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Burek AG, Davis MB, Pechous B, Shaughnessy EE, Meier KA, Mooney S, Woodruff D, Bruner M, Piper L, Liegl M, Pan A, Brousseau DC, Ullman AJ. Inappropriate Use of Peripherally Inserted Central Catheters in Pediatrics: A Multisite Study. Hosp Pediatr 2024; 14:180-188. [PMID: 38404202 PMCID: PMC10896745 DOI: 10.1542/hpeds.2023-007518] [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] [Accepted: 12/22/2023] [Indexed: 02/27/2024]
Abstract
OBJECTIVES This study aimed to describe how the current practice of peripherally inserted central catheter (PICC) use in hospitalized children aligns with the Michigan Appropriateness Guide for Intravenous Catheters (miniMAGIC) in Children recommendations, explore variation across sites, and describe the population of children who do not receive appropriate PICCs. METHODS A retrospective study was conducted at 4 children's hospitals in the United States. Children with PICCs placed January 2019 to December 2021 were included. Patients in the NICU were excluded. PICCs were categorized using the miniMAGIC in Children classification as inappropriate, uncertain appropriateness and appropriate. RESULTS Of the 6051 PICCs identified, 9% (n = 550) were categorized as inappropriate, 9% (n = 550) as uncertain appropriateness, and 82% (n = 4951) as appropriate. The number of PICCs trended down over time, but up to 20% of PICCs each year were not appropriate, with significant variation between sites. Within inappropriate or uncertain appropriateness PICCs (n = 1100 PICC in 1079 children), median (interquartile range) patient age was 4 (0-11) years, 54% were male, and the main reason for PICC placement was prolonged antibiotic course (56%, n = 611). The most common admitting services requesting the inappropriate/uncertain appropriateness PICCs were critical care 24%, general pediatrics 22%, and pulmonary 20%. Complications resulting in PICC removal were identified in 6% (n = 70) of inappropriate/uncertain PICCs. The most common complications were dislodgement (3%) and occlusion (2%), with infection and thrombosis rates of 1% (n = 10 and n = 13, respectively). CONCLUSIONS Although the majority of PICCs met appropriateness criteria, a substantial proportion of PICCs were deemed inappropriate or of uncertain appropriateness, illustrating an opportunity for quality improvement.
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Affiliation(s)
- Alina G. Burek
- Children’s Wisconsin, Milwaukee, Wisconsin
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mary Beth Davis
- University of Iowa Stead Family Childrens Hospital, Iowa City, Iowa
- University of Iowa College of Nursing, Iowa City, Iowa
| | - Brittany Pechous
- University of Iowa Stead Family Childrens Hospital, Iowa City, Iowa
| | - Erin E. Shaughnessy
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Katie A. Meier
- Department of Pediatrics, University of Cincinnati College of Medicine, and Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Sarah Mooney
- Children’s Wisconsin, Milwaukee, Wisconsin
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dana Woodruff
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Meaghan Bruner
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Laura Piper
- Department of Pediatrics, University of Cincinnati College of Medicine, and Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Melodee Liegl
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amy Pan
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David C. Brousseau
- Department of Pediatrics, Nemours Children’s Health Delaware and the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Amanda J. Ullman
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Children’s Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
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Minaglia S, Liegl M. Moonless night sky increases Isistius species (cookiecutter shark) and live human contact. PLoS One 2024; 19:e0291852. [PMID: 38381731 PMCID: PMC10880985 DOI: 10.1371/journal.pone.0291852] [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] [Received: 09/06/2023] [Accepted: 01/18/2024] [Indexed: 02/23/2024] Open
Abstract
The nocturnal feeding behavior and zoogeographical habitat of cookiecutter sharks Isistius brasiliensis and Isistius plutodus (Isistius spp.) greatly reduces interaction of this species with live humans. Attacks on live humans are exceedingly rare with 7 cases reported worldwide, 6 of them in Hawai'i, and 5 of these occuring among channel swimmers. Published research suggests that periods of bright moonlight may increase Isistius spp. contact with live humans and does not otherwise identify significant trends or risk factors. Yet 5 of the 6 Isistius spp. bites on live humans in Hawai'ian waters occurred with the moon set and after nautical twilight end and before nautical twilight start. From 1961-2023 in Hawai'i, 129 successful solo channel crosses and 5 Isistius spp. related injuries in the habitat of cookiecutter sharks were analyzed across two groups: one where both the moon and sun were set (dark group) and one where the moon and/or sun was in the sky (light group). There was a significant difference for swimmers bitten by Isistius spp. in the dark 4 (12%) versus light groups 1 (1%), p = 0.012, RR 12.6 (95% confidence interval: 1.5-108.9). Swim start time and year was also significant (Pearson correlation 0.566, p <0.001). Swimmer gender and use of shark deterrent devices and artificial illumination were not significant. The growing popularity of channel swimming in Hawai'i and swim start times have contributed to an increasing likelihood of live human and Isistius spp. contact and a moonless night sky is a significant risk factor for this interaction.
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Affiliation(s)
- Steven Minaglia
- Division of Urogynecology, Department of Obstetrics & Gynecology, Queen’s University Medical Group and John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, United States of America
| | - Melodee Liegl
- Departments of Pediatrics, Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
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Jacobs ER, Ross GR, Padilla N, Pan AY, Liegl M, Puzyrenko A, Lai S, Dai Q, Uche N, Rubenstein JC, North PE, Ibrahim ESH, Sun Y, Felix JC, Rui H, Benjamin IJ. Profibrotic COVID-19 subphenotype exhibits enhanced localized ER-dependent HSP47 + expression in cardiac myofibroblasts in situ. J Mol Cell Cardiol 2023; 185:1-12. [PMID: 37839656 PMCID: PMC11000691 DOI: 10.1016/j.yjmcc.2023.10.006] [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: 07/24/2023] [Revised: 09/07/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Abstract
We recently described a subgroup of autopsied COVID-19 subjects (∼40%), termed 'profibrotic phenotype,' who exhibited clusters of myofibroblasts (Mfbs), which were positive for the collagen-specific chaperone heat shock protein 47 (HSP47+) in situ. This report identifies increased, localized (hot spot restricted) expression of αSMA, COLα1, POSTN and FAP supporting the identity of HSP47+ cells as myofibroblasts and characterizing a profibrotic extracellular matrix (ECM) phenotype. Coupled with increased GRP78 in COVID-19 subjects, these data could reflect induction of the unfolded protein response for mitigation of proteostasis (i.e., protein homeostasis) dysfunction in discrete clusters of cells. ECM shifts in selected COVID-19 subjects occur without significant increases in either global trichrome positive staining or myocardial injury based quantitively on standard H&E scoring. Our findings also suggest distinct mechanism(s) for ECM remodeling in the setting of SARS-CoV-2 infection. The ratio of CD163+/CD68+ cells is increased in hot spots of profibrotic hearts compared with either controls or outside of hot spots in COVID-19 subjects. In sum, matrix remodeling of human COVID-19 hearts in situ is characterized by site-restricted profibrotic mediated (e.g., HSP47+ Mfbs, CD163+ Mφs) modifications in ECM (i.e., COLα1, POSTN, FAP), with a strong correlation between COLα1 and HSP47+cells within hot spots. Given the established associations of viral infection (e.g., human immunodeficiency virus; HIV), myocardial fibrosis and sudden cardiac death, early screening tools (e.g., plasma biomarkers, noninvasive cardiac magnetic resonance imaging) for diagnosis, monitoring and treatment of fibrotic ECM remodeling are warranted for COVID-19 high-risk populations.
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Affiliation(s)
- Elizabeth R Jacobs
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, United States of America; Clement J. Zablocki VA Medical Center, Milwaukee, WI, United States of America
| | - Gracious R Ross
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Nathan Padilla
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Amy Y Pan
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States of America; Children's Research Institute, Milwaukee, WI, United States of America
| | - Melodee Liegl
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States of America; Children's Research Institute, Milwaukee, WI, United States of America
| | - Andrii Puzyrenko
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Shuping Lai
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Qiang Dai
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Nnamdi Uche
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Jason C Rubenstein
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Paula E North
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States of America; Children's Research Institute, Milwaukee, WI, United States of America
| | - El-Sayed H Ibrahim
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Yunguang Sun
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Juan C Felix
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Hallgeir Rui
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Ivor J Benjamin
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Cell Biology, Neuroanatomy and Anatomy, Medical College of Wisconsin, Milwaukee, WI, United States of America.
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Melamed S, Lee J, Bryant A, Choi R, Liegl M, Pan A. Pediatric COVID-19 Hospitalizations During the Omicron Surge. WMJ 2023; 122:342-345. [PMID: 38180921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
BACKGROUND Treatment recommendations for children hospitalized with COVID-19 during the winter 2021-2022 omicron variant surge included remdesivir and dexamethasone for hypoxia and remdesivir for patients at risk of severe illness, including those with comorbidities. The omicron variant caused many otherwise-healthy children without hypoxia to be hospitalized for common viral syndromes like croup. This study aimed to characterize children hospitalized with COVID-19 during the omicron surge and describe their management and clinical trajectory. METHODS This single-center retrospective study included patients under 19 years old with a COVID-19 discharge diagnosis on the Pediatric Hospital Medicine service in January and February 2022. Hypoxia was defined by sustained oxygen saturation greater than 90%. Primary outcome was return to emergency department or readmission within 14 days. Secondary outcomes were length of stay, multisystem inflammatory syndrome within 6 weeks, and death. RESULTS During the study time frame, 111 children were hospitalized with COVID-19, including 35 who had an incidental COVID-19 result. In the remaining 76 patients, the median length of stay was 1.9 days (1.0 - 3.3). Eight patients (11%) returned to the emergency department or were readmitted within 14 days of discharge; 3 of the emergency department visits were related to ongoing COVID-19 infection. Of the 10 patients with croup, 1 received remdesivir due to prolonged illness, and none returned to the emergency department or were readmitted. DISCUSSION Most children hospitalized with COVID-19 were young, previously healthy and unvaccinated for COVID-19 due to age-based ineligibility. Hypoxia was the most common indication for use of remdesivir/corticosteroids (25%). Return to the emergency department for ongoing COVID-19 symptoms was uncommon (4%). Patients with croup, a presentation seen more commonly with the omicron variant than previously, appeared to do well without remdesivir.
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Affiliation(s)
- Svetlana Melamed
- Children's Minnesota, Section of Hospital Medicine, Minneapolis, Minnesota,
| | | | | | | | | | - Amy Pan
- Medical College of Wisconsin, Milwaukee, Wisconsin
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Ulschmid CM, Patel J, Pan AY, Liegl M, Holland KE. Intralesional measles, mumps, and rubella vaccine after failure of intralesional Candida antigen for the treatment of recalcitrant pediatric warts. Pediatr Dermatol 2023; 40:1057-1059. [PMID: 37596908 DOI: 10.1111/pde.15415] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/25/2023] [Indexed: 08/21/2023]
Abstract
Numerous studies have investigated the efficacy of intralesional immunotherapy for warts, but there are a lack of studies investigating the efficacy of alternative intralesional immunotherapies following failure of initial intralesional immunotherapy. In this retrospective study, we aimed to investigate the efficacy of intralesional measles, mumps, and rubella vaccine for the treatment of pediatric warts following failure of intralesional therapy with Candida antigen. Following intralesional measles, mumps, and rubella vaccine administration, 8/51 (15.5%) patients had complete resolution of their warts, 6/51 (12%) had near complete resolution, 19/51 (37%) had partial improvement, 12/51 (23.5%) had no change, and 6/51 (12%) had worsening. Although limited by retrospective nature and low sample size, our results demonstrate that intralesional immunotherapy with measles, mumps, and rubella vaccine provides an alternative therapeutic option for the treatment of recalcitrant pediatric warts in patients who fail to respond to intralesional Candida antigen.
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Affiliation(s)
- Caden M Ulschmid
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jay Patel
- Department of Dermatology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Amy Y Pan
- Departments of Pediatrics, Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Melodee Liegl
- Departments of Pediatrics, Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kristen E Holland
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Gumm A, Ginde S, Hoffman G, Liegl M, Mack C, Simpson P, Vo N, Telega G, Vitola B, Chugh A. Does High-Intensity Exercise Cause Acute Liver Injury in Patients with Fontan Circulation? A Prospective Pilot Study. Pediatr Cardiol 2023:10.1007/s00246-023-03193-y. [PMID: 37219588 DOI: 10.1007/s00246-023-03193-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023]
Abstract
The Fontan procedure results in chronic hepatic congestion and Fontan-associated liver disease (FALD) characterized by progressive liver fibrosis and cirrhosis. Exercise is recommended in this population, but may accelerate the progression of FALD from abrupt elevations in central venous pressure. The aim of this study was to assess if acute liver injury occurs after high-intensity exercise in patients with Fontan physiology. Ten patients were enrolled. Nine had normal systolic ventricular function and one had an ejection fraction < 40%. During cardiopulmonary exercise testing, patients had near-infrared spectroscopy (NIRS) to measure oxygen saturation of multiple organs, including the liver, and underwent pre- and post-exercise testing with liver elastography, laboratory markers, and cytokines to assess liver injury. The hepatic and renal NIRS showed a statistically significant decrease in oxygenation during exercise, and the hepatic NIRS had the slowest recovery compared to renal, cerebral, and peripheral muscle NIRS. A clinically significant increase in shear wave velocity occurred after exercise testing only in the one patient with systolic dysfunction. There was a statistically significant, albeit trivial, increase in ALT and GGT after exercise. Fibrogenic cytokines traditionally associated with FALD did not increase significantly in our cohort; however, pro-inflammatory cytokines that predispose to fibrogenesis did significantly rise during exercise. Although patients with Fontan circulation demonstrated a significant reduction in hepatic tissue oxygenation based on NIRS saturations during exercise, there was no clinical evidence of acute increase in liver congestion or acute liver injury following high-intensity exercise.
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Affiliation(s)
- Alexis Gumm
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
- Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Salil Ginde
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - George Hoffman
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Melodee Liegl
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Cara Mack
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nghia Vo
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Grzegorz Telega
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Bernadette Vitola
- Department of Pediatrics, MedStar Georgetown University Hospital, Georgetown, WA, USA
| | - Ankur Chugh
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
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Burek AG, Tregoning G, Pan A, Liegl M, Harris GJ, Havens PL. Pediatric Orbital Cellulitis/Abscess: Microbiology and Pattern of Antibiotic Prescribing. WMJ 2023; 122:52-55. [PMID: 36940123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
INTRODUCTION The treatment for pediatric orbital cellulitis/abscess is trending towards intravenous antibiotic management alone in appropriate cases. Without cultures to guide therapy, knowing the local microbiology is of utmost importance in managing these patients. METHODS We conducted a retrospective case series for patients age 2 months to 17 years, who were hospitalized between January 1, 2013, and December 31, 2019, to evaluate the local microbiology and pattern of antibiotic prescribing in pediatric orbital cellulitis. RESULTS AND DISCUSSION Of 95 total patients, 69 (73%) received intravenous antibiotics only and 26 (27%) received intravenous antibiotics plus surgery. The most common organism cultured was Streptococcus anginosus, followed by Staphylococcus aureus, and group A streptococcus. Methicillin-resistant Staphylococcus aureus (MRSA) prevalence was 9%. MRSA-active antibiotics remain the most frequently used antibiotics.
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Affiliation(s)
- Alina G Burek
- Children's Wisconsin, Milwaukee, Wisconsin
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin,
| | - Geanina Tregoning
- Children's Wisconsin, Milwaukee, Wisconsin
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amy Pan
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Melodee Liegl
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gerald J Harris
- Children's Wisconsin, Milwaukee, Wisconsin
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Peter L Havens
- Children's Wisconsin, Milwaukee, Wisconsin
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
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Titus L, Kosasih M, Liegl M, Pan A, Porada K, McFadden V. Adolescent Drug Ingestions Requiring ICU Stay: Single-Center Retrospective Cohort Study. Pediatr Crit Care Med 2023; 24:e128-e136. [PMID: 36728853 DOI: 10.1097/pcc.0000000000003148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Ingestions are a prevalent form of self-harm in teenagers and are unfortunately an increasingly common reason for admission to both acute care and critical care services. The goal of this study was to identify characteristics associated with requiring PICU stay among adolescents hospitalized for ingestions. DESIGN Retrospective cohort study comparing patients admitted to hospital medicine service and critical care service from January 2019 to December 2019. SETTING Freestanding children's hospital in the midwestern United States. PATIENTS Adolescents 12-18 years old hospitalized for ingestion. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Out of 209 patients included in the study cohort, 95 required PICU admission. High-risk behaviors (having had sex or usage of alcohol, drugs, tobacco, or vaping) were endorsed by 190 of 209 patients (91%). We compared patient characteristics, ingestion history, workup, and pharmacological and PICU-specific interventions between patients hospitalized on the hospital medicine service and the PICU. We failed to identify an association between reason for ingestion, substance ingested, and previously identified suicide risk factors including previous suicide attempt, previous self-harm, and psychiatric comorbidity and admission to PICU, as opposed to non-PICU admission. PICU stay was associated with longer peak corrected QT interval value, receiving a pharmacological intervention, and longer duration of hospital stay. Fifteen of 95 patients (16% [95% CI, 9-25%]) in the PICU received a PICU-specific intervention. CONCLUSIONS We failed to identify specific patient demographics or mental behavioral health characteristics associated with PICU stay after ingestion. Therefore, we believe that all adolescents hospitalized due to ingestion-irrespective of disposition-should receive standardized high-risk behavior screening due to the pervasive nature of these behaviors among this patient population. PICU-specific care, beyond observation, could be needed in as high as one-in-four PICU admissions. Further research is needed to inform optimal disposition and resource allocation for this patient population.
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Affiliation(s)
- Lauren Titus
- Section of Hospital Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Matthew Kosasih
- Combined Anesthesiology and Pediatrics Residency Program, The Johns Hopkins Hospital, Baltimore, MD
| | - Melodee Liegl
- Section of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Amy Pan
- Section of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Kelsey Porada
- Section of Hospital Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Vanessa McFadden
- Section of Hospital Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
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Wilcox KA, Redmon V, Seybold A, Cruz M, Pan A, Liegl M, Cohen S. CARDIOVASCULAR DISEASE IN PREGNANCY: THE IMPACT OF MODE OF DELIVERY ON MATERNAL AND NEONATAL OUTCOMES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02659-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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10
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Mehta S, Porada K, Liegl M, Pan A, McFadden V. After "The Talk": Adolescents' Perspectives Reveal Need for Improvement in Hospital Sexual Health Care Delivery. Hosp Pediatr 2023; 13:147-155. [PMID: 36710648 DOI: 10.1542/hpeds.2022-006580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To fill access gaps for adolescents, addressing sexual and reproductive health (SRH) is recommended in nontraditional settings. In previous improvement work, we increased documentation of sexual history to >80% of adolescents hospitalized on our pediatric hospital medicine (PHM) service. This study assessed adolescents' perception of SRH conversations with hospital providers and the extent to which they were helpful. METHODS Postdischarge survey of patients 13 to 17 years discharged from the PHM service at an academic children's hospital between August 2019 and March 2020. Survey items included demographics; whether confidential discussion of sexual health topics such as contraception, sexually transmitted infection (STI), and sexual orientation occurred; perceptions of these discussions, and sexual history. RESULTS Eighty-three patients enrolled and 44 (53%) completed the survey after discharge. A total of 68% of respondents were female and median age was 15 years (interquartile range 14-16). A total of 77% reported discussing SRH privately with a PHM provider. A total of 18% recalled discussing condoms, and 63% rated the discussion helpful. A total of 27% of females reported discussing birth control, and 40% rated it helpful. A total of 57% recalled discussing sexual orientation, and 40% rated it helpful. None reported discussions of STI testing with PHM. Of the 23% who were sexually active, none reported being given condoms. CONCLUSIONS Analysis of adolescent patient experiences identified opportunities for continued improvement in the content and quality of SRH discussions, specifically regarding offering STI testing, condom distribution, and sexual orientation conversations. Our work highlights the importance of incorporating patient-reported data into improvement work to ensure providers are addressing targeted gaps in adolescent care.
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Affiliation(s)
- Sonia Mehta
- Department of Pediatric Emergency Medicine, University of California San Francisco Benioff Children's Hospitals, San Francisco, California
| | - Kelsey Porada
- Department of Pediatrics, Sections of Hospital Medicine
| | - Melodee Liegl
- Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amy Pan
- Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
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Cardinale B, Zembles TN, Ray K, Bushee G, Liegl M, Simpson P, Mitchell M. Retrospective Comparison of Cefdinir, Cephalexin, and Sulfamethoxazole-Trimethoprim in the Treatment of Outpatient Pediatric Urinary Tract Infections. Clin Pediatr (Phila) 2023; 62:47-54. [PMID: 35861216 DOI: 10.1177/00099228221112055] [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: 11/16/2022]
Abstract
This retrospective single-center study included children aged 2 months to 18 years who were prescribed an oral antibiotic for microbiologically confirmed urinary tract infection (UTI). The primary outcomes were re-encounter to the hospital, emergency department, or urgent care within 30 days and modification of the antibiotic regimen within 14 days. Development of Clostridioides difficile (C difficile) infection or new allergic reaction to the antibiotic prescribed was the secondary outcome. The sample included 2685 children. Rates of re-encounter were similar regardless of the initial antibiotic prescribed (P = .88), and patients who received cefdinir had a lower rate of medication changes (5%) compared with both cephalexin (14%) and sulfamethoxazole-trimethoprim (15%) (P ≤ .001). The most common reason for medication change was susceptibility interpretation. Given its low side-effect profile and narrow spectrum compared with the alternatives, cephalexin appears to be a reasonable choice as first-line therapy for the treatment of uncomplicated pediatric UTI.
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Affiliation(s)
| | - Tracy N Zembles
- Children's Wisconsin, Department of Enterprise Safety, Milwaukee, WI, USA
| | - Katie Ray
- Children's Wisconsin, Department of Enterprise Safety, Milwaukee, WI, USA
| | - Glenn Bushee
- Children's Wisconsin, Department of Enterprise Safety, Milwaukee, WI, USA
| | - Melodee Liegl
- Medical College of Wisconsin, Department of Quantitative Health Sciences, Milwaukee, WI, USA
| | - Pippa Simpson
- Medical College of Wisconsin, Department of Quantitative Health Sciences, Milwaukee, WI, USA
| | - Michelle Mitchell
- Medical College of Wisconsin, Department of Pediatrics, Milwaukee, WI, USA
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Lerret SM, Schiffman R, White-Traut R, Medoff-Cooper B, Ahamed SI, Adib R, Liegl M, Alonso E, Mavis A, Jensen K, Peterson CG, Neighbors K, Riordan MK, Semp MC, Vo T, Stendahl G, Chapman S, Unteutsch R, Simpson P. Feasibility and Acceptability of a mHealth Self-Management Intervention for Pediatric Transplant Families. West J Nurs Res 2022; 44:955-965. [PMID: 34154460 PMCID: PMC8688578 DOI: 10.1177/01939459211024656] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 11/15/2022]
Abstract
Families of pediatric solid organ transplant recipients need ongoing education and support in the first 30 days following hospital discharge for the transplantation. The purpose of this report is to describe the feasibility, acceptability, and preliminary efficacy of a mHealth family-self management intervention, (myFAMI), designed to improve post-discharge outcomes of coping, family quality of life, self-efficacy, family self-management, and utilization of health care resources. We enrolled 46 primary family members. myFAMI was feasible and acceptable; 81% (n=17/21) of family members completed the app at least 24/30 days (goal 80% completion rate). Family members generated 134 trigger alerts and received a nurse response within the goal timeframe of < 2 h 99% of the time. Although there were no significant differences between groups, primary outcomes were in the expected direction. The intervention was well received and is feasible for future post-discharge interventions for families of children who receive an organ transplant.
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Affiliation(s)
- Stacee M Lerret
- Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel Schiffman
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Rosemary White-Traut
- Department of Nursing Research, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Barbara Medoff-Cooper
- College of Nursing, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sheikh Iqbal Ahamed
- Department of Mathematics, Statistics, and Computer Science, Marquette University, Milwaukee, WI, USA
| | - Riddhiman Adib
- Department of Mathematics, Statistics, and Computer Science, Marquette University, Milwaukee, WI, USA
| | - Melodee Liegl
- Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Estella Alonso
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Alisha Mavis
- Pediatric Gastroenterology, Hepatology and Nutrition, Duke University Medical Center, Durham, NC
| | - Kyle Jensen
- Pediatric Gastroenterology, Hepatology and Nutrition, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Caitlin G Peterson
- Pediatric Nephrology and Hypertension, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Katie Neighbors
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Mary K Riordan
- Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Melissa C Semp
- Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Truc Vo
- Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Gail Stendahl
- Pediatric Heart Transplant Program, Children's Wisconsin, Milwaukee, WI, USA
| | - Shelley Chapman
- Pediatric Nephrology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel Unteutsch
- Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Pippa Simpson
- Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
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Bradley WH, Hayes MP, Taylor N, Rader JS, Bishop E, Hopp E, McAlarnen LA, Liegl M, Simpson P, Uyar D. An open label, nonrandomized, multisite phase II trial combining bevacizumab, atezolizumab, and rucaparib for the treatment of previously treated recurrent and progressive endometrial cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5510 Background: Patients with metastatic recurrent endometrial cancer have limited effective therapies. Single agent pembrolizumab is utilized in mismatch repair deficient (MMRd) patients, while the combination of lenvatinib and pembrolizumab is now more commonly used in MMR intact patients who have progressed after chemotherapy combinations. This trial investigated a novel three drug regimen. Methods: Patients with recurrent endometrial cancer not amenable to curative intent surgery or radiation after one or two lines of therapy were eligible regardless of histology. This study is a multicenter, open-label, nonrandomized phase II trial. All subjects initially received the three-drug combination of rucaparib, bevacizumab, and atezolizumab. The primary goal of this trial was to estimate the overall response rate in these patients, and secondarily to estimate the progression-free and overall survival of patients treated with this triplet combination. Total enrollment was 30, with the first six subjects participated in a safety lead-in. Treatments until progression, toxicity, or clinician choice. Subjects could continue past progression if, in the estimate of the treating clinician and subject, clinical benefit was being provided. Subjects were eligible for analysis if they received at least one cycle and had one post-dose tumor assessment. The ORR assumption was 27% with a lower bound of 14%. Results: 30 subjects were enrolled between 07/2019 and 06/2021. Of these 26 were evaluable. Median follow up at cut off was 14.9 months. 23 subjects had clinical benefit, with 1 (4%) with CR, 9 (39%) with PR, and 13 (57%) with stable disease as best response. Overall median event-free (progression or death) was 5.3 (95% CI 2.7-7.9) months and overall survival 13.3 (95% CI NA) months at cut off. Median duration of therapy was 4.4 months (IQR 1.7-7.3), with 4 subjects remaining on study directed therapy at data cut off. Histology distribution was 50% serous, 20% endometrioid, and 13% carcinosarcoma. 19 pts were White, 8 African American, 2 identified as Asian, 1 unknown. In the MMR deficient patients, event-free probability was 11.9 months. Grade 3 or 4 treatment related adverse events occurred in 50% patients. Conclusions: To our knowledge, this trial represents the first use of a non-chemotherapy-based triplet therapy for recurrent endometrial cancer. The combination of rucaparib, bevacizumab, and atezolizumab may safely be used to treat recurrent/persistent endometrial cancer. This combination demonstrates clinically meaningful improvement in response, with acceptable toxicity. Enhanced response to therapy was seen in MMR deficient subjects. Clinical trial information: NCT03694262.
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Affiliation(s)
| | - Monica Prasad Hayes
- Mount Sinai Medical Center, Department of Gynecologic Oncology, New York, NY
| | | | - Janet Sue Rader
- Froedtert and the Medical College of Wisconsin, Milwaukee, WI
| | - Erin Bishop
- Froedtert and the Medical College of Wisconsin, Milwaukee, WI
| | - Elizabeth Hopp
- Froedtert and the Medical College of Wisconsin, Milwaukee, WI
| | | | - Melodee Liegl
- Quantitative Health Sciences, Medical College of Wiscosin, Milwaukee, WI
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Reichold A, Liegl M, Brenner S, Förster-Fromme K, Bergheim I, Bischoff S. PP051-SUN ORAL BIFIDOBACTERIUM ADOLESCENTIS SUPPLEMENTATION ATTENUATED DIET-INDUCED NONALCOHOLIC STEATOHEPATITIS (NASH) IN MICE. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60096-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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