scholarly journals Comparing Vancomycin Area Under the Curve With a Pharmacist Protocol that Incorporates Trough and Maximum Doses at a Children's Hospital

2021 ◽  
Vol 26 (7) ◽  
pp. 740-745
Author(s):  
Betool O. Al-Mazraawy ◽  
Jennifer E. Girotto
Keyword(s):  
Area Under The Curve ◽  
Kidney Injury ◽  
Population Data ◽  
Patient Specific ◽  
Prospective Data ◽  
Children's Hospital ◽  
Dose Modification ◽  
Hospital Patients ◽  
Children’S Hospital ◽  
Secondary Analyses

OBJECTIVE Updated vancomycin guidelines suggest dose adjustment based on area under the curve in a 24-hour period (AUC24). This study aims to determine whether a pharmacist managed vancomycin protocol that incorporates maximum dosing paired with trough monitoring can achieve appropriate vancomycin AUC24 exposures. METHODS A retrospective review was performed evaluating vancomycin usage from October 2018 through September 2019 at a children's hospital. Patients with less than 4 doses or lack a trough concentration were excluded. Vancomycin AUC24 were estimated using 2 calculations: 1) the Le method, incorporating age and serum creatinine, and 2) the trapezoidal method based upon population data and patient-specific trough. Target AUC24 ranges were assessed. AUC24 goals were 400 to 600 mg·hr/L, but due to known variations between calculations, a variance of 20 mg·hr/L was allowed for each end of the goal. Secondary analyses included evaluations of efficacy and toxicity. RESULTS Two-hundred twenty-three patients were included. Initial doses were estimated to meet AUC24 goals in only 63%. After trough-based dose modification, 81% achieved a therapeutic AUC24. Using the trapezoidal method, therapeutic concentrations were found in 51% of patients based on the initial dose and 77% after dose modification. Only 6.3% of patients had kidney injury with only 1 of those patients having any calculated AUC24 > 600 mg·hr/L and none above 620 mg·hr/L. No clinical failures were identified. CONCLUSIONS Increased initial dosing in infants and children is needed to result in AUC24 exposures recommended in the guidelines. Maximum dosing paired with trough monitoring may be an alternative to AUC24 monitoring in areas that are unable to perform AUC24 calculations. Prospective data are needed to validate these conclusions.

scholarly journals Real-time Adaptive & Predictive Indicator of Deterioration (RAPID) A collaborative development by Birmingham Children’s Hospital, McLaren Applied Technologies Limited, Aston University, Isansys Lifecare Ltd & University of Birmingham

2020 ◽  
Author(s):  
Heather Duncan ◽  
Balazs Fule ◽  
David Lowe
Keyword(s):  
Intensive Care ◽  
Early Warning ◽  
Early Warning Systems ◽  
Patient Specific ◽  
Formula One ◽  
Children's Hospital ◽  
High Dependency ◽  
Hospital Patients ◽  
Children’S Hospital ◽  
Life Threatening

Abstract 1.5 million UK children are admitted to hospital every year. Approximately 650 suffer cardiac arrest and 2,900 will die in hospital. Early warning systems are recommended to reduce avoidable complications and death. To reduce or eliminate avoidable life-threatening illness developing in hospital, patients need to be identified reliably and quickly to people who can treat them effectively. We are combining the clinical expertise of a Specialist Children’s Hospital with the technology expertise of Formula One racing to monitor and care for children more effectively. This project will build upon prior work in Intensive Care where we have used McLaren Formula One technology to accentuate changes in monitored physiology and develop smart patient specific alarms (http://www.bbc.co.uk/news/technology-18997318). We will have children in the cardiac wards continuously monitored with small wireless sensors. We will combine their vital sign information with other risks related to their general health and display this combined early warning to doctors and nurses. When children are deteriorating they can quickly be identified, the required expert can be called to the bedside and, if necessary, the child could be moved to High Dependency or Intensive Care.This study is to establish that we can collect continuous remote monitoring and act on it to improve patient outcomes. The benefits to patients participating in this study will be reduced duration of stay in hospital and Intensive Care, reduced acute life-threatening events, and less anxiety about intermittent observations or deterioration.Beyond this project, we will take the technology to the rest of the hospital patients and then out of the hospital to patients at home and paramedics at the roadside.

Clinical characteristics and treatment results of Shigella in Digestion department, National Children’s Hospital 2019

2020 ◽  
Vol 4 (6) ◽  
Author(s):  
Hà Ngọc Đạt
Keyword(s):  
Clinical Characteristics ◽  
High Fever ◽  
Treatment Results ◽  
Cross Sectional ◽  
Female Ratio ◽  
Children's Hospital ◽  
Male Female Ratio ◽  
Hospital Patients ◽  
Children’S Hospital ◽  
Epidemiological Characteristics

Objectives: 1. Describe some clinical epidemiological characteristics of Shigella dysentery in children in the Department of Gastroenterology of Central Children's Hospital in 2019; 2. Comment on treatment results in the above patients. Subjects: All patients under 15 years old are admitted to the Hospital of Gastroenterology, Vietnam National Children's Hospital.. Method of cross-sectional description. Results: More morbidity rates in men than in women. The male / female ratio is 1.8 / 1. In which, the highest incidence is from 1 to 3 years old. In comparison with other seasons, autumn has the highest proportion of hospital patients, accounting for 46.4%. The majority of patients admitted to hospital due to diarrhea and fever accompanied by blood in the stool accounted for 41.3%, some came to the hospital due to high fever with 15/184 patients accounting for 7.9%, high fever. Accompanied by seizures, accounting for 16.5%. The rate of treatment with Ciprofloxacin is 89.5%. The recovery rate is quite high, 93.3%, the percentage of patients who are also significantly better at 6.7% and there is no case of treatment failure.  

SO016SPREAD OF ACUTE KIDNEY INJURY IMPROVEMENT PROGAMME ACROSS A LARGE  MULTI SITED NHS HOSPITAL

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Prasanna Hanumapura ◽  
Leonard Ebah ◽  
Deryn Waring ◽  
Robert Henney ◽  
Michelle Murphy ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Change Agent ◽  
Kidney Injury ◽  
Care Process ◽  
Multidisciplinary Teams ◽  
Successful Implementation ◽  
Care Organization ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Incident Cases

Abstract Background and Aims Acute kidney injury (AKI) is a widely recognised serious health care issue. Up to 25% of hospital patients can develop it, with worse outcomes compared non AKI. A UK–wide audit in 2009 and our local audit in 2014 showed consistently poor AKI care including delays in detection and inconsistent management of cases. The trust set up the AKI Team in 2014 to improve AKI detection, care and outcomes. Successful implementation of a Multifaceted Quality Improvement (QI) Programme for AKI across the main hospital campus since 2015 saw significant improvement in AKI care and outcomes; recognition within 24hrs improved from 52% to 100% since 2016; there has been a 34% reduction in AKI incidence, 26% reduction in AKI length of stay (LoS) ,42% reduction in AKI days (time to recovery) and 10% less AKI associated mortality. The Trust being one of the largest acute trusts in the UK (10 hospitals across 6 sites, over 2000 beds), the QI spread represented a formidable challenge. We describe the methodology and outcomes of AKI QI spread across the trust. Method Central Campus Hospitals Improvement on this site involved setting a bespoke electronic alert coupled with education, key stake holder engagement, gradual culture change and AKI Priority Care Checklist (PCC) and use of change agent (AKI Clinical Nurse Specialist-CNS) visiting local teams and empowering them to manage AKI using Demming’s Model for Improvement A stepwise staggered similar approach was implemented first in the Women’s and Eye Hospitals followed by Children’s Hospital after a local adaptation and testing of algorithm, PCC and appointment of local change agent, a Paediatric AKI CNS. West Campus Hospital A DGH with 230 beds, 1-2 incident cases of AKI/day required a bespoke approach. The central AKI team runs an AKI alerts report and remotely alert the local multidisciplinary teams and empowering them to implement the PCC. South Campus Hospitals A large tertiary hospital merged in 2018 with an existing AKI CNS team. Detection algorithms, education material, PCC, reporting, and approach have been progressively harmonized using the Central Campus model. Data is expressed using SPC charts and analysed by t-test. Results Care process and outcome measures have seen a consistent improvement across all sites. As reported in the Central Campus, recognition of AKI within 24hrs has improved from 52% to 100% since 2016; there has been a 34% reduction in AKI incidence (p<0.00001), 26% reduction in AKI LoS and a 42% reduction in AKI days (time to recovery). The Children’s Hospital had 24% reduction (p<0.0001) in AKI incidence and a 34% reduction in hospital acquired AKI. Recognition of AKI has improved from 42% to 100%; 15% reduction in AKI LoS and 22% reduction in AKI days. In the South Campus recognition of AKI has improved from 67% to 100% and 19% reduction (p<0.0015) in AKI incidence. LoS and AKI days data yet to be reported whilst IT systems are been harmonised. In West Campus recognition is 100% but the small numbers prevent any meaningful analysis of other outcomes. Conclusion This study demonstrates how a cluster of simple interventions and approach to AKI detection and care were successfully rolled out across a multisite large complex acute care organization taking into account the local realities of each site/Hospitals whilst maintaining the core interventions.

scholarly journals Acute Kidney Injury in COVID-19-associated Multisystem Inflammatory Syndrome in Children (MIS-C)

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0005372020
Author(s):  
Marissa Lipton ◽  
Ruchi Gupta Mahajan ◽  
Catherine Kavanagh ◽  
Carol Liu Shen ◽  
Ibrahim Batal ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Injury ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Kidney Injury ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Inflammatory Syndrome

Background: Multisystem Inflammatory Syndrome in Children (MIS-C) is a recently identified entity in association with COVID-19. Acute kidney injury (AKI) has been widely reported in patients with primary COVID-19 infection. However, there is a paucity of literature regarding renal injury in MIS-C. We aim to characterize AKI in MIS-C in this cohort identified at a major children's hospital in New York City during the COVID-19 pandemic. Methods: We conducted a retrospective cohort study of children 0-20 years old admitted to Morgan Stanley Children's Hospital (MSCH) between April 18th and September 23rd, 2020. Patients were included if they met criteria for MIS-C based on CDC guidelines. All patients were evaluated for the presence of AKI, and AKI was staged according to KDIGO criteria. Results: Of the 57 children who met inclusion criteria, 46% (26/57) were found to have AKI. The majority of patients, 58% (15/26), were classified as KDIGO Stage 1. AKI was present upon admission in 70% of those identified. All patients had resolution of AKI at discharge, with 61% achieving recovery by day 2. One patient required dialysis. When compared to those without renal injury, the AKI cohort was older (p < 0.001) and with higher median peak values of CRP (p <0.001), IL-6 (p <0.05), ferritin (p < 0.001), and procalcitonin (p <0.05). More patients with AKI had left ventricular systolic dysfunction (p < 0.001) and lymphopenia (p <0.01), when compared to those without AKI. No differences in Body Mass Index or sex were found. Conclusion: While children with MIS-C may develop AKI, our study suggests most experience mild disease, swift resolution, and promising outcome. Older age, increased inflammation, and left ventricular systolic dysfunction may be risk factors. Our study highlights the substantial differences in epidemiology and outcomes between AKI associated with pediatric MIS-C versus primary COVID-19 infection.

scholarly journals Creation and Validation of a Pediatric Vancomycin Nomogram for a Goal Trough of 10–15 mg/L at a Quaternary Care Children’s Hospital

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S300-S300 ◽  
Author(s):  
Philip Lee ◽  
Jessica Frye ◽  
Xing Chen ◽  
Susanna Chang ◽  
Birender Singh ◽  
...  
Keyword(s):  
Kidney Injury ◽  
Target Range ◽  
Older Children ◽  
Children's Hospital ◽  
Starting Dose ◽  
Children’S Hospital ◽  
Mrsa Infection ◽  
The Mean ◽  
Serum Vancomycin ◽  
Schwartz Equation

Abstract Background Recent data suggest a serum vancomycin (vanc) trough (VT) of 11mg/L correlates with an AUC/MIC24 &gt; 400 which has shown to be the optimal concentration to eradicate MRSA infection and improve mortality. There are currently limited published recommendations on how to achieve such a VT in children. This study validates a vancomycin nomogram used to achieve a VT of 10–15 mg/L in pediatric inpatients (pts) at a quaternary care children’s hospital. Methods This is an 18 month (mo) prospective analysis beginning in September 2015. Included pts were ≥2 mo of age and had ≥2 consecutive VT. Pts receiving renal replacement therapy or those with a serum creatinine (Scr) of ≥0.5 mg/dL from a prior admission or within 48 hours of vanc initiation were excluded. The starting dose (SD) of vanc was determined by age and creatinine clearance (CrCl) (Tables 1 and 2). CrCl was measured by Bedside Schwartz equation for patients ≤18 years old (yo) and Cockcroft-Gault equation for patients &gt;18 yo. The maximum CrCl was set to 120 ml/minute. Patients who were on vanc and experienced a Scr increase of ≥0.5 mg/dL were considered to have acute kidney injury (AKI). The study had a 6 mo evaluation period which led to a revised version (RVN) on March 2016. The primary endpoint (PE) was achievement of 10–15 mg/L by the Second VT for patients with the First trough outside of this range, using our RVN (Table 3). Results Overall, a total of 276 patients received vanc, 17 and 29 patients were dosed according to the initial and RVN, respectively. For young children (Table 1), the SD for patients with a CrCL ≥90 ml/minute was therapeutic, sub-, and supra-therapeutic in 43.75%, 47.5% and 8.75%, respectively. For older children (Table 2), the SD for patients with a CrCl ≥100 ml/minute was therapeutic, sub-, and supra-therapeutic in 41.1%, 35.7% and 23.2%, respectively. The initial VN was successful 12/17 (70.6%) in achieving the PE. Success in achieving the PE after the RVN was 26/29 (89.7%). In the RVN group, the most common initial troughs were 5–7 mg/L (33.3%), followed by &gt;18 mg/L (27.6%). The mean VT using the RVN was 13.7 mg/L. The overall AKI incidence throughout the study was 3.2% (9/276) and 0% using the RVN. Conclusion Our RVN led to a Second VT within a target range of 10–15 mg/L for 89.7% of patients, allowing for more accurate and safer use of vancomycin in our institution. Disclosures All authors: No reported disclosures.

scholarly journals Multidisciplinary Cleft Palate Program at BC Children’s Hospital: Are We Meeting the Standards of Care?

2018 ◽  
Vol 26 (2) ◽  
pp. 85-90 ◽  
Author(s):  
Anita Dahiya ◽  
Rebecca Courtemanche ◽  
Douglas J. Courtemanche
Keyword(s):  
Cleft Palate ◽  
Retrospective Review ◽  
Standards Of Care ◽  
Patient Specific ◽  
Specific Patient ◽  
Children's Hospital ◽  
Program Support ◽  
Children’S Hospital ◽  
Using Data

Objective: To characterize current Cleft Palate Program (CPP) practices and evaluate the timeliness of appointments with respect to patient age and diagnosis based on American Cleft Palate-Craniofacial Association (ACPA) population guidelines and CPP patient-specific recommendations. Design: A retrospective review of CPP patient appointments from November 6, 2012, to March 31, 2015, was done. Data were analyzed using descriptive and inferential statistics. Setting: The study was conducted using data from the CPP at BC Children’s Hospital. Patients: A total of 1214 appointments were considered in the analysis, including syndromic and nonsyndromic patients of 0 to 27 years of age. Main Outcome Measures: Percentage of patients meeting follow-up targets by ACPA standards and CPP team recommendations. Results: Our results showed patients 5 years and younger or nonsyndromic were more likely to be seen on time ( P < .001). No relationship between the timeliness of an appointment and specific patient diagnoses or distance to clinic was found. With the exception of nursing (97% of appointments were on time), all disciplines had less than 45% of appointments on time with 51% of appointments meeting ACPA guidelines for timeliness and 32% of all appointments meeting CPP recommendations. Conclusion: Timely care for the cleft/craniofacial patient populations represents a challenge for the CPP. Although half of patients may meet the general ACPA guidelines, only 32% of patients are meeting the CPP patient-specific recommendations. To provide better patient care, future adjustments are needed, which may include improved resource allotment and program support.

scholarly journals Preferences for the Return of Individual Results From Research on Pediatric Biobank Samples

2017 ◽  
Vol 12 (2) ◽  
pp. 97-106 ◽  
Author(s):  
Kurt D. Christensen ◽  
Sarah K. Savage ◽  
Noelle L. Huntington ◽  
Elissa R. Weitzman ◽  
Sonja I. Ziniel ◽  
...  
Keyword(s):  
Mental Health ◽  
Genetic Research ◽  
Adult Onset ◽  
Research Results ◽  
Children's Hospital ◽  
Hospital Patients ◽  
Children’S Hospital

Discussions about disclosing individual genetic research results include calls to consider participants’ preferences. In this study, parents of Boston Children’s Hospital patients set preferences for disclosure based on disease preventability and severity, and could exclude mental health, developmental, childhood degenerative, and adult-onset disorders. Participants reviewed hypothetical reports and reset preferences, if desired. Among 661 participants who initially wanted all results (64%), 1% reset preferences. Among 336 participants who initially excluded at least one category (36%), 38% reset preferences. Participants who reset preferences added 0.9 categories, on average; and their mean satisfaction on 0 to 10 scales increased from 4.7 to 7.2 ( p < .001). Only 2% reduced the number of categories they wanted disclosed. Findings demonstrate the benefits of providing examples of preference options and the tendency of participants to want results disclosed. Findings also suggest that preference-setting models that do not provide specific examples of results could underestimate participants’ desires for information.

scholarly journals A Single Institution’s Overweight Pediatric Population and Their Associated Comorbid Conditions

ISRN Obesity ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-7
Author(s):  
Sigrid Bairdain ◽  
Chueh Lien ◽  
Alexander P. Stoffan ◽  
Michael Troy ◽  
Donald C. Simonson ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Pediatric Population ◽  
Treatment Options ◽  
Population Data ◽  
Morbidly Obese ◽  
Comorbid Conditions ◽  
Odds Ratios ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Rate Ratios

Background. Obesity studies are often performed on population data. We sought to examine the incidence of obesity and its associated comorbidities in a single freestanding children’s hospital. Methods. We performed a retrospective analysis of all visits to Boston Children’s Hospital from 2000 to 2012. This was conducted to determine the incidence of obesity, morbid obesity, and associated comorbidities. Each comorbidity was modeled independently. Incidence rate ratios were calculated, as well as odds ratios. Results. A retrospective review of 3,185,658 person-years in nonobese, 26,404 person-years in obese, and 25,819 person-years in the morbidly obese was conducted. Annual rates of all major comorbidities were increased in all patients, as well as in our obese and morbidly obese counterparts. Incidence rate ratios (IRR) and odds ratios (OR) were also significantly increased across all conditions for both our obese and morbidly obese patients. Conclusions. These data illustrate the substantial increases in obesity and associated comorbid conditions. Study limitations include (1) single institution data, (2) retrospective design, and (3) administrative undercoding. Future treatment options need to address these threats to longevity and quality of life.

Passy-Muir Speaking Valve Use in a Children's Hospital: An Interdisciplinary Approach

2008 ◽  
Vol 18 (2) ◽  
pp. 76-86 ◽  
Author(s):  
Lauren Hofmann ◽  
Joseph Bolton ◽  
Susan Ferry
Keyword(s):  
Tracheostomy Tube ◽  
Pediatric Population ◽  
Interdisciplinary Approach ◽  
Extended Period ◽  
Speech Development ◽  
Tube Placement ◽  
Background Information ◽  
Speaking Valve ◽  
Children's Hospital ◽  
Children’S Hospital

Abstract At The Children's Hospital of Philadelphia (CHOP) we treat many children requiring tracheostomy tube placement. With potential for a tracheostomy tube to be in place for an extended period of time, these children may be at risk for long-term disruption to normal speech development. As such, speaking valves that restore more normal phonation are often key tools in the effort to restore speech and promote more typical language development in this population. However, successful use of speaking valves is frequently more challenging with infant and pediatric patients than with adult patients. The purpose of this article is to review background information related to speaking valves, the indications for one-way valve use, criteria for candidacy, and the benefits of using speaking valves in the pediatric population. This review will emphasize the importance of interdisciplinary collaboration from the perspectives of speech-language pathology and respiratory therapy. Along with the background information, we will present current practices and a case study to illustrate a safe and systematic approach to speaking valve implementation based upon our experiences.

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