Rapid Infliximab Infusion in the Pediatric Population

OBJECTIVES To compare infusion reaction rates between rapid infliximab (REMICADE, Janssen Biotech Inc) infusions and previous standard 2- to 3-hour infusions; additionally, to assess patient satisfaction and reduction in chair time associated with rapid infliximab infusions. METHODS Pediatric rheumatology and gastroenterology patients receiving maintenance infliximab therapy using a standard 2- to 3-hour titrated infusion had the opportunity to enroll in the non-titrated rapid 1-hour infusion protocol following tolerance of induction dosing at 0, 2, and 6 weeks. Patients were included from December 1, 2017, to March 31, 2018, via retrospective chart review and patient satisfaction surveys. RESULTS Data were collected on 55 patients receiving a total of 160 rapid infliximab infusions. There were 2 infusion reactions during the enrollment and data collection period, resulting in an overall infusion reaction rate of 1.3%. The patient satisfaction survey results showed all patients were at minimum satisfied with the information provided regarding rapid infliximab, decreased time spent in clinic, ease of scheduling, and overall process. CONCLUSIONS Our data suggest rapid infliximab infusions are safe in pediatric rheumatology and gastroenterology patients receiving maintenance infliximab infusion therapy. The overall infusion reaction rate of 1.3% in this study is well below the accepted infusion reaction rate of standard-length infliximab infusions of 2% to 3%.

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Safety of Infliximab Treatment in Patients with Rheumatoid Arthritis in a Real-world Clinical Setting: Description and Evaluation of Infusion Reactions

The Journal of Rheumatology ◽

10.3899/jrheum.110956 ◽

2012 ◽

Vol 39 (8) ◽

pp. 1539-1545 ◽

Cited By ~ 13

Author(s):

JOHN KELSALL ◽

PAMELA ROGERS ◽

GRISELDA GALINDO ◽

MARY A. De VERA

Keyword(s):

Inflammatory Arthritis ◽

Reaction Rate ◽

Chart Review ◽

Primary Outcome ◽

Retrospective Chart Review ◽

Infusion Reaction ◽

Secondary Outcome ◽

Infliximab Treatment ◽

Infusion Reactions ◽

Acute Reaction

Objective.To describe acute and delayed infusion reactions in a large cohort of patients with inflammatory arthritis, treated with infliximab (IFX).Methods.We conducted a retrospective chart review of patients treated with IFX at the Mary Pack Arthritis Centre between 2000 and 2008. The primary outcome was the occurrence of acute infusion reactions during infusions or 1–2 hours after each infusion, and secondary outcome was the occurrence of delayed infusion reactions 1–14 days after an infusion. Descriptive analyses were conducted to summarize study outcomes and identify trends over followup.Results.Since 2000, 376 patients were referred to the Mary Pack IFX clinic and 200 received 4399 IFX infusions over a mean 140 ± 132 weeks of followup. Of these, 135 were patients with RA who received 2977 IFX infusions over mean followup of 138 ± 132 weeks. In total 258 episodes of acute reactions were observed for an overall acute reaction rate of 5.8%. Acute infusion reactions were mostly mild (42.6%) and moderate (43.8%) and commonly affected sites were head and neck (31.5%) and cutaneous (21.1%). A total of 37 delayed infusion reaction episodes were observed (0.9% rate); reactions were also mostly mild (16.2%) and moderate (64.9%).Conclusion.These clinical data from 200 patients treated with IFX demonstrate that acute and delayed infusion reactions occur infrequently and are mostly mild to moderate in presentation.

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Practice Characteristics of Pediatric Otolaryngology Same-Day Appointments

Ear Nose & Throat Journal ◽

10.1177/01455613211058101 ◽

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.

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Efficacy of Outpatient Infusion Therapy in Pediatric Patients With Post-Concussive Headaches

Neurology ◽

10.1212/01.wnl.0000801868.92092.d9 ◽

2021 ◽

Vol 98 (1 Supplement 1) ◽

pp. S14.3-S15

Author(s):

James Pate ◽

James Mooney ◽

Erin Katz ◽

Marshall Chandler McLeod ◽

Sara Gould

Keyword(s):

Oral Therapy ◽

Pediatric Patients ◽

Pediatric Population ◽

Symptom Relief ◽

Retrospective Chart Review ◽

Return To Play ◽

Infusion Therapy ◽

Control Group ◽

Treatment Protocols ◽

Significant Difference

ObjectiveThe objective of this study is to determine the relative efficacy of an intravenous therapy for post-concussive headaches in a pediatric population, as compared to oral therapy.BackgroundPost traumatic headache is extremely common in the acute and chronic phases after concussion. To date, there is still not significant evidence-based treatment protocols defined for treatment.Design/MethodsPediatric patients who were treated for post-concussive headaches at an outpatient infusion clinic from 2016 to 2018 were selected for inclusion in the study. Clinic visits before and after infusions were reviewed to determine changes in headache score (HA), symptom severity score (SSS), and self-reported symptom relief. The control group received only oral therapy for their headaches. The infusion consisted of parenteral ketorolac, compazine, diphenhydramine, and a normal saline bolus (20 mg/kg). Of the 95 patients who were treated in clinic, 53 patients were selected for a retrospective chart review.ResultsFollowing infusion therapy, overall mean HA and SSS scores were both reduced (1.6346, SD 1.8997, p < 0.0001 and 23.0385, SD 29.4971, p < 0.0001 respectively). Oral therapy demonstrated a similar mean overall reduction in HA and SS scores (1.4151, SD 1.4992, p < 0.0001 and 25.4906, SD 30.2042, p < 0.0001). While both groups achieved a reduction in HA and SS scores, there was not a statistically significant difference in reduction of symptoms scores between the oral and infusion groups.ConclusionsInfusion therapy is as effective at reducing HA and SSS as established oral therapies. It is hypothesized that infusion therapy may have a shorter time to headache abortion than oral therapy based on pharmacokinetics. Further, some physicians are unwilling to allow an athlete to return to play while taking suppressive medication. Future studies may show that an infusion could allow a more rapid return to play and resolution of symptoms.

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Pediatric endoscopic pilonidal sinus treatment (PEPSiT): what we learned after a 3-year experience in the pediatric population

Updates in Surgery ◽

10.1007/s13304-021-01094-4 ◽

2021 ◽

Author(s):

Ciro Esposito ◽

Ernesto Montaruli ◽

Giuseppe Autorino ◽

Mario Mendoza-Sagaon ◽

Maria Escolino

Keyword(s):

Patient Satisfaction ◽

Laser Therapy ◽

Pilonidal Sinus ◽

Pediatric Population ◽

Treatment Protocol ◽

Pilonidal Sinus Disease ◽

Term Outcome ◽

Long Term Outcome ◽

Clavien Grade

AbstractThis paper aimed to report a multi-institutional 3-year experience with pediatric endoscopic pilonidal sinus treatment (PEPSiT) and describe tips and tricks of the technique. We retrospectively reviewed all patients < 18 years, with primary or recurrent pilonidal sinus disease (PSD), undergoing PEPSiT in the period 2017–2020. All patients received pre-operative laser therapy, PEPSiT and post-operative dressing and laser therapy. Success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed. A total of 152 patients (98 boys) were included. Median patient’s age was 17.1 years. Fifteen/152 patients (9.8%) presented a recurrent PSD. All patients resumed full daily activities 1 day after surgery. The post-operative course was painless in 100% of patients (median VAS pain score < 2/10). Patient satisfaction was excellent (median score 4.8). The median follow-up was 12.8 months (range 1–36). Complete healing in 8 weeks was achieved in 145/152 (95.4%) and the median healing time was 24.6 days (range 16–31). We reported post-operatively immediate Clavien grade 2 complications (3 oedema, 2 burns) in 5/152 (3.3%) and delayed Clavien grade 2 complications (3 granulomas, 8 wound infections) in 11/152 (7.2%). Disease recurrence occurred in 7/152 (4.6%), who were re-operated using PEPSiT. PEPSiT should be considered the standard of care for surgical treatment of PSD in children and teenagers. PEPSiT is technically easy, with short and painless post-operative course and low recurrence rate (4.6%). Standardized treatment protocol, correct patient enrollment and information, and intensive follow-up are key points for the success of the procedure.

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Location-thinking, value-thinking, and graphical forms: combining analytical frameworks to analyze inferences made by students when interpreting the points and trends on a reaction coordinate diagram

Chemistry Education Research and Practice ◽

10.1039/d1rp00037c ◽

2021 ◽

Author(s):

Alexander P. Parobek ◽

Patrick M. Chaffin ◽

Marcy H. Towns

Keyword(s):

Reaction Rate ◽

Research Study ◽

Reaction Rates ◽

Reaction Coordinate ◽

Structured Interviews ◽

Chemistry Students ◽

Qualitative Research Study ◽

The Impact ◽

Analytical Frameworks ◽

Chemical Representations

Reaction coordinate diagrams (RCDs) are chemical representations widely employed to visualize the thermodynamic and kinetic parameters associated with reactions. Previous research has demonstrated a host of misconceptions students adopt when interpreting the perceived information encoded in RCDs. This qualitative research study explores how general chemistry students interpret points and trends on a RCD and how these interpretations impact their inferences regarding the rate of a chemical reaction. Sixteen students participated in semi-structured interviews in which participants were asked to interpret the points and trends along provided RCDs and to compare relative reaction rates between RCDs. Findings derived from this study demonstrate the diversity of graphical reasoning adopted by students, the impact of students’ interpretations of the x-axis of a RCD on the graphical reasoning employed, and the influence of these ideas on inferences made about reaction rate. Informed by analytical frameworks grounded in the resources framework and the actor-oriented model of transfer, implications for instruction are provided with suggestions for how RCDs may be presented to assist students in recognizing the critical information encoded in these diagrams.

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Perborate Oxidation of Substituted 5-Oxoacids in Aqueous Acetic Acid Medium: A Kinetic and Mechanistic Study

ISRN Physical Chemistry ◽

10.1155/2014/924827 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

S. Shree Devi ◽

B. Muthukumaran ◽

P. Krishnamoorthy

Keyword(s):

Acetic Acid ◽

Acid Medium ◽

Reaction Rate ◽

Reaction Medium ◽

Activation Parameters ◽

Reaction Rates ◽

Mechanistic Study ◽

Aqueous Acetic Acid ◽

Sodium Perborate ◽

Acetic Acid Medium

Kinetics and mechanism of oxidation of substituted 5-oxoacids by sodium perborate in aqueous acetic acid medium have been studied. The reaction exhibits first order both in [perborate] and [5-oxoacid] and second order in [H+]. Variation in ionic strength has no effect on the reaction rate, while the reaction rates are enhanced on lowering the dielectric constant of the reaction medium. Electron releasing substituents in the aromatic ring accelerate the reaction rate and electron withdrawing substituents retard the reaction. The order of reactivity among the studied 5-oxoacids is p-methoxy ≫ p-methyl > p-phenyl > –H > p-chloro > p-bromo > m-nitro. The oxidation is faster than H2O2 oxidation. The formation of H2BO3+ is the reactive species of perborate in the acid medium. Activation parameters have been evaluated using Arrhenius and Eyring’s plots. A mechanism consistent with the observed kinetic data has been proposed and discussed. Based on the mechanism a suitable rate law is derived.

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Patient experience and satisfaction with telemedicine during COVID-19: a multi-institution experience (Preprint)

10.2196/preprints.27451 ◽

2021 ◽

Author(s):

Adrian Rodrigues ◽

Jonathan S. Yu ◽

Hriday Bhambhvani ◽

Tyler Uppstrom ◽

William Ricci ◽

...

Keyword(s):

Patient Satisfaction ◽

Cell Phone ◽

Cell Phones ◽

Multivariable Model ◽

Assess Patient Satisfaction ◽

High Satisfaction ◽

Special Surgery ◽

A Cell ◽

Specific Factors ◽

Hospital For Special Surgery

BACKGROUND The coronavirus disease 2019 (COVID-19) heralded an unprecedented increase in telemedicine utilization. OBJECTIVE Assess patient satisfaction with telemedicine during COVID-19 METHODS Telemedicine visit data were gathered from two separate institutions (Stanford Health Care (Stanford) and the Hospital for Special Surgery (HSS)). Patient satisfaction data from HSS were captured from a Press-Ganey questionnaire between April 19, 2020 and December 12, 2020, while the Stanford data was taken from a novel survey instrument that was distributed to all patients between June 22, 2020 and November 1, 2020. There were 60,550 telemedicine visits across 93 services at Stanford, each linked with a post-visit survey. At HSS, there were 66,349 total telemedicine visits with 7,348 randomly linked with a post-visit survey. The percentage of respondents who reported the highest possible likelihood to recommend score (“LTR top box percentage”) and mean overall visit scores were recorded. RESULTS Over 19 weeks, the LTR top box percentage at Stanford increased from 69.6% to 74.0% (p=.0002), and HSS showed no significant change across 35 weeks (p=.7100). LTR trend stability at Stanford was observed across 11 medical, four surgical, and five oncological services (p >.05). In the multivariable model, the use of a cell phone (aOR: 1.18; 95% CI: 1.12–1.23) and tablet (aOR: 1.15; 95% CI: 1.07–1.23) were associated with higher overall scores, while visits with interrupted connections (aOR: 0.49; 95% CI: 0.42–0.57) or help required to connect (aOR: 0.49; 95% CI: 0.42–0.56) predicted lower patient satisfaction. CONCLUSIONS We present the largest published description of patient satisfaction with telemedicine. We found high satisfaction with telemedicine encounters across multiple measures, and we identified a number of important telemedicine-specific factors that predict increased overall visit score. These include the use of cell phones or tablets, phone reminders, and connecting before the visit was scheduled to begin. Visits with poor connectivity, extended wait times, or difficulty being seen, examined, or understood by the provider were linked with reduced odds of high scores. Our results suggest that attention to connectivity and audio/visual definition will help optimize patient satisfaction with telemedicine encounters in the future. CLINICALTRIAL n/a

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3D Calculations of PWR Vessels Neutron Fluence With EFLUVE 3D Code

Volume 1: Plant Operations, Maintenance, Engineering, Modifications, Life Cycle and Balance of Plant; Nuclear Fuel and Materials; Radiation Protection and Nuclear Technology Applications ◽

10.1115/icone21-16316 ◽

2013 ◽

Author(s):

Cécile-Aline Gosmain ◽

Sylvain Rollet ◽

Damien Schmitt

Keyword(s):

Monte Carlo ◽

Fast Neutron ◽

Pressure Vessel ◽

Reaction Rate ◽

Neutron Fluence ◽

Neutron Transport ◽

Reaction Rates ◽

Surveillance Program ◽

Monte Carlo Code ◽

Neutron Sources

In the framework of surveillance program dosimetry, the main parameter in the determination of the fracture toughness and the integrity of the reactor pressure vessel (RPV) is the fast neutron fluence on pressure vessel. Its calculated value is extrapolated using neutron transport codes from measured reaction rate value on dosimeters located on the core barrel. EDF R&D has developed a new 3D tool called EFLUVE3D based on the adjoint flux theory. This tool is able to reproduce on a given configuration the neutron flux, fast neutron fluence and reaction rate or dpa results of an exact Monte Carlo calculation with nearly the same accuracy. These EFLUVE3D calculations does the Source*Importance product which allows the calculation of the flux, the neutronic fluence (flux over 1MeV integrated on time) received at any point of the interface between the skin and the pressure vessel but also at the capsules of the pressurized water reactor vessels surveillance program and the dpa and reaction rates at different axial positions and different azimuthal positions of the vessel as well as at the surveillance capsules. Moreover, these calculations can be carried out monthly for each of the 58 reactors of the French current fleet in challenging time (less than 10mn for the total fluence and reaction rates calculations considering 14 different neutron sources of a classical power plant unit compared to more than 2 days for a classic Monte Carlo flux calculation at a given neutron source). The code needs as input: - for each reaction rate, the geometric importance matrix produced for a 3D pin by pin mesh on the basis of Green’s functions calculated by the Monte Carlo code TRIPOLI; - the neutron sources calculated on assemblies data (enrichment, position, fission fraction as a function of evolution), pin by pin power and irradiation. These last terms are based on local in-core activities measurements extrapolated to the whole core by use of the EDF core calculation scheme and a pin by pin power reconstruction methodology. This paper presents the fundamental principles of the code and its validation comparing its results to the direct Monte Carlo TRIPOLI results. Theses comparisons show a discrepancy of less than 0,5% between the two codes equivalent to the order of magnitude of the stochastic convergence of Monte Carlo results.

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384 Post-Operative ICU Admission for Elective Craniotomy for Intra-axial Brain Tumor Resection

Neurosurgery ◽

10.1093/neuros/nyx417.384 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 291-292

Author(s):

Farhan A Mirza ◽

Catherine Y Wang ◽

Thomas Pittman

Keyword(s):

Brain Tumor ◽

Pediatric Patients ◽

Prolonged Mechanical Ventilation ◽

Pediatric Population ◽

External Ventricular Drain ◽

Tumor Resection ◽

Retrospective Chart Review ◽

Icu Admission ◽

Icu Stay ◽

Brain Tumor Resection

Abstract INTRODUCTION We reviewed our practice at the University of Kentucky in order to assess the safety of admitting adult and pediatric patients to floor beds after craniotomy, exclusively for intra-axial brain tumor resection. METHODS Retrospective chart review of patients, adults and pediatric, who underwent craniotomy by a single surgeon (TP) for intra axial brain tumor resection between January 2012 and December 2015. 413 patient charts were reviewed, 16 were omitted due to incomplete records. RESULTS >421 craniotomies for intra axial brain tumor resection were performed. 397 patients underwent surgery, 35 of whom were <18 years of age.188 females and 209 males. 351 patients (331 adults, 20 pediatric) were admitted to floor beds. In this group, length of operation was <4 hours in 346 patients (99.1%) and >4 hours in only 5 patients (0.9%). 3 patients (0.8%) required transfer to ICU within 24 hours of floor admission. 55 adult patients required ICU stay for various reasons: 9 patients had pre-operative or intra operative EVD placement; 15 patients required prolonged ventilation; 1 patient had to be taken back to the operating room for hemorrhage evacuation; 5 had intraventricular tumors and were planned ICU admissions; 26 patients were admitted pre-operatively to an ICU bed on a non neurosurgical service and were returning to their assigned beds. In the pediatric population, 15 patients required ICU stay: 8 were for EVD management and 7 for prolonged operation or frequent neurological evaluations. In this group, the length of operation was <4 hours in 40 patients(57.1%) and >4 hours in 30 patients (42.9%). CONCLUSION Admitting adult and pediatric patients to floor beds after craniotomy for intra-axial brain tumor resection is safe. There are some conditions that mandate ICU admission: these include prolonged mechanical ventilation and the presence of an external ventricular drain.

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RARE-36. DYSEMBRYOPLASTIC NEUROEPITHELIAL TUMORS: A REVIEW OF CLINICAL AND MOLECULAR CHARACTERISTICS, AND OUTCOME IN A PEDIATRIC POPULATION AT A SINGLE CENTER

Neuro-Oncology ◽

10.1093/neuonc/noaa222.746 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii450-iii450

Author(s):

Valerie Cruz Flores ◽

Thomas Geller ◽

Ignacio Gonzalez Gomez ◽

Luis Rodriguez ◽

Javier Quintana ◽

...

Keyword(s):

Molecular Mechanisms ◽

Pediatric Population ◽

Molecular Genetic ◽

Intractable Epilepsy ◽

Retrospective Chart Review ◽

Braf V600e ◽

Molecular Characteristics ◽

Dysembryoplastic Neuroepithelial Tumor ◽

Free Standing ◽

Presenting Symptoms

Abstract BACKGROUND Neuronal and mixed neuro-glial tumors of the central nervous system (CNS) are relatively rare. Dysembryoplastic neuroepithelial tumor (DNET) is a benign, rare, slow-growing tumor, but in many cases is associated with intractable epilepsy. OBJECTIVE To report the experience with DNET at a single free-standing children’s institution. METHODS A retrospective chart review of 24 patients with confirmed DNET between 2001 and 2019 was performed. Data was collected on clinical characteristics, tumor location, surgical management, histopathological and molecular findings, and outcomes. RESULTS Mean age at diagnosis was 10 years (range 2 to 19 years), with female predominance (54.2%). Most common presenting symptoms were seizures (79.2%) and headaches (12.5%). Location of the tumor was temporal (29.2%), frontal (25.0%), parietal (16.7%), cerebellar (12.5%) and occipital (4.2%). A gross total resection was achieved in half the cases. Recurrence occurred in 4 patients (16.7%), all of whom had subtotal resections. The average follow up since diagnosis was 4.6 years (range 0.3 to 14 years). Nineteen patients presented with seizures, of which 63.2% were seizure free after surgery. The samples with molecular genetic testing (microarrays or FISH), were all normal except one patient positive for BRAF V600E mutation. CONCLUSIONS This is the first and largest review of pediatric DNETs in the last 10 years. Despite majority of patients having a favorable outcome after surgery, a subset of patients remains symptomatic. As molecular mechanisms in DNET remain unknown, future aim is to describe the molecular characteristics of our DNET population, and correlate with outcomes.

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