Ann And Robert H Lurie Childrens Hospital

Chicago, IL, United States

Ann And Robert H Lurie Childrens Hospital

Chicago, IL, United States
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Barfield W.D.,Centers for Disease Control and Prevention | Krug S.E.,Northwestern University | Krug S.E.,Ann And Robert H Lurie Childrens Hospital
Pediatrics | Year: 2017

Disasters disproportionally affect vulnerable, technology-dependent people, including preterm and critically ill newborn infants. It is important for health care providers to be aware of and prepared for the potential consequences of disasters for the NICU. Neonatal intensive care personnel can provide specialized expertise for their hospital, community, and regional emergency preparedness plans and can help develop institutional surge capacity for mass critical care, including equipment, medications, personnel, and facility resources. Copyright © 2017 by the American Academy of Pediatrics.

Winkelman T.N.A.,University of Michigan | Choi H.J.,University of Michigan | Davis M.M.,Ann And Robert H Lurie Childrens Hospital | Davis M.M.,Northwestern University
American Journal of Public Health | Year: 2017

Objectives. To estimate health insurance and health care utilization patterns among previously incarcerated men following implementation of the Affordable Care Act's (ACA's) Medicaid expansion and Marketplace plans in 2014. Methods. We performed serial cross-sectional analyses using data from the National Survey of Family Growth between 2008 and 2015. Our sample included men aged 18 to 44 years with (n = 3476) and without (n = 8702) a history of incarceration. Results. Uninsurance declined significantly among previously incarcerated men after ACA implementation (-5.9 percentage points; 95% confidence interval [CI] =-11.5,-0.4), primarily because of an increase in private insurance (6.8 percentage points; 95% CI = 0.1, 13.3). Previously incarcerated men accounted for a large proportion of the remaining uninsured (38.6%) in 2014 to 2015. Following ACA implementation, previously incarcerated men continued to be significantly less likely to report a regular source of primary care and more likely to report emergency department use than were neverincarcerated peers. Conclusions. Health insurance coverage improved among previously incarcerated men following ACA implementation. However, these men account for a substantial proportion of the remaining uninsured. Previously incarcerated men continue to lack primary care and frequently utilize acute care services.

Tan T.Q.,Northwestern University | Tan T.Q.,Ann And Robert H Lurie Childrens Hospital | Gerbie M.V.,Northwestern University
Clinical Pediatrics | Year: 2017

Male human papillomavirus (HPV) vaccination rates remain very low. The study objective was to gain an understanding of the perceptions of HPV disease and acceptance/barriers to HPV vaccine by parents of boys aged 9 to 18 years. An anonymous, written survey was administered from January 1, 2011 to September 30, 2013 in private pediatric offices (PPOs) and public health clinics (PHCs) in Chicago, Illinois. A total of 230 PPO parents (PPOPs) and 286 PHC parents (PHCPs) completed the survey. Despite significant differences (P <.0001) in education level, socioeconomic status, and HPV disease and vaccine knowledge/awareness between the PPOP and PHCP, there was no difference between PPOP and PHCP who would vaccinate their sons with HPV vaccine. For both groups, health care provider recommendation was the primary influence for vaccination. The major barrier to vaccination was lack of information on HPV disease/vaccine. Health care providers need to proactively discuss and use HPV vaccine in male patients. © 2017 SAGE Publications.

Everitt M.D.,University of Utah | Sleeper L.A.,New England Research Institutes, Inc. | Lu M.,New England Research Institutes, Inc. | Canter C.E.,Washington University in St. Louis | And 13 more authors.
Journal of the American College of Cardiology | Year: 2014

Objectives This study sought to determine the incidence and predictors of recovery of normal echocardiographic function among children with idiopathic dilated cardiomyopathy (DCM). Background Most children with idiopathic DCM have poor outcomes; however, some improve. Methods We studied children <18 years of age from the Pediatric Cardiomyopathy Registry who had both depressed left ventricular (LV) function (fractional shortening or ejection fraction z-score <-2) and LV dilation (end-diastolic dimension [LVEDD] z-score >2) at diagnosis and who had at least 1 follow-up echocardiogram 30 days to 2 years from the initial echocardiogram. We estimated the cumulative incidence and predictors of normalization. Results Among 868 children who met the inclusion criteria, 741 (85%) had both echocardiograms. At 2 years, 22% had recovered normal LV function and size; 51% had died or undergone heart transplantation (median, 3.2 months), and 27% had persistently abnormal echocardiograms. Younger age (hazard ratio [HR]: 0.92; 95% confidence interval [CI]: 0.88 to 0.97) and lower LVEDD z-score (HR: 0.78; 95% CI: 0.70 to 0.87) independently predicted normalization. Nine children (9%) with normal LV function and size within 2 years of diagnosis later underwent heart transplantation or died. Conclusions Despite marked LV dilation and depressed function initially, children with idiopathic DCM can recover normal LV size and function, particularly those younger and with less LV dilation at diagnosis. Investigations related to predictors of recovery, such as genetic associations, serum markers, and the impact of medical therapy or ventricular unloading with assist devices are important next steps. Longer follow-up after normalization is warranted as cardiac failure can recur. (Pediatric Cardiomyopathy Registry; NCT00005391).

Webb C.L.,University of Michigan Congenital Heart Center | Waugh C.L.,Ann And Robert H Lurie Childrens Hospital | Grigsby J.,University of Colorado at Denver | Busenbark D.,University of Colorado at Denver | And 3 more authors.
Journal of the American Society of Echocardiography | Year: 2013

Background Previous single-center studies have shown that telemedicine improves care in newborns with suspected heart disease. The aim of this study was to test the hypothesis that telemedicine would shorten time to diagnosis, prevent unnecessary transports, reduce length of stay, and decrease exposure to invasive treatments. Methods Nine pediatric cardiology centers entered data prospectively on patients aged <6 weeks, matched by gestational age, weight, and diagnosis. Subjects born at hospitals with and without access to telemedicine constituted the study group and control groups, respectively. Data from patients with mild or no heart disease were analyzed. Results Data were obtained for 337 matched pairs with mild or no heart disease. Transport to a tertiary care center (4% [n = 15] vs 10% [n = 32], P =.01), mean time to diagnosis (100 vs 147 min, P <.001), mean length of stay (1.0 vs 26 days, P =.005) and length of intensive care unit stay (0.96 vs 2.5 days, P =.024) were significantly less in the telemedicine group. Telemedicine patients were significantly farther from tertiary care hospitals than control subjects. The use of inotropic support and indomethacin was significantly less in the telemedicine group. By multivariate analysis, telemedicine patients were less likely to be transported (odds ratio, 0.44; 95% confidence interval, 0.23-0.83) and less likely to be placed on inotropic support (odds ratio, 0.16; 95% confidence interval, 0.10-0.28). Conclusions Telemedicine shortened the time to diagnosis and significantly decreased the need for transport of infants with mild or no heart disease. The length of hospitalization and intensive care stay and use of indomethacin and inotropic support were less in telemedicine patients.

Chamberlain J.M.,George Washington University | Chamberlain J.M.,Childrens National Medical Center | Krug S.,Northwestern University | Krug S.,Ann And Robert H Lurie Childrens Hospital | And 2 more authors.
Health Affairs | Year: 2013

A formal emergency care system for children in the United States began in the 1980s with the establishment of specialized training programs in academic children's hospitals. The ensuing three decades have witnessed the establishment of informal regional networks for clinical care and a federally funded research consortium that allows for multisite research on evidence-based practices. However, pediatric emergency care suffers from problems common to emergency departments (EDs) in general, which include misaligned incentives for care, overcrowding, and wide variation in the quality of care. In pediatric emergency care specifically, there are problems with low-volume EDs that have neither the experience nor the equipment to treat children, poor adherence to clinical guidelines, lack of resources for mental health patients, and a lack of widely accepted performance metrics. We call for policies to address these issues, including providing after-hours care in other settings and restructuring payment and reimbursement policies to better address patients' needs. © 2013 Project HOPE-The People-to-People Health Foundation, Inc.

McCarville M.,University of Illinois at Chicago | Sohn M.-W.,Northwestern University | Sohn M.-W.,Hines Veterans Administration Hospital | Oh E.,Northwestern University | And 3 more authors.
Archives of Disease in Childhood | Year: 2013

Objective: To assess the impact of measured versus reported environmental tobacco smoke (ETS) exposure on asthma severity and exacerbations in an urban paediatric population. Design: We analysed cross-sectional data from the Chicago Initiative to Raise Asthma Health Equity study that followed a cohort of 561 children aged 8-14 with physician-diagnosed asthma between 2003 and 2005. Participant sociodemographic data and asthma symptoms were gathered by parental survey; exposures to ETS were determined by salivary cotinine levels and parent report. Multivariable negative binomial and ordered logistic regressions were used to assess associations between ETS and asthma outcomes. Results: Among 466 children included in our analysis, 58% had moderate or severe persistent asthma; 32% had >2 exacerbations requiring a hospitalisation or an emergency room visit or same day care in the previous year. Half of caregivers reported that at least one household member smoked. In multivariable analyses, salivary cotinine was significantly associated with frequently reported exacerbations in the previous year (adjusted incidence rate ratio=1.39, 95% CI 1.09 to 1.79), but not significantly associated with asthma severity. Reported household smoking was not significantly associated with either asthma severity or frequency of exacerbations. Conclusions: Salivary cotinine was more predictive of asthma exacerbation frequency but caregiver- reported household smoking was not. Use of a nicotine biomarker may be important in both the clinical and research settings to accurately identify an important risk factor for asthma exacerbations.

Gratias E.J.,Tc Thompson Childrens Hospital | Jennings L.J.,Ann And Robert H Lurie Childrens Hospital | Anderson J.R.,University of Nebraska Medical Center | Dome J.S.,Childrens National Medical Center | And 2 more authors.
Cancer | Year: 2013

BACKGROUND Wilms tumor is the most common childhood renal tumor. Although the majority of patients with favorable histology Wilms tumor (FHWT) have good outcomes, some patients still experience disease recurrence and death from disease. The goal of the current study was to determine whether tumor-specific chromosome 1q gain is associated with event-free survival (EFS) and overall survival (OS) in patients with FHWT. METHODS Unilateral FHWT samples were obtained from patients enrolled on National Wilms Tumor Study-4 and Pediatric Oncology Group Wilms Biology Study (POG 9046). 1q gain, 1p loss, and 16q loss were determined using multiplex ligation-dependent probe amplification. RESULTS The 8-year EFS rate was 87% (95% confidence interval [95% CI], 82%-91%) for the entire cohort of 212 patients. Tumors from 58 of 212 patients (27%) displayed 1q gain. A strong relationship between 1q gain and 1p/16q loss was observed. The 8-year EFS rate was 76% (95% CI, 63%-85%) for patients with 1q gain and 93% (95% CI, 87%-96%) for those lacking 1q gain (P =.0024). The 8-year OS rate was 89% (95% CI, 78%-95%) for those with 1q gain and 98% (95% CI, 94%-99%) for those lacking 1q gain (P =.0075). Gain of 1q was not found to correlate with disease stage (P =.16). After stratification for stage of disease, 1q gain was associated with a significantly increased risk of disease recurrence (risk ratio estimate: 2.72; P =.0089). CONCLUSIONS Gain of 1q may provide a valuable prognostic marker with which to stratify therapy for patients with FHWT. A confirmatory study is necessary before this biomarker is incorporated into the risk stratification schema of future therapeutic studies. Cancer 2013;119:3887-3894. © 2013 American Cancer Society.

Ramsey G.,Northwestern University | Ramsey G.,Northwestern Memorial Hospital | Ramsey G.,Ann And Robert H Lurie Childrens Hospital
Seminars in Thrombosis and Hemostasis | Year: 2015

Pathogen inactivation (PI), or pathogen reduction technology, reduces the infectious risk of plasma and platelet transfusions, and also affects clotting factor activities and platelet viabilities. Plasma is treated with solvent-detergent to disrupt enveloped viruses, or with photoactive agents methylene blue plus light, or amotosalen (AM) or riboflavin (RF) plus ultraviolet (UV) light, to disrupt pathogen nucleic acids. PI plasmas have average clotting factor activities of 75 to 85% of untreated plasma. PI plasmas are generally equivalent to regular plasma in randomized clinical trials (RCTs) in regard to coagulation test corrections and bleeding outcomes, except for one trial in which RF plasma was inferior for prothrombin time correction. Platelets are treated with UV plus RF or AM. In RCTs, the mean 1-hour corrected count increments from PI platelets are 66 to 94% (trials median, 75%) of those from untreated platelets. PI platelets also have lifespans of 4 to 5 days after 5 days of storage, compared with 6 to 7 days for untreated platelets. Bleeding outcomes comparing PI versus non-PI platelets in RCTs have been equivalent, except one study with more bleeding on AM platelets. Platelet treatment with UVC light alone for PI has entered clinical trials. Copyright © 2016 by Thieme Medical Publishers, Inc.

Phillips G.,Northwestern University | Kuhns L.M.,Ann And Robert H Lurie Childrens Hospital | Kuhns L.M.,Northwestern University | Garofalo R.,Ann And Robert H Lurie Childrens Hospital | And 2 more authors.
Journal of Epidemiology and Community Health | Year: 2014

Background: To generate unbiased estimates for data collected using respondent-driven sampling (RDS), a number of assumptions need to be met: individuals recruit randomly from their social network and people can accurately report their eligible network size. However, research has shown that these assumptions are often violated. Methods: This study used baseline data from Crew 450, a longitudinal study of young men who have sex with men in Chicago who were recruited via a modified form of RDS and its network substudy, in which a subset of 175 participants reported details on the composition and characteristics of their social network at either 1 or 2 years postbaseline. Results: Nearly two-thirds of participants reported giving coupons to at least one alter (64%), and 56.3% believed their alter(s) used the coupons. Frequency of communication, closeness and type of relationship played a major role in determining coupon distribution. Participants whose alters used coupons were significantly less likely to describe the strength of their relationship as 'not at all close' (OR=0.08; 95% CI 0.02 to 0.36) compared with 'very close' and to communicate weekly (OR=0.20; 95% CI 0.08 to 0.49) or 1-6 times in the past 6 months (OR=0.18; 95% CI 0.06 to 0.59). Conclusions: Contrary to RDS assumptions, we found that relationship characteristics played a significant role when individuals decided to whom they would give coupons.

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