Infection Risk Factors in Pediatric Cardiac Surgery

2002 ◽  
Vol 10 (4) ◽  
pp. 329-333 ◽  
Author(s):  
Wojciech Mrowczynski ◽  
Michal Wojtalik ◽  
Danuta Zawadzka ◽  
Girish Sharma ◽  
Jacek Henschke ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Intensive Care ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Heart Surgery ◽  
Positive Culture ◽  
Surface Area Ratio ◽  
Surface Areas ◽  
Infection Risk Factors

Cardiac operations were preformed in 499 children from January 1998 through December 1999. Their median age was 263 days. A positive culture from blood, bronchoalveolar lavage, wound, or central catheter was obtained in 110 patients (22%). Age, sex, presence of pulmonary hypertension, body surface area, ratio of body surface area to oxygenator surface area, whether heart surgery was open or closed, and the duration of the operation, cardiopulmonary bypass, intubation, and intensive care were analyzed. Patients who developed infections were significantly younger, with smaller body surface areas and disparity with the oxygenator surface area, longer operative and bypass times, extended intubation, and prolonged intensive care. There was a significant correlation between infection and pulmonary hypertension. Sex and type of operation were not predictors of infection.

Clinical implication of renal allograft volume to recipient body surface area ratio in pediatric renal transplant

2018 ◽  
Vol 22 (8) ◽  
pp. e13295
Author(s):  
Michael E. Chua ◽  
Jin Kyu Kim ◽  
Michele Gnech ◽  
Jessica M. Ming ◽  
Bisma Amir ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Clinical Implication ◽  
Renal Allograft ◽  
Area Ratio ◽  
Surface Area Ratio ◽  
Pediatric Renal Transplant

scholarly journals P14 Reducing medication errors using prescribing nudges: intravenous aciclovir on paediatric intensive care

2020 ◽  
Vol 105 (9) ◽  
pp. e13.1-e13
Author(s):  
Jenny Gray ◽  
Nicholas Jones ◽  
Olivia Fuller ◽  
Andrew Schia
Keyword(s):  
Intensive Care ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Error Rate ◽  
Paediatric Intensive Care ◽  
Electronic Prescribing ◽  
Second Phase ◽  
Quality Of Prescribing

AimThis Quality Improvement project is the second phase of a long term project to improve the quality of prescribing on the paediatric intensive care unit (PICU). Small adjustments are made to the electronic prescribing (EP) system, known as ‘nudges’, with the aim of improving the quality of prescribing in terms of error rate or user experience.1 2Intravenous aciclovir is prescribed to most patients admitted to the PICU with suspected meningitis/encephalitis. There is a complicated dosing schedule where the prescriber must decide whether to use body surface area (BSA) or weight to calculate the required dose. Underdosing risks subtherapeutic treatment of a viral encephalitis and overdosing risks acute kidney injury. Within our EP system, dosing by weight can be automated, but dosing by BSA cannot.A project in 2018 used a ‘nudge’ to alter the order of prescribing options in the drop down menu on the EP system. This reduced the error rate from 26% to 17% by reducing the likelihood of picking the wrong indication for acyclovir.3 However, a re-audit in October to December 2018 found the error rate had crept back up to 32%. Prescribing on the EP system is a multi-step process. Prescribers had to pick ‘aciclovir’ to choose the weight based dose or ‘aciclovir injection 3 month-11 yr‘ to choose the BSA based dosing. When ‘aciclovir’ was picked, this removed the body surface area dosing option from the prescriber’s screen and led them in the direction of an incorrect dose.MethodThe intervention for this project was to amalgamate all weight and BSA dosing options for acyclovir within the EP system, and then order them by age so that the prescriber could see all options simultaneously. This change was designed and implemented by our electronic prescribing support pharmacist in April 2019. Pre and post change prescriptions were audited by pharmacy undergraduate students for accuracy using data downloaded from the EP system.ResultsThe error rate post change was 8% (pre change 32%). The remaining errors reflect transcribing of an incorrect dose initiated outside of the PICU from a referring ward or hospital.ConclusionThis project shows that small, ‘smart’ changes within EP configuration can improve the quality of prescribing.Future work involves working with the software company to incorporate the ability to automatically calculate the dose based on BSA, further reducing the need for manual calculations. This project would not have been possible without the skills and knowledge of our electronic prescribing support pharmacy team.ReferencesPatel MS, et al. Nudge units to improve the delivery of health care. NEJM 2018; 378: 214–216Cafazzo JA, et al. From discovery to design: the evolution of human factors in healthcare. healthcare quarterly 2012; 15: 24–29Gunning C, Gray J. Audit of acyclovir prescribing to assess whether changing the order of drop down box options in an electronic prescribing system can reduce prescribing errors. Archives of Disease in Childhood 2019; 104:7

The effect of donor/recipient body surface area ratio on outcomes in pediatric kidney transplantation

2009 ◽  
Vol 13 (3) ◽  
pp. 290-299 ◽  
Author(s):  
Stefano Giuliani ◽  
Pier Giorgio Gamba ◽  
Nikunj Kanu Chokshi ◽  
Paolo Gasparella ◽  
Luisa Murer ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Area Ratio ◽  
Surface Area Ratio ◽  
Pediatric Kidney Transplantation

scholarly journals Dose Intensity/Body Surface Area Ratio is a Novel Marker Useful for Predicting Response to Lenvatinib against Hepatocellular Carcinoma

Cancers ◽  
2019 ◽  
Vol 12 (1) ◽  
pp. 49 ◽  
Author(s):  
Yuji Eso ◽  
Shigeharu Nakano ◽  
Masako Mishima ◽  
Soichi Arasawa ◽  
Eriko Iguchi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Therapeutic Response ◽  
Dose Intensity ◽  
Progression Free Survival ◽  
Area Ratio ◽  
Treatment Intensity ◽  
Surface Area Ratio

Lenvatinib was recently approved as a novel first-line molecular targeted agent (MTA) for treating hepatocellular carcinoma (HCC). The importance of relative dose intensity (RDI) has been shown in the treatment of various types of cancers. However, RDI may not accurately reflect the treatment intensity of lenvatinib, as it is the first oral MTA where the dose is based on the patient’s weight. We aimed to evaluate the utility of 2M-DBR (the delivered dose intensity/body surface area ratio at 60 days) by comparing the relationship between 2M-DBR, 2M-RDI (RDI at 60 days), and the therapeutic response. The therapeutic response to lenvatinib was evaluated in 45 patients who underwent computed tomography 8–12 weeks after treatment initiation. We also investigated the clinical factors associated with high 2M-DBR. The area under the receiver operating characteristic of 2M-DBR that predicts the response to lenvatinib was higher than that of 2M-RDI (0.8004 vs. 0.7778). Patients with high 2M-DBR achieved significantly better objective responses and disease control rates than those with low 2M-DBR (p < 0.0001 and 0.0008). Patients with high 2M-DBR experienced significantly longer progression-free survival (PFS) than those with low 2M-DBR (p = 0.0001), while there was no significant correlation between 2M-RDI levels and PFS (p = 0.2198). Patients who achieved higher levels of 2M-DBR had a significantly better modified ALBI grade (p = 0.0437), better CONUT score (p = 0.0222), and higher BTR (p = 0.0281). Multivariate analysis revealed that high 2M-DBR was the only significant factor associated with longer PFS. In conclusion, 2M-DBR could be an important factor that reflects treatment intensity and useful for predicting the response to lenvatinib against HCC, instead of 2M-RDI.

scholarly journals Recovery from an Eighty-Percent Total Body Surface Area Burn Injury Sustained at Work

2012 ◽  
Vol 63 (2) ◽  
pp. 223-226
Author(s):  
Helga Hahn
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Initial Treatment ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Hot Water ◽  
Total Body

Recovery from an Eighty-Percent Total Body Surface Area Burn Injury Sustained at WorkThis article presents a case of severe burn injury at work involving 80 % of body surface area and patient treatment and rehabilitation, which resulted in preserved working ability. The worker was injured by hot water and steam. After initial treatment in the intensive care unit, he underwent comprehensive clinical and outpatient rehabilitation that took 92 weeks, after which he returned to work. His working disability was 100 % after the initial treatment in the intensive care unit, but rehabilitation improved it to 50 %. It should always be kept in mind that even patients with serious or life-threatening injuries can be reintegrated into the workforce if patients, physicians, occupational physicians, and employers all work together.

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