scholarly journals Pre-operative Assessment of Pediatric Congenital Heart Disease Patients in the COVID-19 Era: Lessons Learned

2021 ◽  
pp. 1-18
Author(s):  
Nour K. Younis ◽  
Rana O. Zareef ◽  
Marwa A. Diab ◽  
Omar El Sedawi ◽  
Issam M. El-Rassi ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Pediatric Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Lessons Learned ◽  
Open Heart ◽  
Assessment Protocol ◽  
First Case ◽  
Almost All ◽  
Operative Assessment

Abstract Background: Equal to COVID-19 patients, non-COVID-19 patients are affected by the medical and social drawbacks of the COVID-19 pandemic. A significant reduction in elective life-changing surgeries has been witnessed in almost all affected countries. This study discusses an applicable and effective pre-operative assessment protocol that can be applied during the COVID-19 era. Methods: Our study is a descriptive retrospective observational study that involves pediatric patients with CHD requiring open heart surgeries at our tertiary care center between March and November 2020. We reviewed the charts of eligible patients aged 18 years and below. We identified the total numbers of scheduled, performed, and postponed surgeries, respectively. A thorough description of the clinical and physical presentation of the postponed cases, who tested positive for SARS-CoV-2, is provided. Results: 68 open heart surgeries were scheduled at our center between March and November 2020. Three surgeries (4%) were postponed due to COVID-19. The three patients were asymptomatic COVID-19 cases detected on routine SARS-CoV-2 PCR testing. No symptoms of cough, chest pain, dyspnea, rhinorrhea, diarrhea, abdominal pain, anosmia, and ageusia were reported by our patients. All patients were afebrile and hemodynamically stable. Owing to the pre-operative assessment protocol that was implemented after the first case was detected, only three healthcare workers were at risk of COVID-19 transmission and were imposed to infectious evaluation and home quarantine. Conclusion: Adopting our discussed preoperative COVID-19 assessment protocol for CHD patients is an effective method to detect COVID-19 infections, optimize patient care, and ensure healthcare workers’ safety.

Relationship between Clinical and Biologic Variables and Chloramphenicol Pharmacokinetic Parameters in Pediatric Patients with Sepsis

2000 ◽  
Vol 34 (3) ◽  
pp. 393-397 ◽  
Author(s):  
Gustavo Lugo Goytia ◽  
Ismael Lares-Asseff ◽  
María Gabriela Pérez Guillé ◽  
Adrián Guillé Pérez ◽  
Cynthia Larios Mejía
Keyword(s):  
Population Model ◽  
Pediatric Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Pharmacokinetic Parameters ◽  
Pharmacokinetic Data ◽  
Study Group ◽  
Validation Group ◽  
Wbc Count ◽  
Biologic Factors

OBJECTIVE: To evaluate the influence of several clinical and biologic factors on the disposition kinetics of oral chloramphenicol in pediatric patients and to determine the usefulness of this information to predict chloramphenicol serum concentrations. STUDY DESIGN: The clinical, biologic, and pharmacokinetic data of 30 consecutive pediatric patients diagnosed with sepsis and admitted to a tertiary care center were analyzed retrospectively. The patients were randomly assigned to a study group and a validation group. The model was developed by a three-step approach involving Bayesian estimation of pharmacokinetic parameters, selection of covariates by principal component analysis, and final selection by stepwise multiple linear regression. The model was tested in the study group and compared with a general population model using a prediction error analysis. RESULTS: Regression analysis revealed that weight, albumin, and white blood cell (WBC) count were the most important determinants for chloramphenicol distribution volume, whereas age, WBC count, and serum creatinine were the most important determinants for chloramphenicol clearance. The performance of the constructed population model improved significantly in terms of both bias and precision compared with the general model when tested in the validation group. CONCLUSIONS: Clinical and biologic factors may significantly influence chloramphenicol's disposition in pediatric patients with sepsis and therefore should be considered in programming dosage regimens.

scholarly journals CHARACTERISTICS AND LONGER-TERM OUTCOMES OF PEDIATRIC PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY: A TERTIARY CARE CENTER EXPERIENCE

2019 ◽  
Vol 73 (9) ◽  
pp. 878
Author(s):  
Alaa Alashi ◽  
Laurence Svensson ◽  
Jared Klein ◽  
Kenneth Zahka ◽  
Nicholas Smedira ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Pediatric Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center

scholarly journals Facts about the General Medical Care of Adults with Congenital Heart Defects: Experience of a Tertiary Care Center

2020 ◽  
Vol 9 (6) ◽  
pp. 1943
Author(s):  
Lavinia Seidel ◽  
Kathrin Nebel ◽  
Stephan Achenbach ◽  
Ulrike Bauer ◽  
Peter Ewert ◽  
...  
Keyword(s):  
Heart Disease ◽  
Medical Care ◽  
Primary Care Physicians ◽  
Congenital Heart ◽  
Heart Defects ◽  
Care Center ◽  
Tertiary Care ◽  
Care Practice ◽  
Cross Sectional ◽  
Almost All

Background: Due to the increase in survival rates for congenital heart disease (CHD) in the last decades, over 90% of patients today reach adulthood. Currently, there are more than 300,000 adults with CHD (ACHD) living in Germany. They have an increased need for specialized medical care, since almost all ACHD have chronic heart disease and suffer from specific chronic symptoms, risks, and sequelae. Primary care physicians (PCPs) play a crucial role in referring patients to ACHD specialists or specialized institutions. This cross-sectional study is intended to clarify the real-world care of ACHD from the PCP’s perspective. Methods: This analysis, initiated by the German Heart Centre Munich, was based on a 27-item questionnaire on actual ACHD health care practice in Germany from the PCP’s perspective. Results: In total, 767 questionnaires were considered valid for inclusion. The majority of the PCPs were general practitioners (95.9%), and 84.1% had cared for ACHD during the past year. A majority (69.2%) of the PCPs had cared for patients with simple CHD, while 50.6% and 33.4% had cared for patients with moderate and severe CHD, respectively, in all age groups. PCPs treated almost all typical residual symptoms and sequelae, and advised patients regarding difficult questions, including exercise capacity, pregnancy, genetics, and insurance matters. However, 33.8% of the PCPs did not even know about the existence of certified ACHD specialists or centers. Only 23.9% involved an ACHD-specialized physician in their treatment. In cases of severe cardiac issues, 70.8% of the PCPs referred patients to ACHD-certified centers. Although 52.5% of the PCPs were not sufficiently informed about existing structures, 64.2% rated the current care situation as either “very good” or “good”. Only 26.3% (n = 190) of the responding physicians were aware of patient organizations for ACHD. Conclusions: The present study showed that the majority of PCPs are not informed about the ACHD care structures available in Germany. The need for specialized ACHD follow-up care is largely underestimated, with an urgent need for optimization to reduce morbidity and mortality. For the future, solutions must be developed to integrate PCPs more intensively into the ACHD care network.

scholarly journals Transition to a new electronic health record and pediatric medication safety: lessons learned in pediatrics within a large academic health system

2018 ◽  
Vol 25 (7) ◽  
pp. 848-854 ◽  
Author(s):  
Kimberly Whalen ◽  
Emily Lynch ◽  
Iman Moawad ◽  
Tanya John ◽  
Denise Lozowski ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Medication Safety ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Lessons Learned ◽  
Future Research ◽  
Health Record ◽  
Electronic Health ◽  
Roll Out

Abstract Objective While the electronic health record (EHR) has become a standard of care, pediatric patients pose a unique set of risks in adult-oriented systems. We describe medication safety and implementation challenges and solutions in the pediatric population of a large academic center transitioning its EHR to Epic. Methods Examination of the roll-out of a new EHR in a mixed neonatal, pediatric and adult tertiary care center with staggered implementation. We followed the voluntarily reported medication error rate for the neonatal and pediatric subsets and specifically monitored the first 3 months after the roll-out of the new EHR. Data was reviewed and compiled by theme. Results After implementation, there was a 5-fold increase in the overall number of medication safety reports; by the third month the rate of reported medication errors had returned to baseline. The majority of reports were near misses. Three major safety themes arose: (1) enterprise logic in rounding of doses and dosing volumes; (2) ordering clinician seeing a concentration and product when ordering medications; and (3) the need for standardized dosing units through age contexts created issues with continuous infusions and pump library safeguards. Conclusions Future research and work need to be focused on standards and guidelines on implementing an EHR that encompasses all age contexts.

scholarly journals Clinical Spectrum of COVID-19 in a Pediatric Mexican Population

2020 ◽  
Author(s):  
Edgar Bustos-Cordova ◽  
Daniela Castillo-García ◽  
Magdalena Cerón-Rodriguez ◽  
Nadia Soler-Quiñones
Keyword(s):  
Emergency Department ◽  
Pediatric Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Clinical Spectrum ◽  
Tertiary Care Center ◽  
Rt Pcr ◽  
Excessive Crying ◽  
Pcr Test

Abstract ObjectiveFrom the beginning of the COVID-19 pandemic, it has become evident that the spectrum of manifestations in children is different from those seen in adults. In this study, we aimed to describe a broader clinical spectrum of COVID-19 in children.MethodsIn this descriptive, prospective study, we included confirmed pediatric patients with COVID-19 who presented to the emergency department of a pediatric tertiary care center from April to July 2020. All patients were confirmed by the SARS-CoV-2 RT-PCR test, and we analyzed 24 symptoms and 25 signs.ResultsWe analyzed 50 patients with COVID-19. From the evaluated signs and symptoms, the most common symptoms were fever, excessive crying and dry cough, digestive symptoms were frequently found (24%), and the most common signs were pharyngeal erythema and irritability.ConclusionClinicians should recognize that the clinical spectrum of COVID-19 in children is wider than previously described, often with nonspecific signs and symptoms, and digestive symptoms should raise suspicion.

scholarly journals Perioperative hypothermia in pediatric patients operated in a tertiary care center: Incidence and correlates

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Osman ESEN ◽  
Gülseren YILMAZ ◽  
Nevin AYDIN
Keyword(s):  
Body Temperature ◽  
Surgical Procedures ◽  
Pediatric Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Fluid Replacement ◽  
Prospective Clinical Study ◽  
Tertiary Care Center ◽  
Body Temperatures ◽  
Perioperative Hypothermia

Background & Objectives: Hypothermia, described as temperature < 35°C, is a frequent condition encountered in patients operated under general anesthesia. It is associated with significant morbidity and mortality. We aimed to estimate its incidence and to investigate the conditions associated with hypothermia in pediatric patients. Methods: This prospective clinical study was carried out in the operating theatre of a tertiary care center between August 2015 and September 2015. A total of 108 pediatric patients who underwent various surgical procedures that lasted for more than 30 minutes were enrolled. Baseline demographic data, types of surgical procedures, duration of operations, preoperative and perioperative body temperatures were recorded. The incidence of hypothermia and its possible correlates were sought. Results: Our series consisted of 108 children (77 males, 71.3%; 31 females, 28.7%) with an average age of 6.08±5.09 years were included in the study. There was no case diagnosed with hypothermia in the preoperative, perioperative and postoperative periods. Patients in American Society of Anesthesiologists classification (ASA) three group had significantly higher preoperative body temperatures compared to those in ASA-1 and ASA-2 groups (p = 0.027). The postoperative body temperature in patients receiving intravenous fluid replacement was significantly lower (p=0.017). Conclusion: For pediatric patients scheduled for surgical interventions, we recommend close monitorization and follow-up of body temperature, implementation of preventive measures to avoid hypothermia and routine perioperative heating. Avoidance of hypothermia may prevent hazardous consequences of postoperative hypothermia. doi: https://doi.org/10.12669/pjms.36.4.456 How to cite this:Esen O, Yilmaz G, Aydin N. Perioperative hypothermia in pediatric patients operated in a tertiary care center: Incidence and correlates. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.456 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Risk factors on admission and condition at discharge of 529 consecutive COVID-19 patients at a tertiary care center in Santiago, Chile

2020 ◽  
Author(s):  
Cesar Maquilon ◽  
Jonas Gongora ◽  
Monica Antolini ◽  
Bernardita Alvarado ◽  
Nicolas Valdes ◽  
...  
Keyword(s):  
Health Insurance ◽  
Research Question ◽  
Care Center ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Ventilatory Support ◽  
High Sensitivity ◽  
Quality Adjusted Life Year ◽  
Risk Of Death ◽  
First Case

Abstract Background: The first case of COVID-19 was reported in Chile on March 3, 2020. Public and private hospitals were managed in a centralized manner. On May 30, Chile had 99,668 cases, 1054 deaths, 1383 ICU patients, 1174 patients on invasive mechanical ventilation (IMV), and 51 patients on non-invasive ventilation (NIMV). Research question: What are the variables associated with condition at discharge?Method: We performed a retrospective cohort study of 529 patients with a positive RT-PCR for SARS CoV-2who were consecutively discharged between March 14 and June 4, 2020, at Clínica Dávila, Santiago. Patients were analyzed according to laboratory variables on admission, Quality-Adjusted Life Year (QALY) score, health insurance, and type of respiratory support. Condition at discharge was survivor, non-survivor, or transfer to another center. Differences were evaluated by Chi-square test, Student’s t test, or Mann–Whitney U test. Logistic regression analysis was performed to identify variables that were predictive of condition at discharge.Results: Median (interquartile range, IQR) age was 49 (37–62) years, and the median (IQR) stay in the hospital was 6 (3–10) days. A total of 352 patients (66.5%) had respiratory symptoms, 177 (33.4%) had other symptoms or diagnoses on admission, and 116 required ventilatory support; 448 (84.7%) were survivors, 54 (10.2%) were non-survivors, and 27 (5.1%) were transferred. The median ages of the survivors and non-survivors were 46 (36–59) and 75.5 (66–84), respectively.Having state health insurance increased the risk of death by 2.8-fold (OR, 2.825; 95% CI: 1.383–5.772; P = 0.004). Multivariate analysis revealed the following predictive variables: age ≥ 60 years (OR, 15.3; 95% CI: 7.25–32.2; P = .001); PaO2/FiO2 on admission ≤ 200 vs > 200 (OR, 5,205; CI 95%: 1,942–13,94); high-sensitivity troponin, ≥ 15 vs <15 ng /L (OR, 5,163; 95% CI: 1.95–13,64; P = .001); and QALY ≤ 15 vs > 15 points (OR, 14,011; 95% CI: 4,826–40,679; P=.001).Interpretation: The variables analyzed and patient’s clinical evolution may allow assignment of ICU beds to patients with the greatest chance of survival, especially in countries or regions where this resource is limited.

scholarly journals Foreign body ingestion and associated factors in pediatric patients at a tertiary care center

2021 ◽  
Author(s):  
L.A. Navia-López ◽  
J.F. Cadena-León ◽  
K.R. Ignorosa-Arellano ◽  
E.M. Toro-Monjaraz ◽  
F. Zárate-Mondragón ◽  
...  
Keyword(s):  
Foreign Body ◽  
Associated Factors ◽  
Pediatric Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Foreign Body Ingestion ◽  
Tertiary Care Center
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