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Friligkou E, Løkhammer S, Cabrera-Mendoza B, Shen J, He J, Deiana G, Zanoaga MD, Asgel Z, Pilcher A, Di Lascio L, Makharashvili A, Koller D, Tylee DS, Pathak GA, Polimanti R. Gene Discovery and Biological Insights into Anxiety Disorders from a Multi-Ancestry Genome-wide Association Study of >1.2 Million Participants. medRxiv 2024:2024.02.14.24302836. [PMID: 38405718 PMCID: PMC10889004 DOI: 10.1101/2024.02.14.24302836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
We leveraged information from more than 1.2 million participants to investigate the genetics of anxiety disorders across five continental ancestral groups. Ancestry-specific and cross-ancestry genome-wide association studies identified 51 anxiety-associated loci, 39 of which are novel. Additionally, polygenic risk scores derived from individuals of European descent were associated with anxiety in African, Admixed-American, and East Asian groups. The heritability of anxiety was enriched for genes expressed in the limbic system, the cerebral cortex, the cerebellum, the metencephalon, the entorhinal cortex, and the brain stem. Transcriptome- and proteome-wide analyses highlighted 115 genes associated with anxiety through brain-specific and cross-tissue regulation. We also observed global and local genetic correlations with depression, schizophrenia, and bipolar disorder and putative causal relationships with several physical health conditions. Overall, this study expands the knowledge regarding the genetic risk and pathogenesis of anxiety disorders, highlighting the importance of investigating diverse populations and integrating multi-omics information.
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Auerbach MA, Whitfill T, Montgomery E, Leung J, Kessler D, Gross IT, Walsh BM, Fiedor Hamilton M, Gawel M, Kant S, Janofsky S, Brown LL, Walls TA, Alletag M, Sessa A, Arteaga GM, Keilman A, Van Ittersum W, Rutman MS, Zaveri P, Good G, Schoen JC, Lavoie M, Mannenbach M, Bigham L, Dudas RA, Rutledge C, Okada PJ, Moegling M, Anderson I, Tay KY, Scherzer DJ, Vora S, Gaither S, Fenster D, Jones D, Aebersold M, Chatfield J, Knight L, Berg M, Makharashvili A, Katznelson J, Mathias E, Lutfi R, Abu-Sultaneh S, Burns B, Padlipsky P, Lee J, Butler L, Alander S, Thomas A, Bhatnagar A, Jafri FN, Crellin J, Abulebda K. Factors Associated With Improved Pediatric Resuscitative Care in General Emergency Departments. Pediatrics 2023:e2022060790. [PMID: 37416979 DOI: 10.1542/peds.2022-060790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVES To describe the quality of pediatric resuscitative care in general emergency departments (GEDs) and to determine hospital-level factors associated with higher quality. METHODS Prospective observational study of resuscitative care provided to 3 in situ simulated patients (infant seizure, infant sepsis, and child cardiac arrest) by interprofessional GED teams. A composite quality score (CQS) was measured and the association of this score with modifiable and nonmodifiable hospital-level factors was explored. RESULTS A median CQS of 62.8 of 100 (interquartile range 50.5-71.1) was noted for 287 resuscitation teams from 175 emergency departments. In the unadjusted analyses, a higher score was associated with the modifiable factor of an affiliation with a pediatric academic medical center (PAMC) and the nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. In the adjusted analyses, a higher CQS was associated with modifiable factors of an affiliation with a PAMC and the designation of both a nurse and physician pediatric emergency care coordinator, and nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. A weak correlation was noted between quality and pediatric readiness scores. CONCLUSIONS A low quality of pediatric resuscitative care, measured using simulation, was noted across a cohort of GEDs. Hospital factors associated with higher quality included: an affiliation with a PAMC, designation of a pediatric emergency care coordinator, higher pediatric volume, and geographic location. A weak correlation was noted between quality and pediatric readiness scores.
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Affiliation(s)
| | | | - Erin Montgomery
- Indiana University School of Medicine, Indianapolis, Indiana
| | - James Leung
- McMaster University, Hamilton, Ontario, Canada
| | - David Kessler
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Isabel T Gross
- Yale University School of Medicine, New Haven, Connecticut
| | | | | | - Marcie Gawel
- Yale University School of Medicine, New Haven, Connecticut
| | - Shruti Kant
- University of California San Francisco, San Francisco, California
| | - Stephen Janofsky
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Linda L Brown
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Theresa A Walls
- Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michelle Alletag
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anna Sessa
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Grace M Arteaga
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Ashley Keilman
- University of Washington and Seattle Children's Hospital, Seattle, Washington
| | | | - Maia S Rutman
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Pavan Zaveri
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Grace Good
- Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Meghan Lavoie
- Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mark Mannenbach
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | | | | | | | - Pamela J Okada
- University of Texas, Southwestern Medical Center, Dallas, Texas
| | - Michelle Moegling
- Case Western Reserve University and UH Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Ingrid Anderson
- Case Western Reserve University and UH Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Khoon-Yen Tay
- Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Stacy Gaither
- The University of Alabama at Birmingham, Birmingham, Alabama
| | - Daniel Fenster
- Columbia University Irving Medical Center, New York, New York
| | - Derick Jones
- Mayo Clinic Health System, Albert Lea and Austin, Minnesota
| | | | | | - Lynda Knight
- Stanford Medicine Children's Health, Palo Alto, California
| | - Marc Berg
- Stanford Medicine Children's Health, Palo Alto, California
| | | | | | | | - Riad Lutfi
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Brian Burns
- University of Washington and Seattle Children's Hospital, Seattle, Washington
| | | | - Jumie Lee
- The Lundquist Institute, Torrance, California
| | - Lucas Butler
- Virginia Mason Medical Center, Seattle, Washington
| | - Sarah Alander
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania; and
| | - Anita Thomas
- University of Washington and Seattle Children's Hospital, Seattle, Washington
| | | | | | - Jason Crellin
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania; and
| | - Kamal Abulebda
- Indiana University School of Medicine, Indianapolis, Indiana
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Abulebda K, Yuknis ML, Whitfill T, Montgomery EE, Pearson KJ, Rousseau R, Diaz MCG, Brown LL, Wing R, Tay KY, Good GL, Malik RN, Garrow AL, Zaveri PP, Thomas E, Makharashvili A, Burns RA, Lavoie M, Auerbach MA. Preparedness for Pediatric Office Emergencies: A Multicenter, Simulation-Based Study. Pediatrics 2021; 148:peds.2020-038463. [PMID: 34433688 DOI: 10.1542/peds.2020-038463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/07/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Pediatric emergencies can occur in pediatric primary care offices. However, few studies have measured emergency preparedness, or the processes of emergency care, provided in the pediatric office setting. In this study, we aimed to measure emergency preparedness and care in a national cohort of pediatric offices. METHODS This was a multicenter study conducted over 15 months. Emergency preparedness scores were calculated as a percentage adherence to 2 checklists on the basis of the American Academy of Pediatrics guidelines (essential equipment and supplies and policies and protocols checklists). To measure the quality of emergency care, we recruited office teams for simulation sessions consisting of 2 patients: a child with respiratory distress and a child with a seizure. An unweighted percentage of adherence to checklists for each case was calculated. RESULTS Forty-eight teams from 42 offices across 9 states participated. The mean emergency preparedness score was 74.7% (SD: 12.9). The mean essential equipment and supplies subscore was 82.2% (SD: 15.1), and the mean policies and protocols subscore was 57.1% (SD: 25.6). Multivariable analyses revealed that independent practices and smaller total staff size were associated with lower preparedness. The median asthma case performance score was 63.6% (interquartile range: 43.2-81.2), whereas the median seizure case score was 69.2% (interquartile range: 46.2-80.8). Offices that had a standardized process of contacting emergency medical services (EMS) had a higher rate of activating EMS during the simulations. CONCLUSIONS Pediatric office preparedness remains suboptimal in a multicenter cohort, especially in smaller, independent practices. Academic and community partnerships using simulation can help address gaps and implement important processes like contacting EMS.
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Affiliation(s)
- Kamal Abulebda
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, School of Medicine, Indiana University and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Matthew L Yuknis
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, School of Medicine, Indiana University and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Travis Whitfill
- Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Erin E Montgomery
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, Indiana
| | - Kellie J Pearson
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, Indiana
| | - Rosa Rousseau
- Department of Pediatric Emergency, Inova Fairfax Medical Center, Fairfax, Virginia
| | - Maria Carmen G Diaz
- Nemours Institute for Clinical Excellence, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Linda L Brown
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Alpert Medical School, Brown University and Hasbro Children's Hospital, Providence, Rhode Island
| | - Robyn Wing
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Alpert Medical School, Brown University and Hasbro Children's Hospital, Providence, Rhode Island
| | - Khoon-Yen Tay
- Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Grace L Good
- Center for Simulation, Advanced Education, and Innovation, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rabia N Malik
- Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Amanda L Garrow
- School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, England
| | - Pavan P Zaveri
- Emergency Medicine and Trauma Center, Children's National, Washington, District of Columbia
| | - Eileen Thomas
- College of Health Professions, Pace University, New York, New York
| | - Ana Makharashvili
- Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Rebekah A Burns
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Megan Lavoie
- Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Abulebda K, Whitfill T, Montgomery EE, Thomas A, Dudas RA, Leung JS, Scherzer DJ, Aebersold M, Van Ittersum WL, Kant S, Walls TA, Sessa AK, Janofsky S, Fenster DB, Kessler DO, Chatfield J, Okada P, Arteaga GM, Berg MD, Knight LJ, Keilman A, Makharashvili A, Good G, Bingham L, Mathias EJ, Nagy K, Hamilton MF, Vora S, Mathias K, Auerbach MA. Improving Pediatric Readiness in General Emergency Departments: A Prospective Interventional Study. J Pediatr 2021; 230:230-237.e1. [PMID: 33137316 DOI: 10.1016/j.jpeds.2020.10.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 06/04/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe the impact of a national interventional collaborative on pediatric readiness within general emergency departments (EDs). STUDY DESIGN A prospective, multicenter, interventional study measured pediatric readiness in general EDs before and after participation in a pediatric readiness improvement intervention. Pediatric readiness was assessed using the weighted pediatric readiness score (WPRS) on a 100-point scale. The study protocol extended over 6 months and involved 3 phases: (1) a baseline on-site assessment of pediatric readiness and simulated quality of care; (2) pediatric readiness interventions; and (3) a follow-up on-site assessment of WPRS. The intervention phase included a benchmarking performance report, resources toolkits, and ongoing interactions between general EDs and academic medical centers. RESULTS Thirty-six general EDs were enrolled, and 34 (94%) completed the study. Four EDs (11%) were located in Canada, and the rest were in the US. The mean improvement in WPRS was 16.3 (P < .001) from a baseline of 62.4 (SEM = 2.2) to 78.7 (SEM = 2.1), with significant improvement in the domains of administration/coordination of care; policies, protocol, and procedures; and quality improvement. Six EDs (17%) were fully adherent to the protocol timeline. CONCLUSIONS Implementing a collaborative intervention model including simulation and quality improvement initiatives is associated with improvement in WPRS when disseminated to a diverse group of general EDs partnering with their regional pediatric academic medical centers. This work provides evidence that innovative collaboration facilitated by academic medical centers can serve as an effective strategy to improve pediatric readiness and processes of care.
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Affiliation(s)
- Kamal Abulebda
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN.
| | - Travis Whitfill
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Erin E Montgomery
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, IN
| | - Anita Thomas
- Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, WA
| | - Robert A Dudas
- Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - James S Leung
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Daniel J Scherzer
- Division of Pediatric Emergency Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH
| | | | - Wendy L Van Ittersum
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Akron Children's Hospital, Northeast Ohio Medical University, Akron, OH
| | - Shruti Kant
- Department of Emergency Medicine and Pediatrics, University of California San Francisco, San Francisco, CA
| | - Theresa A Walls
- Department of Pediatrics, Division of Emergency Medicine, The Children's Hospital of Philadelphia at the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Anna K Sessa
- Office of Emergency Medical Services, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Stephen Janofsky
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Daniel B Fenster
- Department of Emergency Medicine, Morgan Stanley Children's Hospital of New York Presbyterian at Columbia University Medical Center, New York, NY
| | - David O Kessler
- Department of Emergency Medicine, Morgan Stanley Children's Hospital of New York Presbyterian at Columbia University Medical Center, New York, NY
| | - Jenny Chatfield
- KidSIM-ASPIRE Simulation Research Program, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Pamela Okada
- Department of Pediatrics, University of Texas Southwestern School of Medicine, Dallas, TX
| | - Grace M Arteaga
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Critical Care, Mayo Clinic, Rochester, MN
| | - Marc D Berg
- Davison of Critical Care Medicine, Lucile Packard children's Hospital Stanford, Stanford University College of Medicine, Palo Alto, CA
| | - Lynda J Knight
- Davison of Critical Care Medicine, Lucile Packard children's Hospital Stanford, Stanford University College of Medicine, Palo Alto, CA
| | - Ashley Keilman
- Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, WA
| | - Ana Makharashvili
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Grace Good
- Department of Pediatrics, Division of Emergency Medicine, The Children's Hospital of Philadelphia at the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ladonna Bingham
- Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Emily J Mathias
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Kristine Nagy
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Akron Children's Hospital, Northeast Ohio Medical University, Akron, OH
| | - Melinda F Hamilton
- Department of Critical Care Medicine and Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | - Marc A Auerbach
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
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Beria G, Makharashvili A, Tabidze L. Challenges of implementing and utilizing effective BLS and PBLS according to European resuscitation council guidelines in the country of Georgia. Resuscitation 2019. [DOI: 10.1016/j.resuscitation.2019.06.160] [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: 10/26/2022]
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Verulava T, Grdzelishvili A, Magaldadze M, Makharashvili A, Chibukhaia G, Jorbenadze R, Dangadze B. Social Problems of Alzheimer Patients and Their Family Members. Home Health Care Management & Practice 2018. [DOI: 10.1177/1084822318775703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alzheimer disease is the most frequently seen and widespread form of dementia. In Georgia, there is no state program that deals with Alzheimer, which means that families of the patients stand alone when dealing with the disease. The study goal was to find out the problems and needs of the Alzheimer patients and their family members. The qualitative approach model was used for the research, which in turn was a biographical-narrative interview. The study has revealed a decreased role of a public sector in the life of people with disease. The families alone have a responsibility to take care of their patients, without any help from the others, which often worsens their already difficult economic situation.
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