scholarly journals Evaluation of Anticoagulant Monitoring in Pediatric Patients Receiving Enoxaparin for Treatment of Venous Thrombosis

2021 ◽  
Vol 26 (4) ◽  
pp. 346-351
Author(s):  
Jason Koury ◽  
Robert Hellinga ◽  
Jennifer Rose ◽  
Shirley Abraham ◽  
Anjali Subbaswamy
Keyword(s):  
Native American ◽  
Pediatric Patients ◽  
Blood Clot ◽  
Retrospective Chart Review ◽  
Central Line ◽  
University Of New Mexico ◽  
Central Line Insertion ◽  
Wall Injury ◽  
The University ◽  
American Ethnicity

OBJECTIVES A venous thromboembolism (VTE) is a blood clot that occurs secondary to vessel wall injury often from a central line insertion. Enoxaparin is often considered a first-line treatment in pediatrics for VTE due to its favorable kinetic profile. Enoxaparin monitoring for pediatric patients is accomplished through anti-Xa monitoring in which monitoring practices may vary between institutions. The objective of this study is to evaluate covariates in pediatric patients to determine which variables are most likely to be associated with enoxaparin dose changes as a result of anti-Xa monitoring. METHODS A single center, retrospective chart review was conducted in pediatric patients treated with enoxaparin for VTE over a 10-year period and who were assessed to determine covariates that lead to dose changes based on anti-Xa levels. Secondary outcomes described monitoring patterns at the University of New Mexico Children's Hospital. RESULTS Sixty-eight patients met inclusion criteria in which results showed that patients aged 2 to 5.9 months (p = 0.026), who had critical care status (p = 0.009), and who were of Native American ethnicity (p = 0.016) were likely to have an enoxaparin dose change at least once during their treatment regimen. The mean number of levels drawn were 7.5 per patient over a 6- to 12-week period, and doses were not frequently changed based on a confirmatory lab draw. However, many doses were adjusted based on the week 1 post-therapeutic level. CONCLUSIONS Patients of Native American ethnicity, younger than 6 months, and those admitted to the PICU were likely to have dose changes based on anti-Xa levels.

The Retention/Intervention Study of Native American Undergraduates at the University of New Mexico

2003 ◽  
Vol 5 (2) ◽  
pp. 175-203 ◽  
Author(s):  
Mary Jiron Belgarde ◽  
Richard K. Loré
Keyword(s):  
Native American ◽  
New Mexico ◽  
Intervention Study ◽  
Student Service ◽  
University Of New Mexico ◽  
Service Programs ◽  
Ethnic Populations ◽  
Native Student ◽  
Key Resources ◽  
The University

Student service programs act as key resources to help students persist in school until graduation. However, some critics question whether service programs aimed at specific ethnic populations contribute sufficiently toward their persistence. Tinto (1975) argues that the stronger one is integrated into the institution, the more likely he/she will graduate from college. Thus, Native students' use of Native and non-Native student service programs is likely to effect the strength of their integration. The article presents study findings to explain how Native undergraduates used mainstream and Native programs to support their persistence to graduation at the University of New Mexico. It reports the students' levels of involvement, satisfaction of the services received, and why some students didn't use them. It also includes stop-out information and reasons for stopping out. Finally, the authors discuss how the findings and conclusions may be viewed in light of Native philosophy and views on education.

Native American studies: a place of community

2017 ◽  
Vol 13 (1) ◽  
pp. 18-25
Author(s):  
Tiffany S Lee
Keyword(s):  
Native American ◽  
Learning Community ◽  
American Studies ◽  
Well Being ◽  
Critical Examination ◽  
Native American Studies ◽  
Community Sustainability ◽  
University Of New Mexico ◽  
The Usa ◽  
The University

Native American Studies at the University of New Mexico in the USA aims to practice a pedagogy of community, which facilitates students’ engagement and contribution to community. I first examine Native American Studies’ growth in the USA toward nurturing a collective and intellectual learning community. Then, I share students’ viewpoints to demonstrate how Native American Studies practices a pedagogy of community. Students exhibit critical Indigenous consciousness, which is the embodiment of perspectives beyond individualistic goals and places the significance of their education on community well-being. Students also display an inward gaze, a necessity for implementing a pedagogy of community. An inward gaze is a critical examination of our communities and how they might be perpetuating the hegemonic, oppressive, and assimilationist conditions under which colonialism has placed them. Practicing a pedagogy of community is about community sustainability.

scholarly journals Ultrasound in pediatric surgery; intraoperative applications of the growing technology

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Osama Bawazir ◽  
Omemh Abdullah Bawazeer
Keyword(s):  
Pediatric Surgery ◽  
Pediatric Patients ◽  
Single Injection ◽  
Intraoperative Ultrasound ◽  
Central Line ◽  
Cystic Hygroma ◽  
Intraoperative Ultrasonography ◽  
Ultrasound Guided ◽  
Central Line Insertion ◽  
Line Insertion

Abstract Background Ultrasonography is increasingly used in pediatric surgery. Intraoperatively, ultrasonography can be used to confirm the preoperative diagnosis, guide the surgical approach, and enhance decision-making. We aimed to report our experience with intraoperative ultrasonography in different neonatal and pediatric procedures. So, a retrospective study was designed. It included all pediatric patients who had intraoperative ultrasound between January 2018 and October 2020 in a single center. Results We used intraoperative ultrasonography in 208 pediatric patients for various types of surgery. The authors compared ultrasound-guided central line insertion (n = 139) to the landmark method (n = 153). The number of trials was significantly lower in the ultrasound-guided method (P < 0.001). Conversion to cut-down was significantly lower with the ultrasound-guided technique (4 (2.8%) vs. 13 (8.5%); P = 0.047) and insertion-related complications were lower with ultrasound (0 vs 13 (8.5%); P < 0.001). We used ultrasound-guided sclerotherapy for cystic hygroma in 15 patients. Nine patients had successful treatment with a single injection (60%). Conclusion The application of intraoperative ultrasound in pediatric patients is increasing in our institution. The technique is safe and could effectively reduce central line insertion complications and enhance cystic hygroma sclerotherapy’s success with a single injection. Ultrasonography should be an essential part of residents’ and fellows’ training in pediatric surgery.

Native Americans and the Third World Strike at UC Berkeley

2019 ◽  
Vol 42 (2) ◽  
pp. 32-39
Author(s):  
LaNada War Jack
Keyword(s):  
Native American ◽  
Native Americans ◽  
Personal Experience ◽  
Third World ◽  
Leadership Roles ◽  
The Third ◽  
The Creation ◽  
The 1960S ◽  
The Third World ◽  
The University

The author reflects on her personal experience as a Native American at UC Berkeley in the 1960s as well as on her activism and important leadership roles in the 1969 Third World Liberation Front student strike, which had as its goal the creation of an interdisciplinary Third World College at the university.

scholarly journals Impact of Critical Care Consultation Requests for Avoidable Central Venous Catheters on Medical-Surgical Units

2020 ◽  
Vol 41 (S1) ◽  
pp. s258-s258
Author(s):  
Madhuri Tirumandas ◽  
Theresa Madaline ◽  
Gregory David Weston ◽  
Ruchika Jain ◽  
Jamie Figueredo
Keyword(s):  
Critical Care ◽  
High Risk ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Bloodstream Infections ◽  
Central Line ◽  
Central Venous Catheters ◽  
High Risk Population ◽  
Central Venous

Background: Although central-line–associated bloodstream infections (CLABSI) in US hospitals have improved in the last decade, ~30,100 CLABSIs occur annually.1,2 Central venous catheters (CVC) carry a high risk of infections and should be limited to appropriate clinical indications.6,7 Montefiore Medical Center, a large, urban, academic medical center in the Bronx, serves a high-risk population with multiple comobidities.8–11 Despite this, the critical care medicine (CCM) team is often consulted to place a CVC when a peripheral intravenous line (PIV) cannot be obtained by nurses or primary providers. We evaluated the volume of CCM consultation requests for avoidable CVCs and related CLABSIs. Methods: Retrospective chart review was performed for patients with CCM consultation requests for CVC placement between July and October 2019. The indication for CVC, type of catheter inserted or recommended, and NHSN data were used to identify CLABSIs. CVCs were considered avoidable if a PIV was used for the stated indication and duration of therapy, with no anatomical contraindications to PIV in nonemergencies, according to the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC).6Results: Of 229 total CCM consults, 4 (18%) requests were for CVC placement; 21 consultations (9%) were requested for avoidable CVCs. Of 40 CVC requests, 18 (45%) resulted in CVC placement by the CCM team, 4 (10%) were deferred for nonurgent PICC by interventional radiology, and 18 (45%) were deferred in favor of PIV or no IV. Indications for CVC insertion included emergent chemotherapy (n = 8, 44%) and dialysis (n = 3, 16%), vasopressors (n = 3, 16%), antibiotics (n = 2, 11%) and blood transfusion (n = 2, 11%). Of 18 CVCs, 9 (50%) were potentially avoidable: 2 short-term antibiotics and rest for nonemergent indications; 2 blood transfusions, 1 dialysis, 2 chemotherapy and 2 vasopressors. Between July and October 2019, 6 CLABSIs occurred in CVCs placed by the CCM team; in 3 of 6 CLABSI events (50%), the CVC was avoidable. Conclusions: More than half of consultation requests to the CCM team for CVCs are avoidable, and they disproportionately contribute to CLABSI events. Alternatives for intravenous access could potentially avoid 9% of CCM consultations and 50% of CLABSIs in CCM-inserted CVCs on medical-surgical wards.Funding: NoneDisclosures: None

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