Etoposide phosphate for pediatric orthopedic malignancies after intravenous etoposide hypersensitivity

2019 ◽  
Vol 26 (1) ◽  
pp. 228-231 ◽  
Author(s):  
Joel P Brooks ◽  
Veronica Azmy ◽  
Alison Thompson ◽  
Darren Luon ◽  
Stephanie D Prozora ◽  
...  
Keyword(s):  
Chart Review ◽  
Pediatric Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hypersensitivity Reactions ◽  
Safe Alternative ◽  
Etoposide Phosphate ◽  
The Third ◽  
Academic Medical ◽  
Pediatric Orthopedic

Background Hypersensitivity reactions to etoposide have been reported and patients have been safely transitioned to etoposide phosphate for continued therapy. However, the safety and efficacy of substituting etoposide phosphate for etoposide has not been well established in pediatric orthopedic malignancies. The aim of this study is to determine whether etoposide phosphate can be substituted for etoposide in pediatric orthopedic malignancies. Methods A chart review of pediatric patients who developed hypersensitivity reactions to etoposide while being treated for orthopedic malignancies was performed at a large academic medical center. Three patients were identified, two with Ewing sarcoma and one with an osteosarcoma. All three patients experienced hypersensitivity reactions to their first doses of etoposide and were switched to etoposide phosphate for further therapy. Results After premedication, all three patients tolerated full doses of etoposide phosphate without a graded dose challenge or desensitization. Two of the patients were premedicated with diphenhydramine alone, while the third received diphenhydramine and dexamethasone. Conclusions Etoposide phosphate is a potentially safe alternative for pediatric patients with orthopedic malignancies who experience etoposide hypersensitivity. However, caution is needed as there are cases of etoposide phosphate hypersensitivity.

scholarly journals Rapid development of telehealth capabilities within pediatric patient portal infrastructure for COVID-19 care: barriers, solutions, results

2020 ◽  
Vol 27 (7) ◽  
pp. 1116-1120 ◽  
Author(s):  
Pious D Patel ◽  
Jared Cobb ◽  
Deidre Wright ◽  
Robert W Turer ◽  
Tiffany Jordan ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Medical Center ◽  
Rapid Development ◽  
Academic Medical Center ◽  
Security Policies ◽  
Patient Portal ◽  
Privacy And Security ◽  
Academic Medical ◽  
Adolescent Autonomy ◽  
National Emergency

Abstract The COVID-19 national emergency has led to surging care demand and the need for unprecedented telehealth expansion. Rapid telehealth expansion can be especially complex for pediatric patients. From the experience of a large academic medical center, this report describes a pathway for efficiently increasing capacity of remote pediatric enrollment for telehealth while fulfilling privacy, security, and convenience concerns. The design and implementation of the process took 2 days. Five process requirements were identified: efficient enrollment, remote ability to establish parentage, minimal additional work for application processing, compliance with guidelines for adolescent autonomy, and compliance with institutional privacy and security policies. Weekly enrollment subsequently increased 10-fold for children (age 0–12 years) and 1.2-fold for adolescents (age 13–17 years). Weekly telehealth visits increased 200-fold for children and 90-fold for adolescents. The obstacles and solutions presented in this report can provide guidance to health systems for similar challenges during the COVID-19 response and future disasters.

scholarly journals 384. SARS-CoV-2 Surveillance Testing Patterns among Hospitalized Pediatric Patients in a Single Academic Medical Center

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S293-S294
Author(s):  
Areej Bukhari ◽  
Jessica Seidelman ◽  
Becky A Smith ◽  
Sarah S Lewis ◽  
Michael J Smith ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Solid Organ ◽  
Cell Transplant ◽  
Infection Rates ◽  
Research Support ◽  
Repeat Testing ◽  
Academic Medical ◽  
Community Infection

Abstract Background Children infected with SARS-CoV-2 often have mild or no symptoms, making symptom screening an ineffective tool for determining isolation precautions. As an infection control measure, universal pre-procedural and admission SARS-CoV-2 testing for pediatric patients was implemented in April and August 2020, respectively. Limited data exist on the utility screening programs in the pediatric population. Methods We performed a retrospective cohort study of pediatric patients (birth to 18 years) admitted to a tertiary care academic medical center from April 2020 to May 2021 that had one or more SARS-CoV-2 point-of-care or polymerase chain reaction tests performed. We describe demographic data, positivity rates and repeat testing trends observed in our cohort. Results A total of 2,579 SARS-CoV-2 tests were performed among 1,027 pediatric inpatients. Of these, 51 tests (2%) from 45 patients (4.3%) resulted positive. Community infection rates ranged from 4.5-60 cases/100,000 persons/day during the study period. Hispanic patients comprised 16% of the total children tested, but were disproportionately overrepresented (40%) among those testing positive (Figure1). Of 654 children with repeated tests, 7 (0.1%) converted to positive from a prior negative result. Median days between repeat tests was 12 (IQR 6-45), not necessarily performed during the same hospital stay. Five of these 7 patients had tests repeated < 3 days from a negative result, of which only 2 had no history of recent infection by testing performed at an outside facility. Pre-procedural tests accounted for 35% of repeat testing, of which 0.9% were positive. Repeated tests were most frequently ordered for patients in hematology/oncology (35%) and solid organ transplant/surgical (33%) wards, each with < 3% positive conversion rate. Notably, no hematopoietic stem cell transplant patients tested positive for SARS-CoV-2 during the study period. Pediatric SARS-CoV-2 Testing Distributed by Race/Ethnicity Conclusion The positivity rate of universal pre-procedural and admission SARS-CoV-2 testing in pediatric patients was low in our inpatient cohort. Tests repeated < 3 days from a negative result were especially low yield, suggesting limited utility of this practice. Diagnostic testing stewardship in certain populations may be useful, especially as community infection rates decline. Disclosures Michael J. Smith, MD, M.S.C.E, Merck (Grant/Research Support)Pfizer (Grant/Research Support) Rebekah W. Moehring, MD, MPH, UpToDate, Inc. (Other Financial or Material Support, Author Royalties)

scholarly journals Aprepitant and Fosaprepitant Use in Children and Adolescents at an Academic Medical Center

2014 ◽  
Vol 19 (2) ◽  
pp. 127-131 ◽  
Author(s):  
Alexandra Shillingburg ◽  
Lisa Biondo
Keyword(s):  
Children And Adolescents ◽  
Pediatric Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Primary Prophylaxis ◽  
Emetogenic Chemotherapy ◽  
Record System ◽  
Patients Âgés ◽  
Academic Medical

OBJECTIVE: To describe the use of aprepitant and fosaprepitant, a neurokinin 1 (NK-1) receptor inhibitor, in children and adolescents at a large academic medical center, for the prevention and management of chemotherapy-induced nausea and vomiting (CINV). METHODS: A retrospective chart review was conducted using an electronic medical record system to evaluate the use of aprepitant and fosaprepitant in all pediatric patients that were discharged from a single academic medical center between February 25, 2009 and May 25, 2012. RESULTS: Twenty-six patients were included in this review and received a total of 287 doses over the span of 114 cycles. Mean age was 10.1 years, with a range of 11 months to 17 years old. In 16 of 26 patients, aprepitant was used as the primary prophylaxis. Of those patients who received primary prophylaxis, 6 of 16 received it for highly emetogenic chemotherapy, and 10 of 16 received it for moderately emetogenic chemotherapy. Intravenous fosaprepitant was used in 7 of 26 patients, ages 13 to 17 (median 14) years old. No adverse effects attributable to aprepitant were reported. CONCLUSIONS: Use of aprepitant and fosaprepitant in pediatric patients appeared to be well tolerated. No currently published reports data using aprepitant in a patient younger than 32 months old, whereas we reported its use in patients as young as 11 months old.

scholarly journals An Ophthalmology Resident-Led Quality Improvement Initiative to Decrease the Incidence of Perioperative Corneal Injury

2019 ◽  
Vol 11 (02) ◽  
pp. e49-e53
Author(s):  
Amanda L. Ely ◽  
Mark Goerlitz-Jessen ◽  
Ingrid U. Scott ◽  
Erik Lehman ◽  
Tabassum Ali ◽  
...  
Keyword(s):  
Risk Factors ◽  
Quality Improvement ◽  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Corneal Injury ◽  
Surgical Case ◽  
Anesthesia Providers ◽  
Academic Medical

Abstract Objective This article evaluates the effectiveness of an ophthalmology resident-led quality improvement (QI) initiative to decrease the incidence of perioperative corneal injury at an academic medical center Design Retrospective chart review. Methods A retrospective chart review was conducted of all surgical cases performed 6 months prior to, and 6 months after, implementation of an ophthalmology resident-led QI initiative at an academic medical center. The QI initiative (which focused on perioperative corneal injury awareness, understanding of risk factors, and presentation of an algorithm designed to prevent perioperative corneal injury) consisted of a lecture and distribution of educational materials to anesthesia providers. Data collected through the chart review included type of surgical case, presence of diabetes mellitus or thyroid disease, patient age and gender, patient positioning (supine, prone, or lateral), level of anesthesia provider training, length of surgical case, surgical service, type of anesthesia, and type (if any) of perioperative eye injury. The rates of perioperative corneal injury pre- versus post-initiative were compared. Results The rates of perioperative corneal injury pre- and post-initiative were 3.7 and 1.9 per 1,000, respectively (p = 0.012). Significant risk factors for perioperative corneal injury include longer duration of surgery (odds ratio [OR] 90–180 vs. < 90 minutes = 4.18, 95% confidence interval [CI] 1.43–12.18; OR > 180 vs. < 90 minutes = 8.56, 95% CI 3.01–24.32; OR > 180 vs. 90–180 = 2.05, 95% CI 1.17–3.58), patient position lateral > prone > supine (OR prone vs. lateral = 0.25, 95% CI 0.09–0.67; OR supine vs. lateral = 0.13, 95% CI 0.07–0.23), nonhead and neck surgeries (OR = 0.32, 95% CI 0.11–0.87), and surgery performed under the general surgery service (OR general surgery service vs. other subspecialty services = 6.50, 95% CI 2.39–24.76). Conclusions An ophthalmology resident-led QI initiative consisting of educating anesthesia providers was associated with a significant decrease in the rate of perioperative corneal injury.

scholarly journals Otolaryngologists and the Early Diagnosis of Mucopolysaccharidoses: A Cross-Sectional Study

Diagnostics ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 187 ◽  
Author(s):  
Danielle de Araujo Torres ◽  
Anneliese Lopes Barth ◽  
Mariana Pires de Mello Valente ◽  
Paulo Pires de Mello ◽  
Dafne Dain Gandelman Horovitz
Keyword(s):  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cross Sectional Study ◽  
Inborn Errors ◽  
Cross Sectional ◽  
Academic Medical ◽  
Fatal Course ◽  
History Of ◽  
Nose And Throat

Mucopolysaccharidoses (MPS) are a group of inborn errors of metabolism with an aggressive and usually fatal course. Therefore, early treatment is essential because the involvement of head and neck structures is almost always present in MPS. Our study aimed to retrospectively assess—via a chart review and a survey of caregivers—the history of ear, nose and throat (ENT) symptoms, the number of otolaryngology visits prior to diagnosis, and whether otolaryngologists diagnosed the disease in a cohort of MPS patients followed at an academic medical center. Twenty-three patients were evaluated. Age at diagnosis ranged from 0.2 to 33.0 years (median, 3.2 years). Prior to being diagnosed with MPS, 20/23 (87%) patients presented with at least one episode of otalgia, airway disorder, sleep disturbance, speech delay or suspected hearing loss. One patient had an adenotonsillectomy with paracentesis of tympanic membranes. Ten of the 23 patients (43%) were seen by an otolaryngologist before the diagnosis of MPS, none of which had the disease suspected during these visits. Notwithstanding limitations, our results suggest that increased awareness of MPS among otolaryngologists may allow for earlier diagnosis and better management of these patients.

scholarly journals Overweight and Obesity Among Adults Identifying on the Transgender Spectrum in Newark, NJ Between 2018 and 2020: A Retrospective Chart Review

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 1244-1244
Author(s):  
Joachim Sackey ◽  
Michelle DallaPiazza ◽  
Sari Bentsianov ◽  
Diana Finkel
Keyword(s):  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Overweight And Obesity ◽  
Future Research ◽  
Obesity Class ◽  
Academic Medical ◽  
White Majority ◽  
Hormone Use

Abstract Objectives To assess levels of overweight and obesity among transgender adults receiving care in an academic medical center in Newark, NJ between 2018 and 2020. Methods We performed a retrospective review of electronic medical records of transgender adults (≥18 years) receiving care in an academic medical center in Newark, NJ from 2018 through 2020. We used CDC Body Mass Index (BMI) cut-offs to determine overweight or obesity. Results Of the 159 patients included in this study, the median age was 28 years (range 18–75 years), 47.8% were Black, 27.4% were LatinX and 24.8% were White. Majority (89.3%) were receiving gender-affirming hormones and 69.2% identified as transfeminine. One-third (34.6%) were current smokers, 35.2% had a diagnosis of depression and/or anxiety and 23.3% were living with HIV. BMI was not associated with gender identity, race, hormone use, smoking, HIV status, depression and/or anxiety. A higher proportion of transfeminine participants (31.8%) were HIV positive compared to 4.1% of those identifying as transmasculine. Median BMI of the sample was 26kg/m2, 26.4% were overweight and 32.7% obese. Of the 32.7% who were obese, 12.6% were classified as obesity class 1, 10.7% as obesity class 2, and 9.4% as obesity class 3. Conclusions In this retrospective chart review, almost 60% of all transgender adults were either overweight or obese. Future research is needed to further explore potential clinical implications of elevated weight, as well as the medical, social, psychological, and health behavior factors associated with overweight and obesity among transgender individuals. Funding Sources None.

scholarly journals Tracking Substance Use Complications: A Collaborative Analysis of Public Health and Academic Medical Center Records on Drug Use-Associated Infective Endocarditis

2020 ◽  
Vol 222 (Supplement_5) ◽  
pp. S437-S441
Author(s):  
David de Gijsel ◽  
Martha DesBiens ◽  
Elizabeth A Talbot ◽  
David J Laflamme ◽  
Stephen Conn ◽  
...  
Keyword(s):  
Public Health ◽  
Substance Use ◽  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Discharge Diagnosis ◽  
Composite Measure ◽  
Academic Medical ◽  
Diagnosis Coding ◽  
The Impact

Abstract Background Healthcare systems and public health agencies use different methods to measure the impact of substance use (SU) on population health. We studied the ability of systems to accurately capture data on drug use-associated infective endocarditis (DUA-IE). Methods We conducted a retrospective analysis of patients with IE discharge diagnosis from an academic medical center, 2011–2017, comparing data from hospital Electronic Health Record (EHR) to State Uniform Hospital Discharge Data Set (UHDDS). To identify SU we developed a composite measure. Results EHR identified 472 IE discharges (430 of these were captured in UHDDS); 406 (86.0%) were correctly coded based on chart review. IE discharges increased from 57 to 92 (62%) from 2012 to 2017. Hospitalizations for the subset of DUA-IE identified by any measure of SU increased from 10 to 54 (440%). Discharge diagnosis coding identified 128 (60.7%) of total DUA-IE hospitalizations. The composite measure identified an additional 65 (30.8%) DUA-IE hospitalizations and chart review an additional 18 (8.5%). Conclusions The failure of discharge diagnosis coding to identify DUA-IE in 40% of hospitalizations demonstrates the need for better systems to capture the impact of SU. Collaborative data sharing could help improve surveillance responsiveness to address an emerging public health crises.

Gross Pathology of Routine Pediatric Tonsillectomy Specimens: Optimizing the Value of Patient Care

2018 ◽  
Vol 160 (2) ◽  
pp. 339-342 ◽  
Author(s):  
Elizabeth A. Hobbs ◽  
Joshua A. Hanson ◽  
Robert G. Nicholas ◽  
Benjamin R. Johnson ◽  
Karen A. Hawley
Keyword(s):  
Patient Care ◽  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Pediatric Malignancy ◽  
Academic Medical ◽  
The Mean ◽  
Pathologic Analysis ◽  
Mean Charge

Objective This investigation seeks to evaluate the effect of gross pathologic analysis on our management of patients undergoing routine tonsillectomy and to evaluate charges and reimbursement. Study Design Retrospective chart review from 2005 through 2016. Setting Academic medical center. Subjects and Methods Participants were pediatric patients aged 14 years and younger undergoing tonsillectomy for either sleep-disordered breathing or tonsillitis, with tonsillectomy specimens evaluated by pathology, and without any risk factors for pediatric malignancy. Records were reviewed for demographics, surgical indications, and pathology. Abnormal reports prompted an in-depth review of the chart. Charges and reimbursement related to both hospital and professional fees for gross tonsil analysis were evaluated. Results From 2005 to 2016, 3183 routine pediatric tonsillectomy cases were performed with corresponding specimens that were sent for gross analysis revealing no significant pathologic findings; 1841 were males and 1342 were females. Ten cases underwent microscopy by pathologist order, revealing normal tonsillar tissue. The mean charge per patient for gross analysis was $60.67 if tonsils were together as 1 specimen and $77.67 if tonsils were sent as 2 separate specimens; respective reimbursement amounts were $28.74 and $35.90. Conclusions Gross pathologic analysis did not change our management of routine pediatric tonsillectomy patients. Foregoing the practice at our institution would eliminate $19,171.72 to $24,543.72 in charges and $9081.40 to $11,344.40 in reimbursement per year. Eliminating this test would improve the value of patient care by saving health care resources without compromising clinical outcomes.

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