scholarly journals Clinical Impact of Malaria Rapid Diagnostic Testing at a US Children’s Hospital

2019 ◽  
Vol 9 (3) ◽  
pp. 298-304
Author(s):  
Leslie A Enane ◽  
Kaede V Sullivan ◽  
Evangelos Spyridakis ◽  
Kristen A Feemster
Keyword(s):  
Diagnostic Testing ◽  
Clinical Signs ◽  
Length Of Hospital Stay ◽  
Clinical Impact ◽  
Rapid Diagnostic Testing ◽  
Children's Hospital ◽  
Antimalarial Therapy ◽  
Children’S Hospital ◽  
The Mean ◽  
Mean Time

Abstract Background Children who develop malaria after returning to a setting in which the disease is not endemic are at high risk for critical delays in diagnosis and initiation of antimalarial therapy. We assessed the clinical impact of the implementation of malaria rapid diagnostic testing (RDT) on the management of children with malaria at an urban US children’s hospital that serves a large immigrant population. Methods This was a retrospective cohort study of all children diagnosed with laboratory-confirmed malaria at the Children’s Hospital of Philadelphia (CHOP) between 2000 and 2014. RDT using a US Food and Drug Administration–approved immunochromatographic assay was introduced at CHOP on August 1, 2007. We compared clinical management and outcomes of patients with malaria diagnosed before and after RDT introduction. Results We analyzed 82 pediatric malaria cases (32 before and 50 after RDT implementation). The majority of these patients had traveled to West Africa (91.5%) and were infected with Plasmodium falciparum (80.5%). The mean time to a positive result decreased from 10.4 to 0.9 hours (P < .001) after the introduction of RDT for patients with P falciparum. The mean time to antimalarial therapy decreased from 13.1 to 6.9 hours (P =; .023) in hospitalized patients. We found no significant reduction in the mean number of clinical signs of severe malaria between 0 and 48 hours of hospitalization and no difference in the need for exchange transfusion, time to resolution of parasitemia, or length of hospital stay. Conclusions Implementation of RDT for malaria was associated with shorter times to malaria diagnosis and initiation of antimalarial therapy. The results of this study support RDT in the optimal management of patients with malaria who present in settings in which the disease is not endemic.

scholarly journals Performance of Verigene Rapid Diagnostic Testing for Detection of Inpatient Pediatric Bacteremia

2021 ◽  
Vol 26 (5) ◽  
pp. 472-477
Author(s):  
Amy Kruger Howard ◽  
Kimberly Claeys ◽  
Jessica M. Biggs ◽  
Kristine A. Parbuoni ◽  
Kristie Johnson ◽  
...  
Keyword(s):  
Diagnostic Testing ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Gram Stain ◽  
Support Tool ◽  
Rapid Diagnostic Testing ◽  
Children's Hospital ◽  
Percent Agreement ◽  
Children’S Hospital ◽  
Resistance Markers

OBJECTIVE Verigene blood culture panels comprise rapid diagnostic testing, which aids in early bacteremia species identification. This study determined the concordance of Verigene rapid diagnostic results compared with the Vitek reference standard in patients admitted to a children's hospital. METHODS This was a 3-year retrospective observational study of neonatal and pediatric patients ≤18 years admitted to a children's hospital with confirmed bacteremia for whom Verigene testing was performed. Verigene testing was conducted on cultures with reported growth on Gram stain and final organism speciation confirmed via Vitek. Percent concordance and positive percent agreement with 95% CIs were calculated for Verigene panel-identifiable organisms. Negative percent agreement with 95% CIs was calculated for non-panel organisms. Time-to-result was calculated from Gram stain reporting to both Verigene and Vitek final organism susceptibility. RESULTS One hundred thirty-five Gram-positive (GP) and 51 Gram-negative (GN) isolates were identified through Vitek. Verigene GP panel-detectable organisms were correctly identified 96.9% (125/129) at the genus level and 95.3% (123/129) at the species level. Overall positive percent agreement was 95.3 (CI: 90.2–98.3). Negative percent agreement was 83.3 (CI: 35.9–99.6) for the 6 non-panel GP organisms. All GN isolates were correctly identified on Verigene. Median time-to-result was 2.9 hours (IQR 2.6, 3.2) and 44.4 hours (IQR: 35.4, 52.5) for Verigene and final susceptibilities, respectively. There was a statistically significant time savings of 41.5 hours (CI: 29.8–53.2) for identification and detection of resistance markers (p < 0.0001). CONCLUSION Verigene concordance at our institution aligns with results from previously published studies and can be considered a reliable clinical decision-support tool.

scholarly journals The Utility of Interaction Design as a Novel Tool to Improve Hand Hygiene Frequency on a Pediatric Hematology-Oncology Ward

2020 ◽  
Vol 41 (S1) ◽  
pp. s411-s411
Author(s):  
Johanna Blaak ◽  
Rachel DiMaio ◽  
Julia Kupis ◽  
Ross Sweetzir ◽  
Conny Betuzzi ◽  
...  
Keyword(s):  
Health Services ◽  
Hand Hygiene ◽  
Interaction Design ◽  
Qualitative Interviews ◽  
Cell Transplant ◽  
Children's Hospital ◽  
University Of Calgary ◽  
Children’S Hospital ◽  
The Mean ◽  
Alberta Health

Johanna Blaak, W21C, University of Calgary; Rachel DiMaio, University of Calgary; Julia Kupis, University of Calgary; Ross Sweetzir, Cisco Systems; Conny Betuzzi, Alberta Children’s Hospital, Alberta Health Services; Corey Dowler, Alberta Children’s Hospital, Alberta Health Services; Krista McIntytre, Alberta Children’s Hospital, Alberta Health Services; Jaime Kaufman, University of Calgary; Greg Hallihan, University of Calgary; John Conly, Foothills Medical Centre; Joseph Vayalumkal, Alberta Childrens HospitalBackground: Interaction design offers a novel interventional strategy to enhance hand-hygiene compliance (HHC) and reduce hospital-acquired infections (HAIs) in the pediatric setting. A quality improvement initiative in collaboration with the University of Calgary and Alberta Health Services led to the implementation of a pilot project with sensor-embedded alcohol -based hand rub (ABHR) dispensers at a hematology-oncology and hematopoietic stem cell transplant unit at Alberta Children’s Hospital (ACH). Methods: Internet of things (IoT) sensors were installed in ABHR dispensers (n = 3) on the unit. Usage data were transmitted to a local server using an MQTT messaging protocol for 16 weeks. Real-time data visualization was presented on a central display next to the nursing station with 11 unique pediatric themes including dinosaurs, transportation, and Canadian animals. Data were collected with and without visualization, and frequency of use (FoU) was determined for both periods. Qualitative interviews with unit stakeholders (n = 13) were held to determine perceptions of the intervention. Results: During the first 8 weeks of the study period, the mean daily use without visualization was 47 times (SD, 14.5) versus 99 times (SD, 23.9) with visualization. When accounting for novelty, by removing the first week of data, the mean daily use was 92 (SD 19.6). The percentage increase from period 1 to period 2 was 96.6%, accounting for novelty. Qualitative interviews with stakeholders (n = 13) on the unit indicated that the intervention increased their personal awareness of hand hygiene (75%) and acted as a constant reminder to perform hand hygiene for everyone on the unit including nonclinical staff, patients, and family members (92%). Conclusions: These limited data suggest that interaction design may improve HH frequency and show promise as a tool for increased HH awareness and education. Interaction design provides a unique, innovative, and acceptable hand hygiene improvement strategy for staff, patients, and families in the pediatric inpatient setting.Funding: NoneDisclosures: None

scholarly journals A Retrospective Study Evaluating the Effectiveness of an Asthma Clinical Pathway in Pediatric Inpatient Practice

2008 ◽  
Vol 13 (4) ◽  
pp. 233-241
Author(s):  
Elisa Edwards ◽  
Kristie Fox
Keyword(s):  
Drug Therapy ◽  
Hospital Stay ◽  
Clinical Pathway ◽  
Length Of Hospital Stay ◽  
Control Group ◽  
Readmission Rates ◽  
Asthma Education ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Pediatric Inpatient

OBJECTIVE To determine if the asthma clinical pathway implemented at Wolfson Children's Hospital reduces the length of hospital stay. To determine if pathway use affected the use of asthma education, the use of appropriate discharge medications based on asthma classification, and readmission rates. METHODS A list of patients aged 2 to 18 years discharged from Wolfson Children's Hospital between September 1, 2004 and August 31, 2006 with the diagnosis of asthma was generated. Medical records of eligible patients were reviewed for demographic information, asthma pathway use, duration of hospital stay in days, readmission rates, receipt of asthma education, and medications prescribed upon discharge. Patients placed on the asthma clinical pathway were compared to a control group with asthma who were matched based on age and discharge date. Length of stay was averaged for each group. Asthma education, discharge medications, and readmission rates were compared between the two groups. RESULTS Forty-three patients placed on the asthma clinical pathway were compared to a 43 patients in the control group that were matched for age and discharge date. Use of the asthma clinical pathway reduced hospital stay by 0.372 days (P = .0373). Receipt of asthma education (P = .3864), the use of appropriate drug therapy prescribed upon discharge (P = .1398), and readmission rates (P = .5486) were unaffected by pathway use. CONCLUSIONS The asthma clinical pathway used at Wolfson Children's Hospital reduces length of hospital stay, but has no bearing on receipt of asthma education, use of appropriate drug therapy upon discharge, or readmission rates.

Utilization of Diagnostic Testing for Renal Anomalies and Congenital Heart Disease in Patients with Microtia

2020 ◽  
Vol 162 (4) ◽  
pp. 554-558
Author(s):  
Vaibhav H. Ramprasad ◽  
Amber D. Shaffer ◽  
Noel Jabbour
Keyword(s):  
Congenital Heart ◽  
Medical Center ◽  
Tertiary Care ◽  
Diagnostic Testing ◽  
Case Series ◽  
Standard Of Care ◽  
Renal Ultrasound ◽  
Renal Anomalies ◽  
Children's Hospital ◽  
Children’S Hospital

Objective Congenital ear anomalies are associated with congenital cardiac and renal defects. Renal ultrasounds, electrocardiogram, and echocardiogram can be utilized for diagnosis of these concurrent defects. No standard of care exists for the workup of patients with microtia. The goals of this study were to describe the utilization of diagnostic testing for cardiac and renal anomalies and to identify their prevalence in patients with microtia. Study Design Case series with chart review. Setting Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center. Subjects and Methods This study is an Institutional Review Board–approved retrospective review of consecutive patients born between 2002 and 2016 who were diagnosed with microtia and seen in the otolaryngology clinic at a tertiary care children’s hospital. Demographics, sidedness and grade of microtia, comorbid diagnoses, and details of renal and cardiovascular evaluations were recorded. Factors associated with retroperitoneal ultrasound and cardiac testing were assessed with logistic regression. Results Microtia was present in 102 patients, and 98 patients were included as they received follow-up. Microtia was associated with craniofacial syndrome in 34.7% of patients. Renal ultrasound was performed in 64.3% of patients, and 12.9% of patients with ultrasounds had renal aplasia. Cardiac workup (electrocardiogram or echocardiogram) was completed in 60.2% of patients, and of this subset, 54.2% had a congenital heart defect. Conclusion Diagnostic testing revealed renal anomalies and cardiac defects in patients with isolated microtia at a higher rate than in the general population. This suggests the need for further evaluation of the role of routine screening in patients with microtia.

scholarly journals The Effect of Rapid Respiratory Viral Diagnostic Testing on Antibiotic Use in a Children's Hospital

2002 ◽  
Vol 156 (12) ◽  
pp. 1230 ◽  
Author(s):  
Carrie L. Byington ◽  
Heidi Castillo ◽  
Kris Gerber ◽  
Judy A. Daly ◽  
Laurie A. Brimley ◽  
...  
Keyword(s):  
Diagnostic Testing ◽  
Antibiotic Use ◽  
Children's Hospital ◽  
Children’S Hospital

scholarly journals Evaluation of quality of care for patients with congenital heart disease using ECHSA Congenital Database integrated tools

2021 ◽  
Vol 25 (1) ◽  
pp. 52
Author(s):  
O. Yu. Kornoukhov ◽  
A. A. Karimov ◽  
V. N. Ilyin
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Hospital Mortality ◽  
Conflict Of Interest ◽  
Congenital Heart ◽  
Z Score ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
The Mean

<p><strong>Background.</strong> A quality of surgical care evaluation based solely on workload and hospital mortality is incomplete. ECHSA Congenital Database integrated tools provide complexity-adjusted methods to evaluate surgical results and the surgical performance of a hospital, and make it possible to demonstrate hospital service level among other congenital heart programmes.</p><p><strong>Methods.</strong> Data on 2,521 operations in a population of children, including 532 newborns, with congenital heart disease (CHD) were uploaded on the European Congenital Heart Surgeons Association Congenital Database. These data were collected between 2012 and 2018 at the Filatov Children's Hospital. We compared our personal results with database mean values according to the following criteria: 1) proportion of newborns among all paediatric surgical cases, 2) hospital mortality, 3) Aristotle Basic Score (ABS) value, 4) STS-EACTS Mortality Score (MtS) value, and 5) MtS Performance value. All data on the database website were analysed using integrated database tools.</p><p><strong>Results.</strong> The proportion of newborns in the Filatov Children's Hospital was 21.1%, while the database mean value was 18.6%, and hospital mortality values were 3.89% and 3.61%, respectively. The mean ABS in the Filatov Children's Hospital was 6.78 ± 2.08, while that on the database was 6.57 ± 2.12 (Z-score = 0.075). The mean MtS values for the hospital and database were 0.74 ± 0.59 and 0.72 ± 0.64, respectively (Z-score = 0.031). The calculated MtS performance for the Filatov Children's Hospital was 0.72 ± 0.56, while that for all European respondents was 0.54 ± 0.29 (Z-score = 0.603).</p><p><strong>Conclusion.</strong> Cooperation with a multicentre international database, such as ECHSA Congenital Database, provides modern complexity-adjusted tools for evaluation of quality of care for children with CHD. The Filatov Children’s Hospital is a high-volume cardiac surgery centre that demonstrates an adequate survival rate regarding complexity level and surgical risk compared to European respondents of the ECHSA Congenital Database.</p><p>Received 19 October 2020. Revised 18 November 2020. Accepted 19 November 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

scholarly journals Taking the next step in publication productivity analysis in pediatric neurosurgery

2018 ◽  
Vol 21 (6) ◽  
pp. 655-665 ◽  
Author(s):  
Ryan P. Lee ◽  
Raymond Xu ◽  
Pooja Dave ◽  
Sonia Ajmera ◽  
Jock C. Lillard ◽  
...  
Keyword(s):  
Basic Science ◽  
Pediatric Neurosurgery ◽  
Faculty Members ◽  
Children's Hospital ◽  
Tier 1 ◽  
Children’S Hospital ◽  
Fellowship Programs ◽  
The Mean ◽  
Tier 3 ◽  
Number Of Citations

OBJECTIVEThere has been an increasing interest in the quantitative analysis of publishing within the field of neurosurgery at the individual, group, and institutional levels. The authors present an updated analysis of accredited pediatric neurosurgery training programs.METHODSAll 28 Accreditation Council for Pediatric Neurosurgery Fellowship programs were contacted for the names of pediatric neurosurgeons who were present each year from 2011 through 2015. Faculty names were queried in Scopus for publications and citations during this time period. The 5-year institutional Hirsch index [ih(5)-index] and revised 5-year institutional h-index [ir(5)-index] were calculated to rank programs. Each publication was reviewed to determine authorship value, tier of research, clinical versus basic science research, subject matter, and whether it was pediatrics-specific. A unique 3-tier article classification system was introduced to stratify clinical articles by quality and complexity, with tier 3 being the lowest tier of publication (e.g., case reports) and tier 1 being the highest (e.g., randomized controlled trials).RESULTSAmong 2060 unique publications, 1378 (67%) were pediatrics-specific. The pediatrics-specific articles had a mean of 15.2 citations per publication (median 6), whereas the non–pediatrics-specific articles had a mean of 23.0 citations per publication (median 8; p < 0.0001). For the 46% of papers that had a pediatric neurosurgeon as first or last author, the mean number of citations per publication was 12.1 (median 5.0) compared with 22.5 (median 8.0) for those in which a pediatric neurosurgeon was a middle author (p < 0.0001). Seventy-nine percent of articles were clinical research and 21% were basic science or translational research; however, basic science and translational articles had a mean of 36.9 citations per publication (median 15) compared with 12.6 for clinical publications (median 5.0; p < 0.0001). Among clinical articles, tier 1 papers had a mean of 15.0 citations per publication (median 8.0), tier 2 papers had a mean of 18.7 (median 8.0), and tier 3 papers had a mean of 7.8 (median 3.0). Neuro-oncology papers received the highest number of citations per publication (mean 25.7). The most common journal was the Journal of Neurosurgery: Pediatrics (20%). MD/PhD faculty members had significantly more citations per publication than MD faculty members (mean 26.7 vs 14.0; p < 0.0001) and also a higher number of publications per author (mean 38.6 vs 20.8). The median ih(5)- and ir(5)-indices per program were 14 (range 5–48) and 10 (range 5.6–37.2), respectively. The mean ir(5)/ih(5)-index ratio was 0.8. The top 5 fellowship programs (in descending order) as ranked by the ih(5)-index corrected for number of faculty members were The Hospital for Sick Children, Toronto; Children’s Hospital of Pittsburgh; University of California, San Francisco Benioff Children’s Hospital; Seattle Children’s Hospital; and St. Louis Children’s Hospital.CONCLUSIONSAbout two-thirds of publications authored by pediatric neurosurgeons are pediatrics-specific, although non–pediatrics-specific articles averaged more citations. Most of the articles authored by pediatric neurosurgeons are clinical, with basic and translational articles averaging more citations. Neurosurgeons with PhD degrees averaged more total publications and more citations per publication. In all, this is the most advanced and informative analysis of publication productivity in pediatric neurosurgery to date.

Iatrogenic hyperadrenocorticism in 28 dogs

1999 ◽  
Vol 35 (3) ◽  
pp. 200-207 ◽  
Author(s):  
HP Huang ◽  
HL Yang ◽  
SL Liang ◽  
YH Lien ◽  
KY Chen
Keyword(s):  
Reference Range ◽  
Clinical Signs ◽  
Acth Stimulation ◽  
Cutaneous Lesions ◽  
Elevated Alkaline Phosphatase ◽  
Baseline Cortisol ◽  
Initial Improvement ◽  
The Mean ◽  
Mean Time ◽  
Aspartate Transferase

Twenty-eight dogs with iatrogenic hyperadrenocorticism were studied. The most common clinical signs were cutaneous lesions (27/28), polydipsia (21/28), polyuria (19/28), and lethargy (16/28). The most predominant findings on biochemical profile were elevated alkaline phosphatase (ALP, 15/28) and alanine transferase (ALT, 14/28); hypercholesterolemia (14/28); elevated aspartate transferase (AST, 12/28); and elevated triglycerides (12/18). Baseline cortisol levels of all 28 dogs were at the lower end of the reference range and exhibited suppressed or no response to adrenocorticotropic hormone (ACTH) stimulation. The mean time for each dog to show initial improvement of clinical signs after corticosteroid withdrawal was six weeks, with another mean time of 12 weeks to demonstrate complete remission.

Clinical signs and duration of cyanide toxicosis delivered by the M-44 ejector in wild dogs

2006 ◽  
Vol 33 (3) ◽  
pp. 181 ◽  
Author(s):  
Amber L. Hooke ◽  
Lee Allen ◽  
Luke K.-P. Leung
Keyword(s):  
Initial Phase ◽  
Clinical Signs ◽  
Sodium Cyanide ◽  
Cerebral Hypoxia ◽  
Ocular Reflex ◽  
Righting Reflex ◽  
The Mean ◽  
The Difference ◽  
Wild Dogs ◽  
Mean Time

Sodium cyanide poison is potentially a more humane method to control wild dogs than sodium fluoroacetate (1080) poison. This study quantified the clinical signs and duration of cyanide toxicosis delivered by the M-44 ejector. The device delivered a nominal 0.88 g of sodium cyanide, which caused the animal to loose the menace reflex in a mean of 43 s, and the animal was assumed to have undergone cerebral hypoxia after the last visible breath. The mean time to cerebral hypoxia was 156 s for a vertical pull and 434 s for a side pull. The difference was possibly because some cyanide may be lost in a side pull. There were three distinct phases of cyanide toxicosis: the initial phase was characterised by head shaking, panting and salivation; the immobilisation phase by incontinence, ataxia and loss of the righting reflex; and the cerebral hypoxia phase by a tetanic seizure. Clinical signs that were exhibited in more than one phase of cyanide toxicosis included retching, agonal breathing, vocalisation, vomiting, altered levels of ocular reflex, leg paddling, tonic muscular spasms, respiratory distress and muscle fasciculations of the muzzle.

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