional or national meeting, for publication, or grant funding. Data were analyzed using descriptive statistics and multivariable logistic regression. RESULTS A total of 464 (60.2%) of 771 residents and 22 PDs (100%) responded. Most residents believed that residents should participate in SA (n = 380, 81.9%). However, only 37.9% (n = 175) were extremely or very satisfied with their training. Residents who reported that training to conduct research (adjusted odds ratio [AOR] = 1.9, 95% confidence interval [CI] 1.1-3.5), availability of a research curriculum (AOR = 1.9, 95% CI 1.2-3.1), and adequate faculty mentorship (AOR = 2.5, 95% CI 1.6-4.1) were not barriers were more satisfied. Protected time was associated with satisfaction (AOR = 1.7, 95% CI 1.1-2.7). A total of 43.8% of residents (n = 203) were productive. Productivity was associated with future plans to conduct research (AOR = 3.3, 95% CI 2.1-5.1). CONCLUSIONS Residents believe SA training is important. Dedicated program infrastructure, protected time, and adequate mentorship appear to be crucial to improving quality perceptions.
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Affiliation(s)
- Erika L Abramson
- Departments of Pediatrics and Healthcare Policy & Research, Weill Cornell Medicine, New York, NY.
| | - Monique M Naifeh
- Department of Pediatrics, University of Oklahoma, Oklahoma City, Okla
| | | | - Elizabeth Mauer
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY
| | - Hoda T Hammad
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY
| | - Linda M Gerber
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY
| | - Su-Ting T Li
- Department of Pediatrics, University of California, Davis, Davis, Calif
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Gregory NS, Seley JJ, Dargar SK, Galla N, Gerber LM, Lee JI. Strategies to Prevent Readmission in High-Risk Patients with Diabetes: the Importance of an Interdisciplinary Approach. Curr Diab Rep 2018; 18:54. [PMID: 29931547 DOI: 10.1007/s11892-018-1027-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Patients with diabetes are known to have higher 30-day readmission rates compared to the general inpatient population. A number of strategies have been shown to be effective in lowering readmission rates. RECENT FINDINGS A review of the current literature revealed several strategies that have been associated with a decreased risk of readmission in high-risk patients with diabetes. These strategies include inpatient diabetes survival skills education and medication reconciliation prior to discharge to send the patient home with the "right" medications. Other key strategies include scheduling a follow-up phone call soon after discharge and an office visit to adjust the diabetes regimen. The authors identified the most successful strategies to reduce readmissions as well as some institutional barriers to following a transitional care program. Recent studies have identified risk factors in the diabetes population that are associated with an increased risk of readmission as well as interventions to lower this risk. A standardized transitional care program that focuses on providing interventions while reducing barriers to implementation can contribute to a decreased risk of readmission.
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Affiliation(s)
- Naina Sinha Gregory
- Department of Medicine, Division of Endocrinology, Weill Cornell Medicine, 211 East 80th Street, New York, NY, 10075, USA.
| | - Jane J Seley
- Division of Nursing, NewYork-Presbyterian Hospital, New York, NY, USA
- Weill Cornell Medicine, 413 East 69 Street, Box 55 Baker Bldg., Room F2025, New York, NY, 10021, USA
| | - Savira Kochhar Dargar
- Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, 1330 York Avenue, Baker F2020, New York, NY, 10065, USA
| | - Naveen Galla
- Weill Cornell Medical College, 420 East 70th Street, Apt 7N1, New York, NY, 10021, USA
| | - Linda M Gerber
- Department of Healthcare Policy and Research, Weill Cornell Medical College, 402 East 67th Street, New York, NY, 10065, USA
| | - Jennifer I Lee
- Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, 1330 York Avenue, Baker F2020, New York, NY, 10065, USA
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Traube C, Ariagno S, Thau F, Rosenberg L, Mauer EA, Gerber LM, Pritchard D, Kearney J, Greenwald BM, Silver G. Delirium in Hospitalized Children with Cancer: Incidence and Associated Risk Factors. J Pediatr 2017; 191:212-217. [PMID: 29173309 DOI: 10.1016/j.jpeds.2017.08.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/10/2017] [Accepted: 08/16/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess the incidence of delirium and its risk factors in hospitalized children with cancer. STUDY DESIGN In this cohort study, all consecutive admissions to a pediatric cancer service over a 3-month period were prospectively screened for delirium twice daily throughout their hospitalization. Demographic and treatment-related data were collected from the medical record after discharge. RESULTS A total of 319 consecutive admissions, including 186 patients and 2731 hospital days, were included. Delirium was diagnosed in 35 patients, for an incidence of 18.8%. Risk factors independently associated with the development of delirium included age <5 years (OR = 2.6, P = .026), brain tumor (OR = 4.7, P = .026); postoperative status (OR = 3.3, P = .014), and receipt of benzodiazepines (OR = 3.7,P < .001). Delirium was associated with increased hospital length of stay, with median length of stay for delirious patients of 10 days compared with 5 days for patients who were not delirious during their hospitalization (P < .001). CONCLUSIONS In this cohort, delirium was a frequent complication during admissions for childhood cancer, and was associated with increased hospital length of stay. Multi-institutional prospective studies are warranted to further characterize delirium in this high-risk population and identify modifiable risk factors to improve the care provided to hospitalized children with cancer.
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Affiliation(s)
| | | | | | | | | | | | | | - Julia Kearney
- Memorial Sloan Kettering Cancer Center, New York, NY
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James GD, Gerber LM. Measuring arterial blood pressure in humans: Auscultatory and automatic measurement techniques for human biological field studies. Am J Hum Biol 2017; 30. [PMID: 28940503 DOI: 10.1002/ajhb.23063] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/11/2017] [Accepted: 08/29/2017] [Indexed: 01/05/2023] Open
Abstract
Human biologists have been examining arterial blood pressure since they began studying the effects of the environment and culture on the health of diverse populations. The Korotkoff auscultatory technique with a trained observer and aneroid sphygmomanometer is the method of choice for blood pressure measurement in many bioanthropological field contexts. Korotkoff sounds (the first and fifth phases) are the preferred determinants of systolic and diastolic pressure, even in infants, children, pregnant women, and the elderly. Training of observers, positioning of individuals, and selection of cuff size are all essential for obtaining standardized measurements. Automatic electronic devices are increasingly being used for blood pressure measurement in human biological studies. The automatic monitors often use the oscillometric method for measuring pressure, but must be validated before use. The emergence of automatic ambulatory blood pressure monitors has opened another avenue of research on blood pressure in human biology, where allostasis and circadian responses to environmental change and real life behavioral challenges can be defined and evaluated, largely because there is now the ability to make multiple measurements over time and in varying contexts. Stand-alone automatic monitors can also be substituted for manual auscultated readings in field contexts, although in studies where participants measure their own pressure, education about how the devices work and protocol specifics are necessary. Finally, computer-driven plethysmographic devices that measure pressure in the finger are available to evaluate short-term reactivity to specific challenges.
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Affiliation(s)
- Gary D James
- Department of Anthropology and Decker School of Nursing, Binghamton University, Binghamton, New York 13902
| | - Linda M Gerber
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, and Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medical College, New York, NY 10065
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