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Saint Peters, MO, United States

There is a paucity of data regarding emergency department (ED) provider type and computed tomography (CT) scan use in the evaluation of pediatric patients with abdominal pain without trauma. The purpose of this retrospective single community hospital study was to determine if there was a difference in CT use between emergency medicine physicians (EMPs) and pediatricians (PEDs) in all patients younger than 18 years with abdominal pain without trauma who presented to the ED during the study period. The study included 165 patients. EMPs saw 83 patients and used CT in 31 compared with PEDs who saw 82 patients and used CT in 12 (P =.002). EMPs used CT significantly more frequently than PEDs in the designated sample. Economic pressures may cause changes in ED provider type in community and rural hospitals and this study shows that ED provider type may affect medical decision making, including CT use. © The Author(s) 2014.

Hogan C.,Cardinal Glennon Childrens Medical Center
Public Health Nursing | Year: 2014

Objective: Though the Back to Sleep Campaign that began in 1994 caused an overall decrease in sudden infant death syndrome (SIDS) rates, racial disparity has continued to increase in St. Louis. Though researchers have analyzed and described various sociodemographic characteristics of SIDS and infant deaths by unintentional suffocation in St. Louis, they have not simultaneously controlled for contributory risk factors to racial disparity such as race, poverty, maternal education, and number of children born to each mother (parity). To determine whether there is a relationship between maternal socioeconomic factors and sleep-related infant death. Design and Sample: This quantitative case-control study used secondary data collected by the Missouri Department of Health and Senior Services between 2005 and 2009. The sample includes matched birth/death certificates and living birth certificates of infants who were born/died within time frame. Measures: Descriptive analysis, Chi-square, and logistic regression. Results: The controls were birth records of infants who lived more than 1 year. Chi-square and logistic regression analyses confirmed that race and poverty have significant relationships with infant sleep-related deaths. Conclusions: The social significance of this study is that the results may lead to population-specific modifications of prevention messages that will reduce infant sleep-related deaths. © 2013 Wiley Periodicals, Inc.

Rahman S.I.,Saint Louis University | Siegfried E.,Cardinal Glennon Childrens Medical Center | Flanagan K.H.,Dermatology and Laser of Alabama | Armbrecht E.S.,Saint Louis University
Journal of the American Academy of Dermatology | Year: 2014

Background The methotrexate (MTX) polyglutamate assay has been validated in adults with arthritis. Objective We sought to assess clinical response rates and the value of the methotrexate polyglutamate assay in MTX-treated children with inflammatory skin diseases. Methods In this retrospective review, 46 MTX-treated children with a diagnosis of atopic dermatitis, psoriasis, or psoriasis-eczema overlap were serially assessed with the methotrexate polyglutamate assay. Results In all, 38 children (83%) achieved good to excellent response: 27 (59%) within 12 weeks and 11 (24%) after dose-adjustment. Good to excellent responses were highest for psoriasis/overlap: 15 of 16 (94%), compared with 23 of 30 (77%) with atopic dermatitis. Mean maximum polyglutamate levels were 31.5 nmol/L for responders versus 18.1 nmol/L for nonresponders (P =.035). This difference was also significant for the subset with atopic dermatitis, but not for those with psoriasis/overlap. After dose modification, late responders ultimately achieved a significantly higher mean maximum methotrexate polyglutamate assay (41.9 nmol/L) compared with nonresponders (P =.002). Limitations Retrospective design and small sample size were limitations. Conclusions MTX is an effective treatment for the majority of children with inflammatory skin diseases, but a subset requires dose modification to achieve good to excellent response. Methotrexate polyglutamate assay levels reflect response to treatment, but are most useful to support dose modification among children who fail to respond within 12 weeks. © 2013 by the American Academy of Dermatology, Inc.

Regan D.M.,Cardinal Glennon Childrens Medical Center | Wofford J.D.,University of Manitoba | Wall D.A.,University of Manitoba
Transfusion | Year: 2010

BACKGROUND: Umbilical cord blood (UCB) products have traditionally been thawed using a washing method intended to stabilize the cells, reduce dimethyl sulfoxide (DMSO) toxicity, and remove potentially ABO-incompatible red blood cell (RBC) stroma and plasma. Concerns with this approach include loss of total nucleated cells (TNCs), bag breakage during centrifugation, and poor reproducibility by transplant centers unfamiliar with this technique. We rationalized that a simple 1:1 dilution without centrifugation would stabilize the product and reduce the DMSO concentration by 50%, allowing for a controlled thaw in the laboratory without the risks of cell loss. STUDY DESIGN AND METHODS: We compared the traditional wash method with albumin reconstitution (dilution) and thaw only (no dilution or wash), assessing measurements of viability, TNC, CD34, and colony-forming cell (CFC) recovery post-thaw. Ten cryopreserved UCB products were thawed, split equally into three parts, and treated using each method. Product stability was measured at multiple time intervals up to 48 hours post-thaw. RESULTS: Throughout the entire evaluation, traditional wash and dilution methods performed equally well with no significant differences observed in 7-aminoactinomycin viability, TNC, CD34, or CFC recovery. For 163 patients in which diluted products were administered, there were no serious adverse effects at infusion and similar time to engraftment was observed when compared to historical experiences with traditional wash and direct infusion. CONCLUSION: We conclude that removing DMSO, RBC stroma, and plasma post-thaw using a wash method is not necessary when UCB products are RBC and plasma reduced before cryopreservation. © 2010 American Association of Blood Banks.

Carrel A.L.,University of Wisconsin - Madison | Myers S.E.,Cardinal Glennon Childrens Medical Center | Whitman B.Y.,Cardinal Glennon Childrens Medical Center | Eickhoff J.,Colorado State University | Allen D.B.,University of Wisconsin - Madison
Journal of Clinical Endocrinology and Metabolism | Year: 2010

Background: Children with Prader-Willi syndrome (PWS) have decreased muscle mass, hypotonia, and impaired linear growth. Recombinant human GH (hGH) treatment reportedly improves body composition and physical function in children with PWS, but these studies lack long-term control data. To assess the impact of hGH therapy begun early in life on the natural history of PWS, we compared height, body composition, and strength in similar-age children with PWS naïve to hGH with those treated with hGH for 6 yr. Objectives: Forty-eight children with PWS were studied: 21 subjects (aged 6-9 yr) treated withhGH for 6 yr (beginning at 4-32 months,mean13±6 months) were compared with 27 children of similar age (5-9 yr) prior to treatment with hGH. Percent body fat, lean body mass, carbohydrate/lipid metabolism, and motor strength were compared using analysis of covariance. Results: PWS children treated with hGH demonstrated lower body fat (mean, 36.1 ± 2.1 vs. 44.6 ± 1.8%, P<0.01), greater height (131±2 vs. 114±2 cm; P<0.001), greatermotorstrength [increased standing broad jump 22.9 ± 2.1 vs. 14.6 ± 1.9 in. (P < 0.001) and sit-ups 12.4 ± 0.9 vs. 7.1 ± 0.7 in 30 sec (P < 0.001)], increased high-density lipoprotein cholesterol (58.9 ± 2.6 vs. 44.9 ± 2.3 mg/dl, P < 0.001), decreased low-density lipoprotein (100 ± 8 vs. 131 ± 7 mg/dl, P < 0.01), and no difference in fasting glucose or insulin. Conclusions: hGH treatment in children with PWS, begun prior to 2 yr of age, improves body composition, motor function, height, and lipid profiles. The magnitude of these effects suggests that long-term hGH therapy favorably alters the natural history of PWS to an extent that exceeds risks and justifies consideration for initiation during infancy. Copyright © 2010 by The Endocrine Society.

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