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Ann Arbor, MI, United States

Li Y.,C.S. Mott Childrens Hospital | Glotzbecker M.,Childrens Hospital Boston | Hedequist D.,Childrens Hospital Boston
Current Reviews in Musculoskeletal Medicine | Year: 2012

The incidence of surgical site infection (SSI) after spinal deformity surgery for adolescent idiopathic scoliosis ranges from 0.5-6.7%. The risk of infection following spinal fusion in patients with neuromuscular scoliosis is greater, with reported rates of 6.1-15.2% for cerebral palsy and 8-41.7% for myelodysplasia. SSIs result in increased patient morbidity, multiple operations, prolonged hospital stays, and significant financial costs. Recent literature has focused on elucidating the most common organisms involved in SSIs, as well as identifying modifiable risk factors and prevention strategies that may decrease the rates of infection. These include malnutrition, positive urine cultures, antibiotic prophylaxis, surgical site antisepsis, antibiotic-loaded allograft, local application of antibiotics, and irrigation solutions. Acute and delayed SSIs are managed differently. Removal of instrumentation is required for effective treatment of delayed SSIs. This review article examines the current literature on the prevention and management of SSIs after pediatric spinal deformity surgery. © Springer Science+Business Media, LLC 2012.

Parrott L.M.,C.S. Mott Childrens Hospital
AANA Journal | Year: 2013

Pain protects the body from damaging effects of harmful stimuli. Congenital insensitivity to pain is a rare inherited disorder characterized by diminished or absent sensitivity to pain, touch, and pressure that leads to frequent trauma and self-mutilation. The disorder is part of the hereditarysensory and autonomic neuropathy (HSAN) family, in which 5 types have been recognized. Research and case reports of anesthetic risks and analgesic needs of these patients is limited due to the infrequent nature of the disorder. Recommendations for anesthesia include modification of intraoperative opioid requirements, use of anesthetics to ensure cooperation and immobility,and intraoperative temperature monitoring. It is imperative for anesthesia providers to understand which type of HSAN their patient experiences and toconduct a thorough preoperative interview because a different interpretation of sensory loss may occur in each HSAN category. This article reports thecase of a patient with HSAN type 2 who presented for knee arthroscopy.

Meert K.L.,Childrens Hospital of Michigan | Templin T.N.,Wayne State University | Michelson K.N.,Childrens Memorial Hospital | Morrison W.E.,Childrens Hospital of Philadelphia | And 5 more authors.
Critical Care Medicine | Year: 2012

Objectives: To evaluate the reliability and validity of the Bereaved Parent Needs Assessment, a new instrument to measure parents' needs and need fulfillment around the time of their child's death in the pediatric intensive care unit. We hypothesized that need fulfillment would be negatively related to complicated grief and positively related to quality of life during bereavement. Design: Cross-sectional survey. Setting: Five U.S. children's hospital pediatric intensive care units. Subjects: Parents (n = 121) bereaved in a pediatric intensive care unit 6 months earlier. Interventions: Surveys included the 68-item Bereaved Parent Needs Assessment, the Inventory of Complicated Grief, and the abbreviated version of the World Health Organization Quality of Life questionnaire. Each Bereaved Parent Needs Assessment item described a potential need and was rated on two scales: 1) a 5-point rating of importance (1 = not at all important, 5 = very important) and 2) a 5-point rating of fulfillment (1 = not at all met, 5 = completely met). Three composite scales were computed: 1) total importance (percentage of all needs rated 4 for importance), 2) total fulfillment (percentage of all needs rated 4 for fulfillment), and 3) percent fulfillment (percentage of important needs that were fulfilled). Internal consistency reliability was assessed by Cronbach's α and Spearman-Brown-corrected split-half reliability. Generalized estimating equations were used to test predictions between composite scales and the Inventory of Complicated Grief and World Health Organization Quality of Life questionnaire. Measurements and Main Results: Two items had mean importance ratings <3, and 55 had mean ratings >4. Reliability of composite scores ranged from 0.92 to 0.94. Total fulfillment was negatively correlated with Inventory of Complicated Grief (r =-.29; p < .01) and positively correlated with World Health Organization Quality of Life questionnaire (r = .21; p < .05). Percent fulfillment was also significantly correlated with both outcomes. Adjusting for parent's age, education, and loss of an only child, percent fulfillment remained significantly correlated with Inventory of Complicated Grief but not with World Health Organization Quality of Life questionnaire. Conclusions: The Bereaved Parent Needs Assessment demonstrated reliability and validity to assess the needs of parents bereaved in the pediatric intensive care unit. Meeting parents' needs around the time of their child's death may promote adjustment to loss. © 2012 by the Society of Critical Care Medicine and Lippincott Williams and Wilkins.

Muzyk A.J.,Campbell University | Muzyk A.J.,Duke University | Leung J.G.,Mayo Medical School | Nelson S.,Mayo Medical School | Jones S.R.,C.S. Mott Childrens Hospital
American Journal on Addictions | Year: 2013

Background Alcohol withdrawal accounts for a significant amount of hospital admissions and can quickly progress to the development of delirium tremens (DTs), seizures, and death. Rapid identification and management of alcohol withdrawal syndrome (AWS) is vital and can be managed with a number of different treatment strategies. Diazepam loading is a treatment strategy that utilizes the pharmacokinetics of this agent to achieve a rapid reduction in symptoms followed by sustained benefit over a period of days. Objective The purpose of this review is to evaluate the role of diazepam loading for AWS. Methods A literature search of four databases - Pubmed, PsychInfo, Biosis, and Embase - was conducted to identify publications between 1960 and August 2011 that described the use of diazepam loading for the treatment of AWS. Eight trials, both open-label and controlled trials were identified. Only four randomized controlled-trials (RCTs) have been published and they are reviewed in this paper. Results Included trials of hospitalized inpatients found that diazepam loading provided rapid symptom relief as well as reduced the incidence of seizures and duration of DTs. In patients diagnosed with severe DTs, rapidly administered doses of diazepam produced a quick calming effect. While no adverse events resulting from diazepam loading were noted, no formal assessment tool was used to evaluate its safety. Larger randomized controlled-trials are needed to better evaluate safety outcomes. Conclusions Diazepam loading is an effective treatment option for hospitalized patients experiencing AWS. Diazepam loading uses the concept of symptom-triggered therapy, a mainstay of current AWS treatment, while exploiting its prolonged elimination half-life and eliminating the need for additional pharmacologic therapy. Studies reviewed found diazepam loading significantly improved a number of important outcomes in AWS, including time in DTs, compared to traditional treatment strategies. (Am J Addict 2013;22:113-118) © American Academy of Addiction Psychiatry.

Rood J.M.,Plymouth Pharmacy and Medical Supplies | Engels M.J.,University of Michigan | Ciarkowski S.L.,University of Michigan | Wagenknecht L.D.,Michigan Pharmacists Association | And 2 more authors.
Journal of the American Pharmacists Association | Year: 2014

Objective: To determine the degree in variation of oral liquid pediatric compounding practices in Michigan pharmacies. Design: Cross-sectional survey study. Setting: All types of inpatient and outpatient pharmacies across the state of Michigan, excluding nuclear pharmacies and long-term care facilities. Participants: 244 Michigan pharmacies. Intervention: An online survey tool was used to assess the current compounding practices of 147 oral liquid pediatric medications. The survey was e-mailed or faxed to hospitals, chain pharmacies, and independent pharmacies. Pharmacists were also mailed a follow-up postcard, and the Michigan Pharmacists Association publicized the project through its journal and annual meeting. Main outcome measures: Pharmacy demographics; number of compounding pharmacies; number of medications compounded; awareness of compounding errors; results of compounding errors; and number of concentrations compounded per medication. Results: The majority of respondents were from outpatient pharmacies, but inpatient and other types of pharmacies were also represented. The majority of participating pharmacies compound fewer than five oral liquid medications per week. Awareness of errors was low overall, with no errors believed to result in permanent harm or death. The number of concentrations compounded per medication ranged from 1 to 9, with the majority of pharmacies compounding more than 3 concentrations per medication. Conclusion: There is a considerable degree of variation in current oral pediatric liquid compounding practices in Michigan pharmacies. This variability poses a significant risk to patient safety.

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