scholarly journals Impact of a reduced palonosetron maximum dose on the incidence of chemotherapy-induced nausea and vomiting in pediatric patients

2021 ◽  
Author(s):  
Liza Kramer ◽  
Heidi Trinkman ◽  
Robert Arrowood ◽  
Anish Ray
Keyword(s):  
Chart Review ◽  
Pediatric Patients ◽  
Maximum Dose ◽  
Medical Center ◽  
Pediatric Population ◽  
Retrospective Chart Review ◽  
Nausea And Vomiting ◽  
Cell Transplant ◽  
The Impact ◽  
Antiemetic Agents

Background Palonosetron is a serotonin-3 (5-HT3) receptor antagonist indicated in the prevention of chemotherapy-induced nausea and vomiting (CINV) in pediatric and adult patients. Traditional dosing for palonosetron in the pediatric population has been 20 mcg/kg with a maximum dose of 1500 mcg. This study aimed to evaluate the impact of an institutional dose cap of 750 mcg on pediatric CINV. Procedure This is a retrospective chart review of admitted patients given palonosetron intended for prevention of CINV at a pediatric medical center between July 1, 2018 and June 30, 2020. Patients 1 month up to 17 years of age who received at least one dose of palonosetron prior to chemotherapy (not preceding stem cell transplant) were included. Information regarding chemotherapy, antiemetic premedication, emesis, and breakthrough antiemetic agents were recorded to quantify the instances of CINV. Results Seven hundred and seventy-one patient encounters met inclusion criteria (n=485 traditional dose, n=286 dose capped). There was no statistical difference in the instances of emesis (p=0.98) or breakthrough agents administered (p=0.65) between the two groups. Dose capping patients at 750 mcg reduced cost by approximately 34.9% compared to traditional dosing. Conclusions The use of a dose cap of palonosetron at 750 mcg maintains efficacy for prevention of CINV while reducing cost in pediatric patients receiving chemotherapy.

scholarly journals 1133. Evaluation of Antibiotic Allergy Documentation in Pediatric Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S403-S403
Author(s):  
Kristin H Wheatley ◽  
Lauren Sterner ◽  
Tibisay I Villalobos-Fry
Keyword(s):  
Broad Spectrum ◽  
Chart Review ◽  
Adverse Reactions ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Retrospective Chart Review ◽  
Adverse Outcomes ◽  
Antibiotic Allergy ◽  
Broad Spectrum Antibiotics ◽  
Standardize Evaluation

Abstract Background Antibiotics are the most prescribed drug class in children and use often results in reports of adverse reactions. Of these adverse reactions, allergic reactions are documented with an incidence of 10% of all antibiotic prescriptions. Documentation of the details of the reaction is incomplete in as many as 66–84% of encounters leading to increased use of broad-spectrum antibiotics and associated adverse outcomes. The purpose of this study was to determine the incidence of complete antibiotic allergy documentation and how antibiotic selection was affected in pediatric patients. Methods A retrospective chart review of electronic medical records was conducted for pediatric patients admitted to a pediatric unit with a documented antibiotic allergy between September 1, 2015 and May 31, 2017. Results The study sample included 536 encounters, 424 individual patients and 689 total allergies. Of all admissions during the study period, 10.3% of encounters had at least one antibiotic allergy documented. Approximately 40% of the encounters were in patients aged 12–17 years. A specific antibiotic was identified in 510 instances (74.0%) whereas an antibiotic class was documented in the remaining 179 instances (26.0%). Amoxicillin was the most commonly reported agent (25.4%). Rash (33.5%) and hives (14.8%) were the most commonly reported reactions. No reaction documentation was found in 78 entries (11.3%). Sixty-six entries (9.6%) did not include a date of occurrence and 452 (65.6%) did not include any specific comments regarding the allergy. Following evaluation of allergy documentation, 87 entries (12.6%) were classified as complete. Empiric broad-spectrum antibiotics were prescribed in 184 encounters (82.5%) compared with narrow-spectrum antibiotic therapy in 39 encounters (17.5%) when an allergy was documented. Conclusion Incomplete documentation of antibiotic allergies was identified in almost 90% of encounters within the pediatric population admitted to Lehigh Valley Reilly Children’s Hospital. Due to the preferential use of broad-spectrum antibiotics in patients with documented antibiotic allergies, an initiative is underway to standardize evaluation and documentation of allergies in patients receiving care within the health network. Disclosures All authors: No reported disclosures.

Head and Neck Infections in Pediatric Cardiac Transplant Patients

1995 ◽  
Vol 74 (6) ◽  
pp. 422-425 ◽  
Author(s):  
Joseph Haddad ◽  
Thomas V. Inglesby ◽  
Linda Addonizio
Keyword(s):  
Head And Neck ◽  
Chart Review ◽  
Pediatric Patients ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Cardiac Transplant ◽  
Transplant Patients ◽  
Cardiac Transplants ◽  
A Prospective Study ◽  
Head And Neck Infections

A retrospective chart review was undertaken at Columbia Presbyterian Medical Center to assess the incidence, etiology and management of head and neck infections in pediatric cardiac transplant patients on immunosuppression. From June 1984 to February 1992, 59 cardiac-transplants were performed on 57 pediatric patients. Standard immunosuppressive therapy was used. Thirteen of these patients died within three months of transplant and were not included. Of the 44 patient charts reviewed, 82 head and neck infections were documented in 27 patients (61%). There were 26 episodes of sinusitis, 27 episodes of otitis media and 20 episodes of tonsillitis/pharyngitis. Unusual middle-ear pathogens seen included Morganella morgagni and Pseudomonas aeruginosa. These preliminary data suggest that children on immunosuppression for cardiac transplant may be at risk for head and neck infections from unusual or unsuspected organisms, and tympanocentesis plays an important role in diagnosis and treatment. A prospective study is planned to gain further data.

Practice Characteristics of Pediatric Otolaryngology Same-Day Appointments

2021 ◽  
pp. 014556132110581
Author(s):  
Jenna Berg ◽  
Alexander Tu ◽  
Dwight Jones ◽  
Katie Geelan-Hansen
Keyword(s):  
Patient Satisfaction ◽  
Otitis Media ◽  
Chart Review ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Demographic Data ◽  
Retrospective Chart Review ◽  
Pediatric Otolaryngology ◽  
Practice Characteristics ◽  
Day Clinic

Objectives This study aims to assess characteristics of same-day clinic appointments in a pediatric population at an academic otolaryngology practice. Methods Retrospective chart review of patients aged 18 or younger who had same-day clinic appointments between January 1, 2016, and December 31, 2018, at a single academic institution. Demographic data, diagnosis(es), procedures, and operations completed were included in the analysis. Results There were 363 same-day visits by 322 patients in the 3-year study period. Two hundred sixty-nine (269) of these visits were from new patients. Otitis media and rhinosinusitis were the most frequently coded diagnoses. One hundred forty-four (144) procedures were completed the day of the visit and 169 operations were performed as a result of the same-day visit. If the patient had a procedure or operation performed, they were more likely to have been referred by another provider. Conclusions Providing same-day appointments can help provide timely and appropriate otolaryngology specialty care to pediatric patients. Further evaluation is needed to determine the effects on patient satisfaction as well as no-show rates.

scholarly journals Time to Stable Dose of Psychostimulants in Pediatric Patients With ADHD

2020 ◽  
Vol 25 (3) ◽  
pp. 228-234
Author(s):  
Selena R. Pasadyn ◽  
Kimberly Giuliano ◽  
Deanna LaBianca ◽  
Michael Manos
Keyword(s):  
Chart Review ◽  
Extended Release ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Stable Dose ◽  
Stimulant Use ◽  
Hyperactivity Disorder ◽  
The Impact ◽  
Medication Switching

OBJECTIVES The prevalence of attention-deficit/hyperactivity disorder (ADHD) is increasing and psychostimulants are the pharmacological standard of care. Patients benefit most when there is efficient titration to a stable dose of medication as defined by maintaining that same dose for 6 months. The aims of this study were to describe time to stable dose in a cohort of children with ADHD and examine the impact of demographic factors. METHODS A list of pediatric patients with a diagnosis of ADHD in the electronic health record was generated, and a retrospective chart review of stimulant use was conducted on 500 patients randomly selected from 2010 to 2015 who met inclusion criteria. Time to stable dosing and its association with demographic characteristics were assessed. RESULTS Patients were predominantly male (72%), white (81%), and privately insured (67%). Fifty-five percent of patients achieved a stable dose of medication on first attempt; therefore, the median time to stable dosing for the cohort was 0 days with the interquartile range being 0 to 133.8 days. There was significant increase in time to stable dose for patients younger than 10 years compared with those ≥10 years of age (p = 0.01). Time to stable dose was not significantly associated with race (p = 0.13), sex (p = 0.72), type of insurance (p = 0.56), or formulation being immediate or extended release (p = 0.56). CONCLUSIONS Many patients had long titration periods when trying to reach a stable dose. Given that medication switching can be challenging for patients and families, more frequent contact with providers during titration may be necessary.

scholarly journals Tongue Blade Bite Test Predicts Mandible Fractures

2016 ◽  
Vol 9 (2) ◽  
pp. 121-124 ◽  
Author(s):  
John Neiner ◽  
Rachael Free ◽  
Gloria Caldito ◽  
Tara Moore-Medlin ◽  
Cherie-Ann Nathan
Keyword(s):  
Predictive Value ◽  
Chart Review ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Retrospective Chart Review ◽  
High Sensitivity ◽  
Ct Scans ◽  
Facial Trauma ◽  
Institutional Review ◽  
Mandible Fractures

The aim of the study is to evaluate the utility of a simple tongue blade bite test in predicting mandible fractures and use this test as an alternative screening tool for further workup. This is a retrospective chart review. An institutional review board approved the retrospective review of patients evaluated by the Department of Otolaryngology at a single institution for facial trauma performed from November 1, 2011, to February 27, 2014. Patients who had a bite test documented were included in the study. CT was performed in all cases and was used as the gold standard to diagnose mandible fractures. Variables analyzed included age, sex, fracture type/location on CT, bite test positivity, and operative intervention. A total of 86 patients met the inclusion criteria and of those 12 were pediatric patients. Majority of the patients were male (80.2%) and adult (86.0%; average age: 34.3 years). Fifty-seven patients had a negative bite test and on CT scans had no mandible fracture. Twenty-three patients had a positive bite test and a CT scan confirmed fracture. The bite test revealed a sensitivity of 88.5% (95% CI: 69.8–97.6%), specificity of 95.0% (95% CI:86.1–99%), positive predictive value [PPV] of 88.5% (95% CI: 69.8–97.6%), and negative predictive value [NPV] of 95.0% (95% CI: 86.1–99.0%). Among pediatric patients, the sensitivity was 100% (95% CI: 29.9–100%), specificity was 88.9% (95% CI: 68.4–100%), PPV was 75.0% (95% CI: 19.4–99.4%), and NPV was 100% (95% CI: 63.1–100%). The tongue blade bite test is a quick inexpensive diagnostic tool for the otolaryngologist with high sensitivity and specificity for predicting mandible fractures. In the pediatric population, where avoidance of unnecessary CT scans is of highest priority, a wider range of data collection should be undertaken to better assess its utility.

scholarly journals 1346. Implementation of a Multidisciplinary 48 Hour Antibiotic Timeout in a Pediatric Population

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S684-S684
Author(s):  
Victoria Konold ◽  
Palak Bhagat ◽  
Jennifer Pisano ◽  
Natasha N Pettit ◽  
Anish Choksi ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Intervention Group ◽  
Post Intervention ◽  
Days Of Therapy ◽  
New Antibiotics ◽  
Core Elements ◽  
Quasi Experimental ◽  
Empirical Antibiotics ◽  
The Impact

Abstract Background To meet the core elements required for antimicrobial stewardship programs, our institution implemented a pharmacy-led antibiotic timeout (ATO) process in 2017 and a multidisciplinary ATO process in 2019. An antibiotic timeout is a discussion and review of the need for ongoing empirical antibiotics 2-4 days after initiation. This study sought to evaluate both the multidisciplinary ATO and the pharmacy-led ATO in a pediatric population, compare the impact of each intervention on antibiotic days of therapy (DOT) to a pre-intervention group without an ATO, and to then compare the impact of the pharmacy-led ATO versus multidisciplinary ATO on antibiotic days of therapy (DOT). Methods This was a retrospective, pre-post, quasi-experimental study of pediatric patients comparing antibiotic DOT prior to ATO implementation (pre-ATO), during the pharmacy-led ATO (pharm-ATO), and during the multidisciplinary ATO (multi-ATO). The pre-ATO group was a patient sample from February-September 2016, prior to the initiation of a formal ATO. The pharmacy-led ATO was implemented from February-September 2018. This was followed by a multidisciplinary ATO led by pediatric residents and nurses from February-September 2019. Both the pharm-ATO and the multi-ATO were implemented as an active non-interruptive alert added to the electronic health record patient list. This alert triggered when new antibiotics had been administered to the patient for 48 hours, at which time, the responsible clinician would discuss the antibiotic and document their decision via the alert workspace. Pediatric patients receiving IV or PO antibiotics administered for at least 48 hours were included. The primary outcome was DOT. Secondary outcomes included length of stay (LOS) and mortality. Results 1284 unique antibiotic orders (n= 572 patients) were reviewed in the pre-ATO group, 868 (n= 323 patients) in the pharm-ATO and 949 (n= 305 patients) in the multi-ATO groups. Average DOT was not significantly different pre vs post intervention for either methodology (Table 1). Mortality was similar between groups, but LOS was longer for both intervention groups (Table 1). Impact of an ATO on DOT, Mortality and LOS Conclusion An ATO had no impact on average antibiotic DOT in a pediatric population, regardless of the ATO methodology. Disclosures All Authors: No reported disclosures

Evaluation of Cost-effectiveness and Clinical Value of Routine Histopathologic Examination of Septoplasty Specimens

2021 ◽  
pp. 019459982110129
Author(s):  
Randall S. Ruffner ◽  
Jessica W. Scordino
Keyword(s):  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Clinical Value ◽  
Level Of Evidence ◽  
Significant Pathology ◽  
National Model ◽  
Routine Histopathologic Examination

Objectives During septoplasty, normal cartilage and bone are often sent for pathologic examination despite benign appearance. We explored pathology results following septoplasty from April 2016 to April 2018, examining clinical value and relevance, implications, and cost analysis. Study Design Retrospective chart review. Setting Single-institution academic medical center. Methods A retrospective chart review was compiled by using Current Procedural Terminology code 30520 for septoplasty for indication of nasal obstruction, deviated septum, and nasal deformity. Results A total of 236 consecutive cases were identified spanning a 2-year period. Septoplasty specimens were sent for pathology evaluation in 76 (31%). The decision to send a specimen for histopathology was largely physician dependent. No cases yielded unexpected or significant pathology that changed management. The average total charges for septoplasty were $10,200 at our institution, with 2.2% of procedural charges accounting for pathology preparation and review, averaging $225. Nationally, this results in an estimated charged cost of $58.5 million. The Centers for Medicare and Medicaid Services (CMS) reimbursement for septoplasty pathology charges was $46 in 2018, accounting for 1.3% of hospital-based reimbursements and 2.2% of ambulatory center reimbursements. With CMS as a national model for reimbursement, $11.8 million is spent yearly for septoplasty histopathology. Given that CMS reimbursement is significantly lower than private insurers, national total reimbursement is likely considerably higher. Conclusion Routine pathology review of routine septoplasty specimens is unnecessary, unremarkable, and wasteful. Correlation of the patient’s presentation and intraoperative findings should justify the need for pathology evaluation. This value-based approach can offer significant direct and indirect cost savings. Level of evidence 4.

An Evaluation of the Effects of Elevated Body Mass Index on Skeletal Age

2021 ◽  
Author(s):  
Michael H. French ◽  
Michael S. Kung ◽  
W. Nathan Holmes ◽  
Hossein Aziz ◽  
Evelyn S. Thomas ◽  
...  
Keyword(s):  
Chart Review ◽  
Pediatric Patients ◽  
Intraclass Correlation ◽  
Retrospective Chart Review ◽  
Skeletal Age ◽  
Chronological Age ◽  
Age Group ◽  
Obese Children ◽  
Significant Difference ◽  
Hand Radiographs

Abstract BackgroundMany treatment decisions in children’s Orthopaedics are based on age. This study determined whether a discrepancy between chronological age (CA) and skeletal age (SA) is dependent on BMI and if overweight or obese children would have an advanced SA.Materials and Methods120 children between ages 8-17 with an adequate hand radiograph and a correlating BMI were enrolled by retrospective chart review. Stratification based on age, sex, ethnicity, and BMI percentile was performed. For each age group, 6 males and 6 females were selected with 50% of each group having an elevated BMI. Two blinded physicians independently evaluated hand radiographs and recorded the SA. Statistical analyses evaluated inter-rater reliability and any discrepancy between groups.ResultsThe final statistical analysis included 96 children. The Intraclass Correlation Coefficient for SA determined by the two reviewers was excellent at 0.95. A difference of 13 months was found between CA and SA in the elevated BMI cohort versus the non-elevated BMI cohort, (p<0.001). No significant difference was seen between CA and SA for the non-elevated cohort (p=0.72), while matching for age and sex. ConclusionChronological age and skeletal age are not always equivalent especially in pediatric patients who are overweight or obese.

Abstract P305: Post-Stroke Aphasia as a Predictor of 30-Day Readmission Associated With Infection: A Retrospective Chart Review

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Emma M Loebel ◽  
Mary Rojas ◽  
Connor Mensching ◽  
Danielle Wheelwright ◽  
Laura K Stein
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Mount Sinai Hospital ◽  
Index Admission ◽  
Negative Consequences ◽  
Medical Comorbidities ◽  
Post Stroke ◽  
Increased Risk ◽  
Adjusted Model ◽  
The Impact

Introduction: Studies have demonstrated that aphasia may negatively impact morbidity and mortality among ischemic stroke (IS) patients. However, the association between post-stroke aphasia and readmission with infection (RI) is poorly understood. We sought to assess the impact of aphasia on post-stroke RI. We hypothesized that aphasic patients are at increased risk of infection in the 30-day post-stroke period. Methods: We performed retrospective chart review of the Mount Sinai Hospital IS patients with 30-day all cause readmission from January 2016 - December 2019. All variables were abstracted from the index admission (IA) electronic medical records except for aspects related to the readmission (RA). Aphasia was present if a neurologist diagnosed the patient with acquired language dysfunction during IA. We performed chi square and logistic regression analyses to compare readmitted patients with and without aphasia at IA. Our fully adjusted model controlled for age, sex, medical comorbidities, NIHSS ≥ 8, IA LOS > 7, IA infection, discharge to facility. We completed all analyses with SPSS. Results: During IA, 36% (n=42) were diagnosed with aphasia. At IA, there were no significant differences in age (dichotomized at 65), sex, or medical comorbidities between aphasic and non-aphasic cohorts. However, more aphasic patients had admission NIHSS ≥ 8 (89% vs 35%, p<0.0001), LOS > 7 (76% vs 42%, p=0.0004), discharge to facility (79% vs 49%, p=0.0016), and RI (52% vs 19%, p=0.002). The presence of aphasia predicted RI in both unadjusted (OR=4.6, p<0.001) and adjusted (OR= 3.3, p=0.014) multivariate analyses. The Kappa inter-reliability ranged from 0.7-1.0 for the key variables included in our adjusted model. Conclusions: The adjusted odds of 30-day readmission with infection were significantly greater in those with diagnosis of aphasia at the time of index admission compared to those without. Our study provides preliminary evidence that the presence of aphasia may have negative consequences on a patient’s health beyond the language disturbance. Further study is needed to better understand the reasons and risk reduction strategies in this vulnerable population.

65 Complication rate of cuffed versus uncuffed PICC lines placed by interventional radiology in pediatric patients

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e46-e46
Author(s):  
Maria Al Bandari ◽  
John Donnellan ◽  
Filomena Tavares
Keyword(s):  
Chart Review ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Electronic Record ◽  
Subject Area ◽  
Mechanical Failure ◽  
Complication Rates ◽  
Tertiary Referral Centre ◽  
Complications Rate ◽  
Premature Removal

Abstract Primary Subject area Paediatric Radiology Background Peripherally inserted central catheters are commonly used in pediatrics to offer stable access for administering prolonged courses of antibiotics, chemotherapy, parenteral nutrition, or other intravenous fluids. Objectives To assess the complication rates of cuffed versus uncuffed PICCs in a pediatric tertiary referral centre. Design/Methods Research ethics board approval was sought and granted. A dual arm study design was employed with a retrospective chart review of PICCs inserted between June 2017 - June 2018, and a prospective chart review of PICCS inserted between January 2019 - June 2019 at a large tertiary pediatric referral center. Data collected from the electronic record included age, weight, and diagnosis. Line type, size, location, insertion and removal dates, and indications were recorded. Primary outcome was removal of PICC after completion of therapy or premature removal due to the following complications: infection, thrombosis, or mechanical failure (defined as catheter breakage, blockage, or dislodgement). Results The study included 266 patients. Across all patients weighing &lt; 10 kg, 90.5% of those with cuffed PICCs and 65% of those with uncuffed catheters completed therapy. The predominant complication resulting in premature removal was mechanical failure, but this was only observed in patients with uncuffed catheters (25%). Infection was also observed only in uncuffed catheters (10%), and thrombosis (4.8%) was only in the cuffed lines. For patients weighing ≥ 10 kg, 86% of those with cuffed PICCs and 77.2% with uncuffed catheters completed therapy. More complications were observed in uncuffed catheters (infection 7.7%, mechanical failure 6.6%, thrombosis 5%). Infection resulting in premature removal occurred in 7% of cuffed catheters. There was no reported mechanical failure or thrombosis in the cuffed group. The distribution of diagnoses was relatively homogenous between the groups for most diagnoses. However, there was a higher percentage of oncology patients in the uncuffed group (23%) than the cuffed group (7%) due to the need for power-injectable lines, which were not available in a cuffed variant during this study. Conclusion All-cause pediatric PICC-associated complications rate in the neonate group for patients &lt; 10kg in the uncuffed group is 35% and in the cuffed group is 4.8%. Whereas in the pediatric group ≥ 10kg, all-cause pediatric PICC-associated complications rate in the uncuffed group is 19.3% and in the cuffed group is 7%. There were no mechanical complications in the cuffed group and the vast majority of lines made it to completion of therapy. This work supports utilization of cuffed PICC lines in selected pediatric patients.

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