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Banach L.P.,Childrens National Health System
Academic Pediatrics | Year: 2016

Objective: Food security is the ability to access sufficient food to maintain a healthy, active life. Previous studies link food insecurity with adverse health outcomes. Our objectives were to determine the prevalence of food insecurity, identify sociodemographic risk factors, and quantify receipt of public nutrition assistance among recently hospitalized children in the United States. Methods: Cross-sectional analyses of a representative sample of the US population aged 0 to 19 years from the National Health and Nutrition Examination Survey, 2007 to 2012 (N = 12,627). Consistent with previous literature, households were defined as food insecure if they answered "yes" to 3 or more of 18 food security questions. Children were considered recently hospitalized if admitted overnight in the past year (n = 706). Descriptive statistics characterized food insecurity and receipt of nutrition assistance. Multiple logistic regression analyses evaluated associations of food insecurity with age, sex, race/ethnicity, insurance status, family income, and hospitalization. Results: One-quarter (25.3%) of recently hospitalized children lived in food insecure households. More than one-third of recently hospitalized low-income, uninsured, or Hispanic children lived in food insecure households. In the adjusted analysis, recently hospitalized low-income children and girls had significantly greater odds of living in food insecure households. Of potentially eligible hospitalized children, 26.9% had not received Women, Infants, and Children benefits and 31.0% had not received Supplemental Nutrition Assistance Program benefits in the past year. Conclusions: One-quarter of recently hospitalized children lived in food insecure households. Many eligible families were not enrolled in public nutrition programs. Hospitalization represents a potential opportunity to identify these children and help families access nutrition assistance. © 2016 Academic Pediatric Association. Source


DeBiasi R.L.,Childrens National Health System | DeBiasi R.L.,George Washington University
Current Infectious Disease Reports | Year: 2014

Diagnostic testing for Lyme disease in the clinical setting primarily relies on assessment of serologic responses to infection, with the exception of the early localized phase of disease, in which the diagnosis must be made clinically, due to the recognized insensitivity of serologic testing at this phase of disease. For the diagnosis of early disseminated and late disease, the Centers for Disease Control and Prevention (CDC) recommends a two-tiered approach to testing consisting of initial IgM and IgG quantitative enzyme-linked immunosorbent assay (ELISA), followed by confirmation of all indeterminate or positive ELISA tests with separate IgG and IgM Western blots. This critical analysis addresses the sensitivity, specificity, and predictive value of serologic testing for Lyme disease in early localized, early disseminated, and late disease. Other testing modalities currently under evaluation are also discussed, including IgG vlsE C6 peptide ELISA, other two-tiered testing strategies, rapid diagnostics, and PCR. An understanding of the strengths and limitations of currently available testing for Lyme disease is critical for appropriate diagnosis. © 2014, Springer Science+Business Media New York. Source


Su L.,Childrens National Health System
Current Problems in Pediatric and Adolescent Health Care | Year: 2015

Since humans are an integral part of healthcare delivery, it is appropriate to understand how human nature and human error impact patient safety. A thorough understanding of the interactions between humans and the medical environment could help decrease errors that result in patient harm. This article describes some of our findings from a study that revealed unexpected behaviors which were documented on video during critical events (cardiac arrests) in a pediatric cardiac intensive care unit (CICU). We changed our training process for cardiac arrests as well as our nurse staffing in the CICU based upon results of our study. We believe that the lessons learned in our CICU are generalizable to both inpatient and ambulatory settings. We also emphasize the importance of collaborating with social scientists to rigorously study innate maladaptive patterns of human behavior to determine strategies to mitigate "human factors" during acute medical crises. © 2015 Mosby, Inc. All rights reserved. Source


Augustine E.M.,Childrens National Health System
Pediatric Emergency Care | Year: 2016

OBJECTIVES: Approximately 5% of pediatric patients return to the emergency department (ED) within 72 hours of initial evaluation. The goal of this study was to identify reasons for return visits from the caretaker perspective. METHODS: Two parent focus groups were conducted in November 2012. Parents were excluded from participation if the return visit was unrelated to the initial visit or the child was asked to return (e.g., wound check). The focus groups were audiotaped, transcribed, and analyzed using a thematic content analysis approach. RESULTS: A total of 13 parents participated. Children were 10 months to 11 years of age (median, 3.1 years). Primary symptoms and diagnoses were related to respiratory (n = 6); gastrointestinal (n = 2); dermatologic (n = 2); musculoskeletal (n = 2); and ear, nose, throat and mouth diseases (n = 1). Return visits occurred 12 to 50 hours (median, 24 hours) after the initial visit. Reasons for return visits were divided into 4 domains: (1) the caretakerʼs response to the initial visit (e.g., dissatisfaction with medical staff, medical care, or information provided), (2) the childʼs illness (e.g., continued, worsening, or concerning symptoms), (3) the nature of the ED itself (e.g., subspecialist availability, convenient hours), and (4) follow-up care (e.g., lack of appointments with primary physicians or subspecialists). CONCLUSIONS: Several of the reasons parents identify for return visits are within the locus of control of the ED, and several could be addressed by improving regional health care coordination. Surveys based on these themes will quantitate the reasons for return visits and prioritize future strategies to address the perceived need for return visits. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Source


Tosi L.L.,Childrens National Health System | Warman M.L.,Orthopaedic Research Laboratories
Bone | Year: 2015

Rare bone diseases account for 5% of all birth defects and can cause significant morbidity throughout patients' lives. Significant progress is being made to elucidate the pathophysiological mechanisms underlying these diseases. This paper summarizes presentation highlights of a workshop on Rare Skeletal Diseases convened to explore how the study of rare diseases has influenced the field's understanding of bone anabolism and catabolism and directed the search for new therapies benefiting patients with rare conditions as well as patients with common skeletal disorders. © 2015. Source

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