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Giglia T.M.,Childrens Hospital of Philadelphia | Witmer C.,Childrens Hospital of Philadelphia | Procaccini D.E.,Johns Hopkins Medical Center | Byrnes J.W.,University of Cincinnati
Pediatric Critical Care Medicine | Year: 2016

Objective: Thrombotic complications are increasingly being recognized as a significant cause of morbidity and mortality in pediatric and congenital heart disease. The objective of this article is to review the medications currently available to prevent and treat such complications. Data Sources: Online searches were conducted using PubMed. Study Selection: Studies were selected for inclusion based on their scientific merit and applicability to the pediatric cardiac population. Data Extraction: Pertinent information from each selected study or scientific review was extracted for inclusion. Data Synthesis: Four classes of medications were identified as potentially beneficial in this patient group: anticoagulants, antiplatelet agents, thrombolytic agents, and novel oral anticoagulants. Data on each class of medication were synthesized into the follow sections: mechanism of action, pharmacokinetics, dosing, monitoring, reversal, considerations for use, and evidence to support. Conclusions: Anticoagulants, antiplatelet agents, and thrombolytic agents are routinely used successfully in the pediatric patient with heart disease for the prevention and treatment of a wide range of thrombotic complications. Although the novel oral anticoagulants have been approved for a limited number of indications in adults, studies on the safety and efficacy of these agents in children are pending. © 2016 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. Source


Walsh K.E.,University of Cincinnati | Walsh K.E.,University of Massachusetts Medical School | Walsh K.E.,Meyers Primary Care Institute | Cutrona S.L.,Meyers Primary Care Institute | And 6 more authors.
Pediatrics | Year: 2014

OBJECTIVES: Describe rates of adherence for sickle cell disease (SCD) medications, identify patient and medication characteristics associated with nonadherence, and determine the effect of nonadherence and moderate adherence (defined as taking 60%-80% of doses) on clinical outcomes. METHODS: In February 2012 we systematically searched 6 databases for peer-reviewed articles published after 1940. We identified articles evaluating medication adherence among patients <25 years old with SCD. Two authors reviewed each article to determine whether it should be included. Two authors extracted data, including medication studied, adherence measures used, rates of adherence, and barriers to adherence. RESULTS: Of 24 articles in the final review, 23 focused on 1 medication type: antibiotic prophylaxis (13 articles), iron chelation (5 articles), or hydroxyurea (5 articles). Adherence rates ranged from 16% to 89%; most reported moderate adherence. Medication factors contributed to adherence. For example, prophylactic antibiotic adherence was better with intramuscular than oral administration. Barriers included fear of side effects, incorrect dosing, and forgetting. Nonadherence was associated with more vaso-occlusive crises and hospitalizations. The limited data available on moderate adherence to iron chelation and hydroxyurea indicates some clinical benefit. CONCLUSIONS: Moderate adherence is typical among pediatric patients with SCD. Multicomponent interventions are needed to optimally deliver life-changing medications to these children and should include routine monitoring of adherence, support to prevent mistakes, and education to improve understanding of medication risks and benefits. Copyright © 2014 by the American Academy of Pediatrics. Source


Camargo Jr. C.A.,Harvard University | Budinger G.R.S.,Northwestern University | Escobar G.J.,Kaiser Permanente | Hansel N.N.,Johns Hopkins Medical Center | And 3 more authors.
Annals of the American Thoracic Society | Year: 2014

Lung-related research primarily focuses on the etiology and management of diseases. In recent years, interest in primary prevention has grown. However, primary prevention also includes "health promotion" (actions in a population that keep an individual healthy). We encourage more research on population-based (public health) strategies that could not only maximize lung health but also mitigate "normal" age-related declines - not only for spirometry but across multiple measures of lung health. In developing a successful strategy, a "life course" approach is important. Unfortunately, we are unable to achieve the full benefit of this approach until we have better measures of lung health and an improved understanding of the normal trajectory, both over an individual's life span and possibly across generations. We discuss key questions in lung health promotion, with an emphasis on the upper (healthier) end of the distribution of lung functioning and resiliency and briefly summarize the few interventions that have been studied to date. We conclude with suggestions regarding the most promising future research for this important, but largely neglected, area of lung research. Copyright © 2014 by the American Thoracic Society. Source


Leonard B.E.,International Academy of Hi Technology Services | Thompson R.E.,Johns Hopkins Medical Center | Beecher G.C.,International Academy of Hi Technology Services
Dose-Response | Year: 2011

In the prior Part I, the potential influence of the low level alpha radiation induced bystander effect (BE) on human lung cancer risks was examined. Recent analysis of adaptive response (AR) research results with a Microdose Model has shown that single low LET radiation induced charged particles traversals through the cell nucleus activates AR. We have here conducted an analysis based on what is presently known about adaptive response and the bystander effect (BE) and what new research is needed that can assist in the further evaluation human cancer risks from radon. We find that, at the UNSCEAR (2000) worldwide average human exposures from natural background and man-made radiations, the human lung receives about a 25% adaptive response protection against the radon alpha bystander damage. At the UNSCEAR (2000) minimum range of background exposure levels, the lung receives minimal AR protection but at higher background levels, in the high UNSCEAR (2000) range, the lung receives essentially 100% protection from both the radon alpha damage and also the endogenic, spontaneously occurring, potentially carcinogenic, lung cellular damage. © 2011 University of Massachusetts. Source


Leonard B.E.,International Academy of Hi Technology Services | Thompson R.E.,Johns Hopkins Medical Center | Beecher G.C.,International Academy of Hi Technology Services
Dose-Response | Year: 2011

Since the publication of the BEIR VI report in 1999 on health risks from radon, a significantamount of new data has been published showing various mechanisms that mayaffect the ultimate assessment of radon as a carcinogen, at low domestic and workplaceradon levels, in particular the Bystander Effect (BE) and the Adaptive Response radio-protection(AR). We analyzed the microbeam and broadbeam alpha particle data of Miller etal. (1995, 1999), Zhou et al. (2001, 2003, 2004), Nagasawa and Little (1999, 2002), Hei etal. (1999), Sawant et al. (2001a) and found that the shape of the cellular response toalphas is relatively independent of cell species and LET of the alphas. The same alpha particletraversal dose response behavior should be true for human lung tissue exposure toradon progeny alpha particles. In the Bystander Damage Region of the alpha particleresponse, there is a variation of RBE from about 10 to 35. There is a transition regionbetween the Bystander Damage Region and Direct Damage Region of between one andtwo microdose alpha particle traversals indicating that perhaps two alpha particle "hits"are necessary to produce the direct damage. Extrapolation of underground miners lungcancer risks to human risks at domestic and workplace levels may not be valid. © 2011 University of Massachusetts. Source

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