Medicine and Health Sciences Commons^™

The Role Of Parent Partners In Health Education (Pphe) To Enhance Family Medicine Residents' Awareness Of Medical And Social Issues Affecting Children With Developmental Disabilities, Sanjeev Vasishtha

Sanjeev Vasishtha MD

No abstract provided.

Don’T Leave Without Them: Dispensing Asthma Medications To Pediatric Patients Upon Discharge Is Associated With Decreased Hospital Readmissions, Kelly J. Hiteshew, Thaddeus T. Franz, Kristen Lamberjack, Aleda M.H. Chen

Kelly J. Wright, R.Ph., Pharm.D.

Purpose: Asthma exacerbations are a leading cause of hospital and emergency department admissions at pediatric institutions. The objective of this study was to determine if patients who obtain discharge medications from a pediatric institution’s outpatient pharmacy after an admission for asthma have a lower thirty-day readmission rate than those who do not obtain discharge medications from the outpatient pharmacy. Methods: This multi-phase retrospective study included an initial chart review, an intervention period, and a second chart review of the intervention period. The chart reviews included patients ages two years and older with a discharge diagnosis of asthma or wheezing. During …

Success With Extended-Infusion Meropenem After Recurrence Of Baclofen Pump-Related Achromobacter Xylosoxidans Meningitis In An Adolescent, Kristen R. Nichols, Chad A. Knoderer, Nicholas G. Jackson, John J. Manaloor, John C. Christenson

Chad A. Knoderer

A 13-year-old female experienced a recurrence of baclofen pump-related central nervous system (CNS) infection caused by Achromobacter, despite absence of retained foreign material. Due to the failure of meropenem (120 mg/kg/d in divided doses every 8 hours and infused over 30 minutes) in the initial infection, the dose was infused over 4 hours during the recurrence. Meropenem is an antibiotic for which efficacy is time dependent, and 4-hour versus 30-minute infusions have been shown to prolong the time the concentration of the antibiotic exceeds the minimum inhibitory concentration (MIC) of the organism at the site of infection (T>MIC). Meropenem …

Late-Occurring Vancomycin-Associated Acute Kidney Injury In Children Receiving Prolonged Therapy, Chad Knoderer, Allison Gritzman, Kristen Nichols, Amy Wilson

Chad A. Knoderer

Background: Acute kidney injury (AKI) in patients receiving vancomycin has been associated with trough concentrations ≥15 mg/L and longer therapy duration. The objective of this study was to determine the incidence and factors associated with late AKI in children receiving ≥8 days of vancomycin therapy. Methods: Children aged 30 days to 17 years who were admitted to our institution and received intravenous vancomycin for at least 8 days during January to December of 2007 and 2010 and had a suspected or proven gram-positive infection were included. Late AKI was categorized as AKI occurring after the first 7 days of therapy …

Optimized Antimicrobial Dosing Strategies: A Survey Of Pediatric Hospitals, Chad Knoderer, Kristen Nichols, Elaine Cox

Chad A. Knoderer

Background Extended-interval aminoglycoside (EIAG) and extended- and continuous-infusion β-lactam (EIBL and CIBL) dosing strategies are increasingly used in adults, but pediatric literature is limited. Objective The objective of this study was to describe the use of EIAG, EIBL, and CIBL dosing in pediatric hospitals in the USA. Study Design, Setting, and Participants A national survey of children’s hospitals was conducted. A single practitioner from each target hospital was identified through the Children’s Hospital Association. Practice-based survey questions identified whether hospitals utilize EIAG, EIBL, and CIBL dosing. Main Outcome Measure The main outcome measure was the percentage utilization of the dosing …

Success With Extended-Infusion Meropenem After Recurrence Of Baclofen Pump-Related Achromobacter Xylosoxidans Meningitis In An Adolescent, Kristen R. Nichols, Chad A. Knoderer, Nicholas G. Jackson, John J. Manaloor, John C. Christenson

Kristen R. Nichols

A 13-year-old female experienced a recurrence of baclofen pump-related central nervous system (CNS) infection caused by Achromobacter, despite absence of retained foreign material. Due to the failure of meropenem (120 mg/kg/d in divided doses every 8 hours and infused over 30 minutes) in the initial infection, the dose was infused over 4 hours during the recurrence. Meropenem is an antibiotic for which efficacy is time dependent, and 4-hour versus 30-minute infusions have been shown to prolong the time the concentration of the antibiotic exceeds the minimum inhibitory concentration (MIC) of the organism at the site of infection (T>MIC). Meropenem …

Late-Occurring Vancomycin-Associated Acute Kidney Injury In Children Receiving Prolonged Therapy, Chad A. Knoderer, Allison L. Gritzman, Kristen R. Nichols, Amy C. Wilson

Kristen R. Nichols

Background: Acute kidney injury (AKI) in patients receiving vancomycin has been associated with trough concentrations ≥15 mg/L and longer therapy duration. The objective of this study was to determine the incidence and factors associated with late AKI in children receiving ≥8 days of vancomycin therapy. Methods: Children aged 30 days to 17 years who were admitted to our institution and received intravenous vancomycin for at least 8 days during January to December of 2007 and 2010 and had a suspected or proven gram-positive infection were included. Late AKI was categorized as AKI occurring after the first 7 days of therapy …

Optimized Antimicrobial Dosing Strategies: A Survey Of Pediatric Hospitals, Chad A. Knoderer, Kristen R. Nichols, Elaine G. Cox

Kristen R. Nichols

Background Extended-interval aminoglycoside (EIAG) and extended- and continuous-infusion β-lactam (EIBL and CIBL) dosing strategies are increasingly used in adults, but pediatric literature is limited. Objective The objective of this study was to describe the use of EIAG, EIBL, and CIBL dosing in pediatric hospitals in the USA. Study Design, Setting, and Participants A national survey of children’s hospitals was conducted. A single practitioner from each target hospital was identified through the Children’s Hospital Association. Practice-based survey questions identified whether hospitals utilize EIAG, EIBL, and CIBL dosing. Main Outcome Measure The main outcome measure was the percentage utilization of the dosing …

Data From: The Cardiovascular Effects Of Adjunctive Metformin Therapy In Overweight/Obese Youth With Type 1 Diabetes: A Randomized, Double-Blind, Placebo-Controlled Trial, Benjamin U. Nwosu, Louise S. Maranda, Karen Cullen, Lisa Greenman, Jody Fleshman, Nancy Mcshea, Bruce A. Barton, Mary M. Lee

Benjamin U. Nwosu

This dataset is the primary data source for a manuscript submitted for publication. Manuscript abstract: Context: The cardiovascular effect of adjunctive metformin therapy in overweight/obese youth with type 1 diabetes (T1D) is unknown. Objective: To compare the effect of prolonged, adjunctive metformin vs. placebo therapy on markers of cardiovascular risk in overweight/obese youth with T1D based on differences in total cholesterol (TC)/ high-density lipoprotein (HDL) ratio, triglycerides (TG)/HDL ratio, Atherogenic Index of Plasma (AIP) log [TG/HDL] ratio, adiponectin/leptin ratio, and 25-hydroxyvitamin D [25(OH)D] concentration. Hypothesis: Adjunctive metformin therapy will improve markers of cardiovascular health in overweight/obese youth with T1D. Setting: …

Data From: The Cardiovascular Effects Of Adjunctive Metformin Therapy In Overweight/Obese Youth With Type 1 Diabetes: A Randomized, Double-Blind, Placebo-Controlled Trial, Benjamin U. Nwosu, Louise S. Maranda, Karen Cullen, Lisa Greenman, Jody Fleshman, Nancy Mcshea, Bruce A. Barton, Mary M. Lee

Benjamin U. Nwosu

This dataset is the primary data source for a manuscript submitted for publication. Manuscript abstract: Context: The cardiovascular effect of adjunctive metformin therapy in overweight/obese youth with type 1 diabetes (T1D) is unknown. Objective: To compare the effect of prolonged, adjunctive metformin vs. placebo therapy on markers of cardiovascular risk in overweight/obese youth with T1D based on differences in total cholesterol (TC)/ high-density lipoprotein (HDL) ratio, triglycerides (TG)/HDL ratio, Atherogenic Index of Plasma (AIP) log [TG/HDL] ratio, adiponectin/leptin ratio, and 25-hydroxyvitamin D [25(OH)D] concentration. Hypothesis: Adjunctive metformin therapy will improve markers of cardiovascular health in overweight/obese youth with T1D. Setting: …

A Randomized, Double-Blind, Placebo-Controlled Trial Of Adjunctive Metformin Therapy In Overweight/Obese Youth With Type 1 Diabetes, Benjamin U. Nwosu, Louise Maranda, Karen Cullen, Lisa Greenman, Jody Fleshman, Nancy Mcshea, Bruce A. Barton, Mary M. Lee

Mary M. Lee

CONTEXT: Insulin resistance has been proposed as one of the causes of poor glycemic control in overweight/obese youth with type 1 diabetes (T1D). However, the role of adjunctive metformin, an insulin sensitizer, on glycemic control in these patients is unclear.

OBJECTIVE: To compare the effect of metformin vs. placebo on hemoglobin A1c (HbA1c), total daily dose (TDD) of insulin, and other parameters in overweight/obese youth with T1D.

HYPOTHESIS: Adjunctive metformin therapy will improve glycemic control in overweight/obese youth with T1D.

DESIGN, SETTING, AND PARTICIPANTS: A 9-mo randomized, double-blind, placebo controlled trial of metformin and placebo in 28 subjects (13m/15f) of …

Got Milk?, Sanjeev Vasishtha

Sanjeev Vasishtha MD

No abstract provided.

A Randomized, Double-Blind, Placebo-Controlled Trial Of Adjunctive Metformin Therapy In Overweight/Obese Youth With Type 1 Diabetes, Benjamin U. Nwosu, Louise Maranda, Karen Cullen, Lisa Greenman, Jody Fleshman, Nancy Mcshea, Bruce A. Barton, Mary M. Lee

Benjamin U. Nwosu

CONTEXT: Insulin resistance has been proposed as one of the causes of poor glycemic control in overweight/obese youth with type 1 diabetes (T1D). However, the role of adjunctive metformin, an insulin sensitizer, on glycemic control in these patients is unclear.

OBJECTIVE: To compare the effect of metformin vs. placebo on hemoglobin A1c (HbA1c), total daily dose (TDD) of insulin, and other parameters in overweight/obese youth with T1D.

HYPOTHESIS: Adjunctive metformin therapy will improve glycemic control in overweight/obese youth with T1D.

DESIGN, SETTING, AND PARTICIPANTS: A 9-mo randomized, double-blind, placebo controlled trial of metformin and placebo in 28 subjects (13m/15f) of …

Acute Interstitial Nephritis Associated With Iga Nephropathy In Children., Sanjeev Vasishtha, B Gauthier, E Valderrama, H Trachtman

Sanjeev Vasishtha MD

IgA nephropathy (IgAN) is a relatively common glomerulopathy in children and adolescents. The etiology of this disease is uncertain. We previously reported a child with IgAN who developed acute interstitial nephritis. We now describe three pediatric patients, including the index case, who had IgAN and who developed concomitant acute interstitial nephritis in association with renal functional impairment. We suggest that this histopathological lesion be considered in any child with IgAN and unexpectedly severe kidney dysfunction.

Nephrotic Syndrome As The Initial Manifestation Of Acquired Immunodeficiency Syndrome., Sanjeev Vasishtha, H Trachtman, B Gauthier, E Valderrama

Sanjeev Vasishtha MD

No abstract provided.

Sinusitis In Children - An Update, Sanjeev Vasishtha

Sanjeev Vasishtha MD

No abstract provided.

Emergence Of Candida Parapsilosis As The Predominant Species Causing Candidemia In Children., I Levy, L G Rubin, Sanjeev Vasishtha, V Tucci, S K Sood

Sanjeev Vasishtha MD

An increase in the rate of isolation of Candida parapsilosis, relative to other Candida species, in our children's hospital led us to analyze the clinical and epidemiological variables associated with candidemia. We sought to determine if these variables are different for patients infected with C. parapsilosis. All episodes of candidemia occurring over a 7-year period were analyzed retrospectively. Of 81 episodes in 80 patients, 35 (43%) were in neonates, and 46 (57%) were in nonneonates. C. parapsilosis was isolated in 40 episodes (49%). C. parapsilosis was significantly more likely than non-C. parapsilosis species to be associated with prematurity (P = …

Gemella Morbillorum As A Cause Of Septic Shock., Sanjeev Vasishtha, H D Isenberg, S K Sood

Sanjeev Vasishtha MD

The gram-positive bacterium Gemella morbillorum has been recovered from patients with endocarditis but has rarely been associated with acute fulminant infections. We describe two children with a rapid onset of septic shock, which was fatal in one, following infection with this organism. G. morbillorum is a commensal organism of the upper respiratory tract; it gained access to the bloodstreams in these patients, and bacteremia occurred. A clinical drawback is that the initial colonial morphology of this organism leads to presumptive identification as a viridans streptococcus, an organism not commonly associated with septic shock syndrome. Resistance of G. morbillorum to penicillin …

Medical, Developmental, And Mental Health Considerations, Heather Forkey, Linda Sagor

Heather Forkey

Citation: Forkey, H., Sagor, L. Medical, Developmental and Mental Health Considerations: Adoption from Foster Care (Chapter 7). In M. Henry (ed.) Adoption in the US: A Reference for Families, Professionals and Students. Chicago, IL: Lyceum Books, 2009. Link to book on publisher's website

Milna Bubur Bayi Organik, Mpasi Terbaik Untuk Si Kecil, Rosdiana Diana Basri

Rosdiana Diana Basri

Bunda memerlukan informasi tentang makanan pendamping ASI yang tepat untuk Si Kecil? Anda sedang membaca informasi yang benar, dan kami sarankan untuk memilih Milna Bubur Bayi Organik, MPASI Terbaik Untuk Si Kecil, Mengapa? Baca lebih lanjut yuk ...!

Understanding Multifactorial Influences On The Continuum Of Maternal Weight Trajectories In Pregnancy And Early Postpartum: Study Protocol, And Participant Baseline Characteristics, Tiffany A. Moore Simas, Silvia Corvera, Mary M. Lee, Ningning Zhang, Katherine Leung, Barbara C. Olendzki, Bruce A. Barton, Milagros C. Rosal

Mary M. Lee

BACKGROUND: Maternal and offspring immediate and long-term health are affected by pregnancy weight gain and maternal weight. This study was designed to determine feasibility of: 1) recruiting a socio-economically and racially/ethnically diverse sample of pregnant women into a longitudinal observational study, including consenting the women for serial biologic specimen evaluations; 2) implementing comprehensive assessments (including biologic, anthropometric, behavioral, cognitive/psychosocial and socio-demographic, and cultural measures) at multiple time points over the study period, including collecting biologic specimens at planned and unplanned pregnancy delivery times; and 3) retaining the sample for one year into the postpartum period. Additionally, the study will provide …

Data From: A Randomized, Double-Blind, Placebo-Controlled Trial Of Adjunctive Metformin Therapy In Overweight/Obese Youth With Type 1 Diabetes, Benjamin U. Nwosu, Louise Maranda, Karen Cullen, Lisa Greenman, Jody Fleshman, Nancy Mcshea, Bruce A. Barton, Mary M. Lee

Benjamin U. Nwosu

Manuscript abstract: CONTEXT: Insulin resistance has been proposed as one of the causes of poor glycemic control in overweight/obese youth with type 1 diabetes (T1D). However, the role of adjunctive metformin, an insulin sensitizer, on glycemic control in these patients is unclear. OBJECTIVE: To compare the effect of metformin vs. placebo on hemoglobin A1c (HbA1c), total daily dose (TDD) of insulin, and other parameters in overweight/obese youth with T1D. HYPOTHESIS: Adjunctive metformin therapy will improve glycemic control in overweight/obese youth with T1D. DESIGN, SETTING, AND PARTICIPANTS: A 9-mo randomized, double-blind, placebo controlled trial of metformin and placebo in 28 subjects …

Prepubertal Organochlorine Pesticide Concentrations And Age Of Pubertal Onset Among Russian Boys, Thuy Lam, Paige Williams, Mary Lee, Susan Korrick, Linda Birnbaum, Jane Burns, Oleg Sergeyev, Boris Revich, Larisa Altshul, Donald Patterson, Wayman Turner, Russ Hauser

Mary M. Lee

BACKGROUND: In animal studies, organochlorine pesticide (OCP) exposure alters pubertal development; however, epidemiological data are limited and inconsistent. OBJECTIVE: To evaluate the associations of serum OCP concentrations [hexachlorobenzene (HCB), beta-hexachlorocyclohexane (beta-HCH), and p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE)] with male pubertal onset. METHODS: In Chapaevsk, Russia, a town environmentally contaminated with OCPs, 350 8-9 year old boys with measured OCPs were enrolled during 2003-2005 and were followed annually for eight years. We evaluated three measures of pubertal onset: testicular volume (TV) > 3 mL in either testis, or stage 2 or greater for genitalia (G2+), or pubic hair (P2+). We used multivariable interval-censored models to …

Engaging Teens And Parents In Collaborative Practice: Perspectives On Diabetes Self-Management, Susan Sullivan-Bolyai, Carol Bova, Kimberley Johnson, Karen Cullen, Carol Jaffarian, Diane Quinn, Edwin Aroke, Sybil Crawford, Mary Lee, Olga Gupta

Mary M. Lee

PURPOSE: The purpose of this exploratory focus group study was to describe the perspectives of teens and their parents about self-management knowledge, behaviors (including division of labor associated with T1D management), and resources used to manage T1D. The overall goal is to use this information to develop a teen-family transition clinic.

METHODS: The self and family management behaviors framework undergirded the separate teen-parent focus groups that were conducted concurrently. Note-based qualitative content analysis was used, resulting in several important messages. RESULTS: From the teens' perspective there was variation in interest in learning more about T1D and management. Those teens who …

Association Between Chlorinated Pesticides In The Serum Of Prepubertal Russian Boys And Longitudinal Biomarkers Of Metabolic Function, Jane Burns, Paige Williams, Susan Korrick, Russ Hauser, Oleg Sergeyev, Boris Revich, Thuy Lam, Mary Lee

Mary M. Lee

Organochlorine pesticides (OCPs) have been linked to adult metabolic disorders; however, few studies have examined these associations in childhood. We prospectively evaluated the associations of baseline serum OCPs (hexachlorobenzene, beta-hexachlorocyclohexane, and p,p'-dichlorodiphenyldichloroethylene) in Russian boys with subsequent repeated measurements of serum glucose, insulin, lipids, leptin, and calculated homeostatic model assessment of insulin resistance (IR). During 2003-2005, we enrolled 499 boys aged 8-9 years in a prospective cohort; 318 had baseline serum OCPs and serum biomarkers measured at ages 10-13 years. Multivariable generalized estimating equation and mediation regression models were used to examine associations and direct and indirect (via body mass …

Asthma Knowledge, Control, And Administration Techniques In Hispanic Caregivers Of Pediatrics, Kelly J. Wright, Joshua Arnold, Rachel Culp, Kyle Hultz, Benjamin Robertson, Jon Wilkie, Amy Wuobio

Kelly J. Wright, R.Ph., Pharm.D.

Objectives: The objectives of this study were to (1) describe asthma knowledge, control, and administration techniques in Hispanic caregivers of pediatric asthma patients in primary care clinics and (2) determine the association between asthma knowledge and control. Methods: A pilot, cross-sectional study was conducted by administering a survey to Spanish-speaking primary caregivers of children under 12 years old with a current diagnosis of asthma. The survey contained: demographic questions (8 items), a modified version of the Asthma Control Test (ACT, 5 self-assessment items, 5-point, Likert-type scale), knowledge (21 items, correct/incorrect response), and inhaler use (1 item, rank ordering steps for …

Clinical Insights In Pediatrics: Early Detection And Optimal Treatment Of Growth Disorders, Jan Foote, Jennifer Cook

Jan M. Foote

No abstract provided.

Development And Validation Of A Seizure Prediction Model In Critically Ill Children, Amy Yang, Daniel Arndt, Robert Berg, Jessica Carpenter, Kevin Chapman, Dennis Dlugos, William Gallentine, Christopher Giza, Joshua Goldstein, Cecil Hahn, Jason Lerner, Tobias Loddenkemper, Joyce Matsumoto, Kendall Nash, Eric Payne, Ivan Fernandez, Justine Shults, Alexis Topjian, Korwyn Williams, Courtney Wusthoff, Nicholas Abend

Ivan J. Fernandez

No abstract provided.

Everyday Life In Southeast Asia, Kathleen Adams

Kathleen M. Adams

This lively survey of the peoples, cultures, and societies of Southeast Asia introduces a region of tremendous geographic, linguistic, historical, and religious diversity. Encompassing both mainland and island countries, these engaging essays describe personhood and identity, family and household organization, nation-states, religion, popular culture and the arts, the legacies of war and recovery, globalization, and the environment. Throughout, the focus is on the daily lives and experiences of ordinary people. Most of the essays are original to this volume, while a few are widely taught classics.

Acid-Suppressing Agents And Risk For Clostridium Difficile Infection In Pediatric Patients, Katelyn Brown, Chad Knoderer, Kristen Nichols, Ashley Crumby

Chad A. Knoderer

Background. Acid-suppressing agents have been associated with increased Clostridium difficile infection (CDI) in adults. The objective of this study was to evaluate the association of acid-suppressing therapy with the development of CDI in the pediatric population. Methods. This was a retrospective case-control study. Children aged 1 through 17 years with a positive C difficile polymerase chain reaction (PCR) result obtained between June 1, 2008, and June 1, 2012, were randomly matched to a control population selected from patients with negative PCR. Results. A total of 458 children were included. No difference was observed in acid-suppressive therapy prior to PCR in …