Magtanong R.,Case Western Reserve University |
Rork K.,Rainbow Babies & Childrens Hospital
Behavioral Sleep Medicine | Year: 2015
This study investigated how violence influences children’s sleep environments. Sixty-five children ages 8–16 years and a parent or guardian were recruited from agencies serving families experiencing violence. At baseline (5 weeks post–violent event), 6 months, and 12 months postbaseline, study staff collected sleep-behavior information and conducted systematic, qualitative assessments of sleep environments. Child sleep problems were generally frequent and persistent. However, 9 children reported improved sleep after the violent event, mainly because perpetrators were no longer present. Sleeping environments were dynamic via changes in location and modifications to improve safety and sleep. Incongruence between children’s and parents’ perceptions of environmental characteristics influencing sleep was common. Families’ motivation to improve children’s sleep represents a foundation to build upon when working with families victimized by violence. © 2015, Routledge. All rights reserved.
PubMed | Washington University in St. Louis, University of California at San Francisco, National Jewish Health, Northwestern University and 5 more.
Type: Journal Article | Journal: American journal of respiratory and critical care medicine | Year: 2016
Restoration of vitamin D sufficiency may reduce asthma exacerbations, events that are often associated with respiratory tract infections and cold symptoms.To determine whether vitamin D supplementation reduces cold symptom occurrence and severity in adults with mild to moderate asthma and vitamin D insufficiency.Colds were assessed in the AsthmaNet VIDA (Vitamin D Add-on Therapy Enhances Corticosteroid Responsiveness) trial, in which 408 adult patients were randomized to receive placebo or cholecalciferol (100,000 IU load plus 4,000 IU/d) for 28 weeks as add-on therapy. The primary outcome was cold symptom severity, which was assessed using daily scores on the 21-item Wisconsin Upper Respiratory Symptom Survey.A total of 203 participants experienced at least one cold. Despite achieving 25-hydroxyvitamin D levels of 41.9 ng/ml (95% confidence interval [CI], 40.1-43.7 ng/ml) by 12 weeks, vitamin D supplementation had no effect on the primary outcome: the average peak WURSS-21 scores (62.0 [95% CI, 55.1-68.9; placebo] and 58.7 [95% CI, 52.4-65.0; vitamin D]; P = 0.39). The rate of colds did not differ between groups (rate ratio [RR], 1.2; 95% CI, 0.9-1.5); however, among African Americans, those receiving vitamin D versus placebo had an increased rate of colds (RR, 1.7; 95% CI, 1.1-2.7; P = 0.02). This was also observed in a responder analysis of all subjects achieving vitamin D sufficiency, regardless of treatment assignment (RR, 1.4; 95% CI, 1.1-1.7; P = 0.009).Our findings in patients with mild to moderate asthma undergoing an inhaled corticosteroid dose reduction do not support the use of vitamin D supplementation for the purpose of reducing cold severity or frequency.
PubMed | Washington University in St. Louis, Medical University of South Carolina, UH Rainbow Babies and Childrens Hospital, University of Wisconsin - Madison and 17 more.
Type: | Journal: American journal of respiratory and critical care medicine | Year: 2016
Reducing asthma exacerbation frequency is an important criterion for approval of asthma therapies, but the clinical features of exacerbation prone asthma (EPA) remain incompletely defined.Describe the clinical, physiological, inflammatory and co-morbidity factors associated with EPA.Baseline data from the NHLBI Severe Asthma Research Program-3 were analyzed. An exacerbation was defined as a burst of systemic corticosteroids lasting 3 days. Patients were classified by their number of exacerbations in the past year - none, few (1-2) or exacerbation prone (3). Replication of a multivariable model was performed with data from the SARP 1+2 cohort.Of 709 subjects in the SARP-3 cohort, 294 (41%) had no exacerbations, and 173 (24%) were exacerbation prone in the prior year. Several factors normally associated with severity (asthma duration, age, sex, race, and socioeconomic status) did not associate with exacerbation frequency in SARP-3; bronchodilator responsiveness also discriminated exacerbation proneness from asthma severity. In the SARP-3 multivariable model, blood eosinophils, BMI and bronchodilator responsiveness were positively associated with exacerbation frequency [rate ratios (95%CI); 1.6 (1.2-2.1) for every log unit of eosinophils, 1.3 (1.1-1.4) for every 10 BMI units, and 1.2 (1.1-1.4) for every 10% increase in bronchodilatory responsiveness]. Chronic sinusitis and gastroesophageal reflux were also associated with exacerbation frequency [1.7 (1.4-2.1) and 1.6 (1.3-2.0)], even after adjustment for multiple factors. These effects were replicated in the SARP 1+2 multivariable model.EPA may be a distinct susceptibility phenotype with implications for the targeting of exacerbation prevention strategies. Clinical trial registration available at www.clinicaltrials.gov, ID NCT01760915.
PubMed | Neurological Institute, Ohio University, Rainbow Babies & Childrens Hospital and Section of Pediatric Epilepsy and.
Type: Case Reports | Journal: Journal of neurosurgery. Pediatrics | Year: 2016
Catastrophic epilepsy in infants, often due to extensive cortical dysplasia, has devastating consequences with respect to brain development. Conventional lobar, multilobar, or hemispheric resection in these infants is challenging, carrying an increased operative risk compared with that in older children. Removing a larger tissue volume versus removing or disconnecting the epileptogenic region does not always guarantee better seizure outcome. The authors describe 2 infants with catastrophic epilepsy who benefited from individually tailored disconnections based on a hypothesized epileptogenic zone following intensive presurgical evaluation. Two infants with catastrophic epilepsy and epileptic spasms underwent leukotomies between 3 and 12 months of age. They were followed up postoperatively for 19-36 months. Both patients had 90%-100% seizure reduction and a significantly improved neurodevelopmental outcome without postoperative complication. Cortical malformation was seen in both patients. Modifications of established surgical disconnection techniques, tailored to each patients specific epileptogenic zone, optimized seizure and neurodevelopmental outcomes while minimizing the risks associated with more extensive resections.
PubMed | George Washington University, University of South Carolina, Substance Use Research Unit, Rainbow Babies & Childrens Hospital and Childrens National Health System
Type: Journal Article | Journal: Journal of the International AIDS Society | Year: 2016
Changes in combination antiretroviral therapy (cART) throughout childhood challenge the continuity of paediatric HIV treatment. This study aimed to evaluate the prevalence of treatment interruption (TI), including lamivudine (3TC) monotherapy, and the relationship of TI to virologic and immunologic parameters in HIV-infected paediatric patients.Nested within a prospective observational study of a city-wide cohort of HIV-infected persons in the District of Columbia, this sub-study collected retrospective data on antiretroviral therapy, enrolment (endpoint) and historic (lifelong) CD4 counts and HIV RNA viral load (VL) of the paediatric cohort. TI was defined as interruption of cART 4 consecutive weeks. Data on TI, including 3TC monotherapy TI (MTI), were collected. Descriptive statistics and univariate testing were used to compare children with TI and MTI to children on continuous treatment (CT).Thirty-eight (28%) out of 136 enrolled children (median age=12.9 years) experienced TI, with 14 (37%) of those placed on 3TC MTI. Significantly lower endpoint median CD4 counts (598 cells/mmIn our study, we observed high frequency of the TI in HIV in paediatric HIV clinical practice. All TIs, including 3TC MTI, were associated with significantly lower endpoint median CD4 counts and higher median VLs, as compared to CT in paediatric patients. The high frequency of TI and associated poor outcomes suggest a need for a better strategy in managing the course of the paediatric and adolescent cART.
PubMed | University of Wisconsin - Madison, University of Texas Medical Branch, Emory University, Rainbow Babies & Childrens Hospital and 7 more.
Type: Journal Article | Journal: PloS one | Year: 2016
Worldwide, asthma is a leading cause of morbidity, mortality and economic burden, with significant gender and racial disparities. However, little attention has been given to the independent role of age on lifetime asthma severity and hospitalization. We aimed to assess the effect of age, gender, race and ethnicity on indicators of asthma severity including asthma related hospitalization, mortality, hospital cost, and the rate of respiratory failure.We analyzed the 2011 and 2012 Healthcare Cost and Utilization Project- National Inpatient Sample (NIS). We validated and extended those results using the National Heart, Lung, and Blood Institute-Severe Asthma Research Program (SARP; 2002-2011) database. Severe asthma was prospectively defined using the stringent American Thoracic Society (ATS) definition.Hospitalization for asthma was reported in 372,685 encounters in 2012 and 368,528 in 2011. The yearly aggregate cost exceeded $2 billion. There were distinct bimodal distributions for hospitalization age, with an initial peak at 5 years and a second at 50 years. Likewise, this bimodal age distribution of patients with severe asthma was identified using SARP. Males comprised the majority of individuals in the first peak, but women in the second. Aggregate hospital cost mirrored the bimodal peak distribution. The probability of respiratory failure increased with age until the age of 60, after which it continued to increase in men, but not in women.Severe asthma is primarily a disease of young boys and middle age women. Greater understanding of the biology of lung aging and influence of sex hormones will allow us to plan for targeted interventions during these times in order to reduce the personal and societal burdens of asthma.
PubMed | Maternal and Child Health Bureau, Rainbow Babies & Childrens Hospital, Children's Hospital of Philadelphia, Center for Community Health and Evaluation and 3 more.
Type: Journal Article | Journal: Haemophilia : the official journal of the World Federation of Hemophilia | Year: 2016
The National Hemophilia Program Coordinating Center, with the U.S. Regional Hemophilia Network conducted a national needs assessment of U.S. Hemophilia Treatment Center (HTC) patients. The objectives were to determine: (i) To what extent do patients report that they receive needed services and education; (ii) How well do the services provided meet their needs; and (iii) What are the patients perspectives about their care.A survey was mailed to active patients of 129 HTCs. Respondents completed the anonymous surveys on line or returned them by mail. Questions focused on management and information, access and barriers to care, coping, resources, and transition.Of 24 308 questionnaires mailed, 4004 (16.5%) were returned. Most respondents reported very few gaps in needed services or information and reported that services and information met their needs. Over 90% agreed or strongly agreed that care was patient-centred and rated HTC care as important or very important. Identified gaps included dietary advice, genetic testing, information on ageing, sexual health and basic needs resources. Minority respondents reported more barriers.This survey is the largest assessment of the HTC population. Respondents reported that the services and information provided by the HTCs met their needs. Quality improvement opportunities include transition and services related to ageing and sexual health. Further investigation of barriers to care for minorities is underway. Results will help develop national priorities to better serve all patients in the US. HTCs.
PubMed | Rainbow Babies & Childrens Hospital and Nationwide Childrens Hospital
Type: Journal Article | Journal: American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists | Year: 2016
The reduction of immunization errors through the use of age-specific alerts within the electronic medical record (EMR) and mandatory interactive education for prescribers is described.A health system-wide initiative was implemented at an academic pediatric hospital to reduce the number of immunization errors. The preimplementation period (January 1-December 31, 2013) involved a baseline review of adverse drug events (ADEs) reported through a voluntary event reporting system to determine the number and types of immunization errors. During the prescribing phase of the medication-use process, 57% (43 of 75) of errors occurred. First, age-based restrictions were implemented within the EMR. This was followed by mandatory immunization education for all prescribers working in the primary care network. Data collection included all reported vaccine errors within the voluntary event reporting system and completion rates of education by physicians, nurse practitioners, and medical residents.During the seven-month postimplementation period (January 1- July 31, 2014), prescribing events decreased from 57% to 25%. Following implementation of age-specific immunization alerts and mandatory prescriber education, the hospital went 175 days without a vaccine ADE.The implementation of age-specific alerts within the EMR and mandatory prescriber education decreased the number of immunization errors within a pediatric health system.
PubMed | Yale University and Rainbow Babies & Childrens Hospital
Type: Journal Article | Journal: The Journal of bone and joint surgery. American volume | Year: 2015
Many radiographic indices that are used to assess adolescents for femoroacetabular impingement rely on an ossified posterior acetabular wall. A recent study identified a secondary ossification center in the posterior rim of the acetabulum, the ossification of which may affect perceived acetabular coverage. The purpose of this study was to characterize ossification of the posterior rim of the acetabulum with use of a longitudinal radiographic study and quantify its impact on the radiographic assessment of femoroacetabular impingement.In this study, we utilized a historical collection of annual radiographs made in a population of healthy adolescents. Six hundred and twelve anteroposterior radiographs of the left hip of ninety-eight patients were reviewed to identify the appearance, duration, and fusion of the secondary ossification center in the posterior rim of the acetabulum. The center-edge angle was then measured before appearance and after fusion of the secondary ossification center in a subset of ten patients who had <5 of rotation on all radiographs.The secondary ossification center in the posterior rim was identified in seventy-three of the ninety-eight subjects, with no significant difference between the sexes. The mean patient age at the time of radiographic appearance of this secondary ossification center was fourteen years for males and twelve years for females. The mean duration of radiographic appearance was ten months for both sexes. Serial center-edge angles were measured in a subset of ten patients, and they increased during posterior rim ossification by a mean of 4.1.The secondary ossification center in the posterior rim of the acetabulum (the posterior rim sign) is a common radiographic finding that reliably appears for ten months around the time of triradiate closure. Posterior rim ossification led to a mean increase of 4 of perceived acetabular coverage through the center-edge angle. Given the narrow margin between normal coverage (33 to 36) and acetabular overcoverage (>40), the use of radiographs in adolescents with incompletely ossified hips may lead to misinterpretation of acetabular coverage. In patients with open triradiate cartilage, magnetic resonance imaging may be considered for the assessment of femoroacetabular impingement.The posterior rim ossification sign is a normal finding in adolescent hip development and has important implications for the proper evaluation of femoroacetabular impingement.
PubMed | Rainbow Babies & Childrens Hospital
Type: Journal Article | Journal: Respiratory physiology & neurobiology | Year: 2013
With increased survival of preterm infants as young as 23 weeks gestation, maintaining adequate respiration and corresponding oxygenation represents a clinical challenge in this unique patient cohort. Respiratory instability characterized by apnea and periodic breathing occurs in premature infants because of immature development of the respiratory network. While short respiratory pauses and apnea may be of minimal consequence if oxygenation is maintained, they can be problematic if accompanied by chronic intermittent hypoxemia. Underdevelopment of the lung and the resultant lung injury that occurs in this population concurrent with respiratory instability creates the perfect storm leading to frequent episodes of profound and recurrent hypoxemia. Chronic intermittent hypoxemia contributes to the immediate and long term co-morbidities that occur in this population. In this review we discuss the pathophysiology leading to the perfect storm, diagnostic assessment of breathing instability in this unique population and therapeutic interventions that aim to stabilize breathing without contributing to tissue injury.