Publications by authors named "Anita Patel"

205 Publications

Parenting Pressures Among Academic Pediatricians During the COVID-19 Pandemic.

Pediatrics 2021 Feb 24. Epub 2021 Feb 24.

Division of Adolescent Medicine, Children's Hospital at Montefiore and Albert Einstein College of Medicine, New York, New York.

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http://dx.doi.org/10.1542/peds.2020-033159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8015152PMC
February 2021

First-Dose COVID-19 Vaccination Coverage Among Skilled Nursing Facility Residents and Staff.

JAMA 2021 Feb 24. Epub 2021 Feb 24.

COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia.

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http://dx.doi.org/10.1001/jama.2021.2352DOI Listing
February 2021

Severe Acute Respiratory Syndrome Coronavirus 2 Seropositivity among Healthcare Personnel in Hospitals and Nursing Homes, Rhode Island, USA, July-August 2020.

Emerg Infect Dis 2021 03;27(3):823-834

Healthcare personnel are recognized to be at higher risk for infection with severe acute respiratory syndrome coronavirus 2. We conducted a serologic survey in 15 hospitals and 56 nursing homes across Rhode Island, USA, during July 17-August 28, 2020. Overall seropositivity among 9,863 healthcare personnel was 4.6% (95% CI 4.2%-5.0%) but varied 4-fold between hospital personnel (3.1%, 95% CI 2.7%-3.5%) and nursing home personnel (13.1%, 95% CI 11.5%-14.9%). Within nursing homes, prevalence was highest among personnel working in coronavirus disease units (24.1%; 95% CI 20.6%-27.8%). Adjusted analysis showed that in hospitals, nurses and receptionists/medical assistants had a higher likelihood of seropositivity than physicians. In nursing homes, nursing assistants and social workers/case managers had higher likelihoods of seropositivity than occupational/physical/speech therapists. Nursing home personnel in all occupations had elevated seropositivity compared with hospital counterparts. Additional mitigation strategies are needed to protect nursing home personnel from infection, regardless of occupation.
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http://dx.doi.org/10.3201/eid2703.204508DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920685PMC
March 2021

Clinical impact of pre-kidney transplant pulmonary hypertension on post-transplant outcomes.

Int J Cardiovasc Imaging 2021 Feb 22. Epub 2021 Feb 22.

Heart and Vascular Institute, Henry Ford West Bloomfield Hospital, 6777 West Maple, West Bloomfield, MI, 48322, USA.

Outcomes of kidney transplant (KT) patients with pre-transplant pulmonary hypertension (PH) are poorly understood. PH patients are often considered high risk and excluded from KT. We investigated the association of pre-transplant PH with KT recipient's outcomes. A single-center, retrospective study that reviewed all patients transplanted from 2010 to 2016, who had a transthoracic echocardiogram (TTE) before KT and at least one TTE post-KT. The TTE closest to the KT was used for analyses. PH is defined as pulmonary artery systolic pressure (PASP) ≥ 40 mm Hg. Of 204 patients, 61 had PASP ≥ 40 mm Hg (with PH) and 143 had PASP < 40 mm Hg (without PH) prior to KT. No statistically significant differences existed between the two groups in baseline demographics, renal failure etiologies, dialysis access type, and cardiovascular risk factors. The mean difference in pre-KT PASP was 18.1 ± 7 mm Hg (P < 0.001). Patients with PH had a statistically significant decrease in PASP post-KT compared to the patients without PH with a mean change of -7.03 ± 12.28 mm Hg vs. + 3.96 ± 11.98 mm Hg (p < 0.001), respectively. Moderate mitral and moderate-severe tricuspid regurgitation were the only factors found to be independently associated with PH (p = 0.001) on multivariable analysis. No statistically significant difference was notable in patient survival, graft function, and creatinine post-KT in both groups. PH pre-KT particularly mild-moderate PH did not adversely affect intermediate (90-day) and long-term allograft and patient survival. Patients with mild-moderate PH should not be excluded from KT.
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http://dx.doi.org/10.1007/s10554-021-02182-7DOI Listing
February 2021

GFRAL-expressing neurons suppress food intake via aversive pathways.

Proc Natl Acad Sci U S A 2021 Feb;118(8)

Department of Surgery, University of Michigan, Ann Arbor, MI 48109;

The TGFβ cytokine family member, GDF-15, reduces food intake and body weight and represents a potential treatment for obesity. Because the brainstem-restricted expression pattern of its receptor, GDNF Family Receptor α-like (GFRAL), presents an exciting opportunity to understand mechanisms of action for area postrema neurons in food intake; we generated and conditional mice to visualize and manipulate GFRAL neurons. We found infection or pathophysiologic states (rather than meal ingestion) stimulate GFRAL neurons. TRAP-Seq analysis of GFRAL neurons revealed their expression of a wide range of neurotransmitters and neuropeptides. Artificially activating -expressing neurons inhibited feeding, decreased gastric emptying, and promoted a conditioned taste aversion (CTA). GFRAL neurons most strongly innervate the parabrachial nucleus (PBN), where they target CGRP-expressing (CGRP) neurons. Silencing CGRP neurons abrogated the aversive and anorexic effects of GDF-15. These findings suggest that GFRAL neurons link non-meal-associated pathophysiologic signals to suppress nutrient uptake and absorption.
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http://dx.doi.org/10.1073/pnas.2021357118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7923658PMC
February 2021

Demographic Characteristics of Persons Vaccinated During the First Month of the COVID-19 Vaccination Program - United States, December 14, 2020-January 14, 2021.

MMWR Morb Mortal Wkly Rep 2021 Feb 5;70(5):174-177. Epub 2021 Feb 5.

In December 2020, two COVID-19 vaccines (Pfizer-BioNTech and Moderna) were authorized for emergency use in the United States for the prevention of coronavirus disease 2019 (COVID-19).* Because of limited initial vaccine supply, the Advisory Committee on Immunization Practices (ACIP) prioritized vaccination of health care personnel and residents and staff members of long-term care facilities (LTCF) during the first phase of the U.S. COVID-19 vaccination program (1). Both vaccines require 2 doses to complete the series. Data on vaccines administered during December 14, 2020-January 14, 2021, and reported to CDC by January 26, 2021, were analyzed to describe demographic characteristics, including sex, age, and race/ethnicity, of persons who received ≥1 dose of COVID-19 vaccine (i.e., initiated vaccination). During this period, 12,928,749 persons in the United States in 64 jurisdictions and five federal entities initiated COVID-19 vaccination. Data on sex were reported for 97.0%, age for 99.9%, and race/ethnicity for 51.9% of vaccine recipients. Among persons who received the first vaccine dose and had reported demographic data, 63.0% were women, 55.0% were aged ≥50 years, and 60.4% were non-Hispanic White (White). More complete reporting of race and ethnicity data at the provider and jurisdictional levels is critical to ensure rapid detection of and response to potential disparities in COVID-19 vaccination. As the U.S. COVID-19 vaccination program expands, public health officials should ensure that vaccine is administered efficiently and equitably within each successive vaccination priority category, especially among those at highest risk for infection and severe adverse health outcomes, many of whom are non-Hispanic Black (Black), non-Hispanic American Indian/Alaska Native (AI/AN), and Hispanic persons (2,3).
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http://dx.doi.org/10.15585/mmwr.mm7005e1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861480PMC
February 2021

Early COVID-19 First-Dose Vaccination Coverage Among Residents and Staff Members of Skilled Nursing Facilities Participating in the Pharmacy Partnership for Long-Term Care Program - United States, December 2020-January 2021.

MMWR Morb Mortal Wkly Rep 2021 Feb 5;70(5):178-182. Epub 2021 Feb 5.

Residents and staff members of long-term care facilities (LTCFs), because they live and work in congregate settings, are at increased risk for infection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1,2). In particular, skilled nursing facilities (SNFs), LTCFs that provide skilled nursing care and rehabilitation services for persons with complex medical needs, have been documented settings of COVID-19 outbreaks (3). In addition, residents of LTCFs might be at increased risk for severe outcomes because of their advanced age or the presence of underlying chronic medical conditions (4). As a result, the Advisory Committee on Immunization Practices has recommended that residents and staff members of LTCFs be offered vaccination in the initial COVID-19 vaccine allocation phase (Phase 1a) in the United States (5). In December 2020, CDC launched the Pharmacy Partnership for Long-Term Care Program* to facilitate on-site vaccination of residents and staff members at enrolled LTCFs. To evaluate early receipt of vaccine during the first month of the program, the number of eligible residents and staff members in enrolled SNFs was estimated using resident census data from the National Healthcare Safety Network (NHSN) and staffing data from the Centers for Medicare & Medicaid Services (CMS) Payroll-Based Journal. Among 11,460 SNFs with at least one vaccination clinic during the first month of the program (December 18, 2020-January 17, 2021), an estimated median of 77.8% of residents (interquartile range [IQR] = 61.3%- 93.1%) and a median of 37.5% (IQR = 23.2%- 56.8%) of staff members per facility received ≥1 dose of COVID-19 vaccine through the Pharmacy Partnership for Long-Term Care Program. The program achieved moderately high coverage among residents; however, continued development and implementation of focused communication and outreach strategies are needed to improve vaccination coverage among staff members in SNFs and other long-term care settings.
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http://dx.doi.org/10.15585/mmwr.mm7005e2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861479PMC
February 2021

Prevalence of SARS-CoV-2 Antibodies in First Responders and Public Safety Personnel, New York City, New York, USA, May-July 2020.

Emerg Infect Dis 2021 03 25;27(3):796-804. Epub 2021 Jan 25.

We conducted a serologic survey in public service agencies in New York City, New York, USA, during May-July 2020 to determine prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among first responders. Of 22,647 participants, 22.5% tested positive for SARS-CoV-2-specific antibodies. Seroprevalence for police and firefighters was similar to overall seroprevalence; seroprevalence was highest in correctional staff (39.2%) and emergency medical technicians (38.3%) and lowest in laboratory technicians (10.1%) and medicolegal death investigators (10.8%). Adjusted analyses demonstrated association between seropositivity and exposure to SARS-CoV-2-positive household members (adjusted odds ratio [aOR] 3.52 [95% CI 3.19-3.87]), non-Hispanic Black race or ethnicity (aOR 1.50 [95% CI 1.33-1.68]), and severe obesity (aOR 1.31 [95% CI 1.05-1.65]). Consistent glove use (aOR 1.19 [95% CI 1.06-1.33]) increased likelihood of seropositivity; use of other personal protective equipment had no association. Infection control measures, including vaccination, should be prioritized for frontline workers.
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http://dx.doi.org/10.3201/eid2703.204340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920688PMC
March 2021

Societal costs of chemotherapy in the UK: an incidence-based cost-of-illness model for early breast cancer.

BMJ Open 2021 01 11;11(1):e039412. Epub 2021 Jan 11.

Aim: To estimate annual societal costs associated with chemotherapy for early breast cancer in the UK.

Design: Mixed methods: (a) an incidence-based cost-of-illness model was developed of indirect costs in patients with breast cancer and carers, and estimated from diagnosis through active treatment until death; (b) interviews with stakeholders were also undertaken to understand actual experiences and impacts of these costs.

Data Sources: Model data were collated from relevant national data sources covering general population statistics, UK cancer registries, clinical guidelines and published literature, and patient survey data. Patient and staff views were collected through semistructured interviews.

Participants: Model: patients with early breast cancer receiving systemic anticancer therapy in the UK. Interviews were undertaken with women who had chemotherapy and medical practitioners involved in breast cancer care.

Results: Total costs of chemotherapy in the UK economy are over £248 million. Societal productivity losses amount to £141.4 million, which includes £3.2 million associated with premature mortality, short-term and long-term work absence (£28.6 million and £105 million, respectively). £3.4 million is associated with mortality losses from secondary malignancies due to adjuvant chemotherapy. A further £1.1 million in lost productivity arises from informal care provision. Out-of-pocket costs per round of chemotherapy account for £4.2 million, or an annual average of almost £1100 per patient. Interview findings support the cost burden modelled and also highlight the impact on cognitive function of patients and how this could increase the cost burden to patients, their families and wider society. In addition, estimated costs for carer emotional well-being are £82 million in lost quality of life.

Conclusion: Chemotherapy use carries significant indirect costs for society, as well as patients and their carers. These wider costs and societal perspective should be considered by commissioners to ensure chemotherapy is better targeted at those who most need it and to avoid placing unnecessary costs on patients, their caregivers and wider society.
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http://dx.doi.org/10.1136/bmjopen-2020-039412DOI Listing
January 2021

The Association of Laboratory Test Abnormalities With Mortality Risk in Pediatric Intensive Care.

Pediatr Crit Care Med 2021 Feb;22(2):147-160

Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC.

Objectives: To determine the bivariable associations between abnormalities of 28 common laboratory tests and hospital mortality and determine how mortality risks changes when the ranges are evaluated in the context of commonly used laboratory test panels.

Design: A 2009-2016 cohort from the Health Facts (Cerner Corporation, Kansas City, MO) database.

Setting: Hospitals caring for children in ICUs.

Patients: Children cared for in ICUs with laboratory data.

Interventions: None.

Measurements And Main Results: There were 2,987,515 laboratory measurements in 71,563 children. The distribution of laboratory test values in 10 groups defined by population percentiles demonstrated the midrange of tests was within the normal range except for those measured predominantly when significant abnormalities are suspected. Logistic regression analysis at the patient level combined the population-based groups into ranges with nonoverlapping mortality odds ratios. The most deviant test ranges associated with increased mortality risk (mortality odds ratios > 5.0) included variables associated with acidosis, coagulation abnormalities and blood loss, immune function, liver function, nutritional status, and the basic metabolic profile. The test ranges most associated with survival included normal values for chloride, pH, and bicarbonate/total Co2. When the significant test ranges from bivariable analyses were combined in commonly used test panels, they generally remained significant but were reduced as risk was distributed among the tests.

Conclusions: The relative importance of laboratory test ranges vary widely, with some ranges strongly associated with mortality and others strongly associated with survival. When evaluated in the context of test panels rather than isolated tests, the mortality odds ratios for the test ranges decreased but generally remained significant as risk was distributed among the components of the test panels. These data are useful to develop critical values for children in ICUs, to identify risk factors previously underappreciated, for education and training, and for future risk score development.
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http://dx.doi.org/10.1097/PCC.0000000000002610DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7855885PMC
February 2021

Lack of antibodies to SARS-CoV-2 in a large cohort of previously infected persons.

Clin Infect Dis 2020 Nov 4. Epub 2020 Nov 4.

Centers for Disease Control and Prevention, Hyattsville, Maryland, USA.

Background: Reports suggest that some persons previously infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lack detectable IgG antibodies. We aimed to determine the proportion IgG seronegative and predictors for seronegativity among persons previously infected with SARS-CoV-2.

Methods: We analyzed serologic data collected from health care workers and first responders in New York City and the Detroit metropolitan area with history of a positive SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) test result and who were tested for IgG antibodies to SARS-CoV-2 spike protein at least 2 weeks after symptom onset.

Results: Of 2,547 persons with previous confirmed SARS-CoV-2 infection, 160 (6.3%) were seronegative. Of 2,112 previously symptomatic persons, the proportion seronegative slightly increased from 14 to 90 days post symptom onset (p=0.06). The proportion seronegative ranged from 0% among 79 persons previously hospitalized to 11.0% among 308 persons with asymptomatic infections. In a multivariable model, persons taking immunosuppressive medications were more likely to be seronegative (31.9%, 95% confidence interval [CI] 10.7%-64.7%), while participants of non-Hispanic Black race/ethnicity (versus non-Hispanic White) (2.7%, 95% CI 1.5%-4.8%), with severe obesity (versus under/normal weight) (3.9%, 95% CI 1.7%-8.6%), or with more symptoms were less likely to be seronegative.

Conclusions: In our population with previous RT-PCR confirmed infection, approximately one in 16 persons lacked IgG antibodies. Absence of antibodies varied independently by illness severity, race/ethnicity, obesity, and immunosuppressive drug therapy. The proportion seronegative remained relatively stable among persons tested up to 90 days post symptom onset.
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http://dx.doi.org/10.1093/cid/ciaa1685DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7665429PMC
November 2020

CDC's Flu on Call Simulation: Testing a National Helpline for Use During an Influenza Pandemic.

Health Secur 2020 Sep/Oct;18(5):392-402

Lisa M. Koonin, DrPH, MN, MPH, was Deputy Director at the time this study was conducted; and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; both in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA. Kellye Sliger, MPH, is an Epidemiologist; Kevin Farris, MAEd, is Health Communication, Preparedness, and Training Manager; and Diane Krause, MS-MPH is a Health Education Specialist; all at Oak Ridge Associated Universities, Oak Ridge, TN. Justin Kerr, PhD, is Head of Research; and Ellie Graeden, PhD, is Chief Executive Officer; both at Talus Analytics, Boulder, CO. Lisa Bullen-Austin is Senior Vice President, Vigilant Watch Integration Inc, Stafford, VA. Christopher Ionta is Senior Business Process Analyst with SRA International/CSRA, Inc., Atlanta, GA.

During an influenza pandemic, healthcare facilities are likely to be filled to capacity, leading to delays in seeing a provider and obtaining treatment. Flu on Call is a collaborative effort between the US Centers for Disease Control and Prevention and partners to develop a toll-free telephone helpline to reduce the burden on healthcare facilities and improve access to antivirals for people who are ill during an influenza pandemic. This study tested the feasibility of Flu on Call during a 1-day simulation using a severe pandemic scenario. Trained volunteer actors placed calls to the helpline using prepared scripts that were precoded for an expected outcome ("disposition") of the call. Scripts represented callers who were ill, those calling for someone else who was ill, and callers who were only seeking information. Information specialists and medical professionals managed the calls. Results demonstrated that Flu on Call may effectively assist callers during a pandemic, increase access to antiviral prescriptions, and direct patients to the appropriate level of care. Overall, 84% of calls exactly matched the expected call disposition; few calls (2%) were undermanaged (eg, the caller was ill but not transferred to a medical professional or received advice from the medical professional that was less intensive than what was warranted). Callers indicated a high level of satisfaction (83% reported their needs were met). Because of the high volume of calls that may be received during a severe pandemic, the Flu on Call platform should evolve to include additional triage channels (eg, through internet, chat, and/or text access).
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http://dx.doi.org/10.1089/hs.2019.0152DOI Listing
October 2020

Acute Kidney Injury in a Predominantly African American Cohort of Kidney Transplant Recipients With COVID-19 Infection.

Transplantation 2021 01;105(1):201-205

Division of Nephrology, Department of Medicine, Henry Ford Transplant Institute, Henry Ford Health System, Detroit, MI.

Background: Renal involvement in severe or critical acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is frequent. Acute kidney injury (AKI) in African American (AA) kidney transplant recipients (KTRs) with COVID-19 is not well described. We report our experience with a predominantly AA cohort (79%) of KTRs with COVID-19 infections in the Detroit Metropolitan area.

Methods: In this retrospective, single-center study, we identified 39 KTRs who tested positive for SARS-CoV-2 between March 16 and April 25, 2020. Data from electronic medical records were retrieved and compared between KTRs without AKI and KTRs with AKI.

Results: One patient was excluded due to delayed graft function. Final analysis of AKI in KTRs with proven COVID-19 was done on 38 patients of which 30 were AA (79%). AKI occurred in 71.1% of COVID-19 KTRs (n = 27), of whom 6 (22.2%) patients required HD. The incidence of AKI in our cohort was 71% (27/38). AKI rate among AA was 76.7% versus 50% in non-AA cohort (P = 0.195). In a univariate logistic regression analysis, AA race was not significantly associated with AKI odds ratio (3.4; CI, 0.68-17.4; P = 0.14). After risk adjustment by race, patients with diabetes showed a significantly higher risk of AKI (adjusted odds ratio, 19.85; CI, 1.65-58.66; P = 0.012). KTRs with AKI had more preexisting renin angiotensin aldosterone system inhibitor use than KTRs without AKI (P = 0.03).

Conclusions: KTRs infected with SARS-CoV-2 have a high incidence of AKI, with associated increased morbidity and mortality. Although no racial differences in mortality were noted in our KTRs with AKI, we await data from registries to help elucidate this difference.
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http://dx.doi.org/10.1097/TP.0000000000003498DOI Listing
January 2021

Developing core economic parameter sets for asthma studies: a realist review and an analytical framework.

BMJ Open 2020 10 20;10(10):e037889. Epub 2020 Oct 20.

Brighton and Sussex Medical School, University of Sussex, Brighton, UK

Objective: To develop a standardised set of economic parameters (core economic parameter set) for economic evaluations in asthma studies.

Design: A systematic literature review and an analytical framework.

Outcome Measures: Economic parameters used to evaluate costs and cost-effectiveness of healthcare interventions for people with asthma.

Data Sources: PubMed, the Cochrane Database of Systematic Reviews, the National Health Service Economic Evaluation Database, the Database of Abstracts of Reviews of Effects and the Health Technology Aaaessment Library starting from 1990.

Review Methods: Research methods were based on the realist review methodology and included a number of non-sequential, iterative and overlapping components, such as developing an analytical framework for the realist review; systematic literature review of economic parameters; identifying and categorising economic parameters; producing preliminary list of core economic parameters.

Results: Database searches found 2531 publications of which 224 were included in the systematic review. We identified 65 economic parameters that were categorised into 11 groups to enable the realist synthesis. Parameters related to secondary care, primary care, medication use, emergency care and work productivity comprised 84% of all economic parameters. An analytical framework was used to investigate the rationale behind the choices of economic parameters in these studies. The main framework domains included type of intervention, research population, study design, study setting and a stakeholder's perspective.

Conclusion: Past research thus suggests that in asthma study parameters depicting the use of secondary care, primary care, medication, emergency care and work productivity can be considered as core economic parameters, since they apply to different types of studies. Parameters including diagnostics, healthcare delivery, school activity, informal care, medical devices and health utility apply to a particular type of study (or research question), and thus can be recommended as supplemental parameters.

Prospero Registration Number: CRD42017067867.
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http://dx.doi.org/10.1136/bmjopen-2020-037889DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577034PMC
October 2020

A randomised trial of social support group intervention for people with aphasia: A Novel application of virtual reality.

PLoS One 2020 24;15(9):e0239715. Epub 2020 Sep 24.

Centre for Human Computer Interaction Design, City, University of London, London, United Kingdom.

About a third of strokes cause aphasia, or language loss, with profound consequences for the person's social participation and quality of life. These problems may be mitigated by group social support. But this intervention is not available to all individuals. This study investigated whether it is feasible to deliver group social support to people with aphasia via a multi-user, virtual reality platform. It also explored the indicative effects of intervention and the costs. Intervention aimed to promote wellbeing and communicative success. It enabled participants to form new social connections and share experiences of living with aphasia. It comprised 14 sessions delivered over 6 months and was led by community based co-ordinators and volunteers. Feasibility measures comprised: recruitment and retention rates, compliance with intervention and assessment of treatment fidelity. Effects of intervention were explored using a waitlist randomised controlled design, with outcome measures of wellbeing, communication, social connectedness and quality of life. Two intervention groups were randomised to an immediate condition and two were randomised to a delayed condition. The main analysis explored scores on the measures between two time points, between which those in the immediate condition had received intervention, but those in the delayed group had not (yet). A comprehensive approach to economic data collection ensured that all costs of treatment delivery were recorded. Feasibility findings showed that the recruitment target was met (N = 34) and 85.3% (29/34) of participants completed intervention. All groups ran the 14 sessions as planned, and participants attended a mean of 11.4 sessions (s.d. 2.8), which was 81.6% of the intended dose. Fidelity checking showed minimal drift from the manualised intervention. No significant change was observed on any of the outcome measures, although the study was not powered to detect these. Costs varied across the four groups, from £7,483 - £12,562 British Pounds Sterling ($10,972 - $18,419 US dollars), depending on travel costs, the relative contributions of volunteers and the number of hardware loans that were needed. The results suggest that a larger trial of remote group support, using virtual reality, would be merited. However the treatment content and regime, and the selection of outcome measures should be reviewed before conducting the trial. Trail registration: Study registered with ClinicalTrials.gov; Identifier: https://www.ncbi.nlm.nih.gov/NCT03115268.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239715PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7514104PMC
November 2020

SARS-CoV-2 Seroprevalence among Healthcare, First Response, and Public Safety Personnel, Detroit Metropolitan Area, Michigan, USA, May-June 2020.

Emerg Infect Dis 2020 12 21;26(12):2863-2871. Epub 2020 Sep 21.

To estimate seroprevalence of severe acute respiratory syndrome 2 (SARS-CoV-2) among healthcare, first response, and public safety personnel, antibody testing was conducted in emergency medical service agencies and 27 hospitals in the Detroit, Michigan, USA, metropolitan area during May-June 2020. Of 16,403 participants, 6.9% had SARS-CoV-2 antibodies. In adjusted analyses, seropositivity was associated with exposure to SARS-CoV-2-positive household members (adjusted odds ratio [aOR] 6.18, 95% CI 4.81-7.93) and working within 15 km of Detroit (aOR 5.60, 95% CI 3.98-7.89). Nurse assistants (aOR 1.88, 95% CI 1.24-2.83) and nurses (aOR 1.52, 95% CI 1.18-1.95) had higher likelihood of seropositivity than physicians. Working in a hospital emergency department increased the likelihood of seropositivity (aOR 1.16, 95% CI 1.002-1.35). Consistently using N95 respirators (aOR 0.83, 95% CI 0.72-0.95) and surgical facemasks (aOR 0.86, 95% CI 0.75-0.98) decreased the likelihood of seropositivity.
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http://dx.doi.org/10.3201/eid2612.203764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7706918PMC
December 2020

Criticality: A New Concept of Severity of Illness for Hospitalized Children.

Pediatr Crit Care Med 2021 Jan;22(1):e33-e43

Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC.

Objectives: To validate the conceptual framework of "criticality," a new pediatric inpatient severity measure based on physiology, therapy, and therapeutic intensity calibrated to care intensity, operationalized as ICU care.

Design: Deep neural network analysis of a pediatric cohort from the Health Facts (Cerner Corporation, Kansas City, MO) national database.

Setting: Hospitals with pediatric routine inpatient and ICU care.

Patients: Children cared for in the ICU (n = 20,014) and in routine care units without an ICU admission (n = 20,130) from 2009 to 2016. All patients had laboratory, vital sign, and medication data.

Interventions: None.

Measurements And Main Results: A calibrated, deep neural network used physiology (laboratory tests and vital signs), therapy (medications), and therapeutic intensity (number of physiology tests and medications) to model care intensity, operationalized as ICU (versus routine) care every 6 hours of a patient's hospital course. The probability of ICU care is termed the Criticality Index. First, the model demonstrated excellent separation of criticality distributions from a severity hierarchy of five patient groups: routine care, routine care for those who also received ICU care, transition from routine to ICU care, ICU care, and high-intensity ICU care. Second, model performance assessed with statistical metrics was excellent with an area under the curve for the receiver operating characteristic of 0.95 for 327,189 6-hour time periods, excellent calibration, sensitivity of 0.817, specificity of 0.892, accuracy of 0.866, and precision of 0.799. Third, the performance in individual patients with greater than one care designation indicated as 88.03% (95% CI, 87.72-88.34) of the Criticality Indices in the more intensive locations was higher than the less intense locations.

Conclusions: The Criticality Index is a quantification of severity of illness for hospitalized children using physiology, therapy, and care intensity. This new conceptual model is applicable to clinical investigations and predicting future care needs.
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http://dx.doi.org/10.1097/PCC.0000000000002560DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790867PMC
January 2021

Severity Trajectories of Pediatric Inpatients Using the Criticality Index.

Pediatr Crit Care Med 2021 Jan;22(1):e19-e32

Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC.

Objectives: To assess severity of illness trajectories described by the Criticality Index for survivors and deaths in five patient groups defined by the sequence of patient care in ICU and routine patient care locations.

Design: The Criticality Index developed using a calibrated, deep neural network, measures severity of illness using physiology, therapies, and therapeutic intensity. Criticality Index values in sequential 6-hour time periods described severity trajectories.

Setting: Hospitals with pediatric inpatient and ICU care.

Patients: Pediatric patients never cared for in an ICU (n = 20,091), patients only cared for in the ICU (n = 2,096) and patients cared for in both ICU and non-ICU care locations (n = 17,023) from 2009 to 2016 Health Facts database (Cerner Corporation, Kansas City, MO).

Interventions: None.

Measurements And Main Results: Criticality Index values were consistent with clinical experience. The median (25-75th percentile) ICU Criticality Index values (0.878 [0.696-0.966]) were more than 80-fold higher than the non-ICU values (0.010 [0.002-0.099]). Non-ICU Criticality Index values for patients transferred to the ICU were 40-fold higher than those never transferred to the ICU (0.164 vs 0.004). The median for ICU deaths was higher than ICU survivors (0.983 vs 0.875) (p < 0.001). The severity trajectories for the five groups met expectations based on clinical experience. Survivors had increasing Criticality Index values in non-ICU locations prior to ICU admission, decreasing Criticality Index values in the ICU, and decreasing Criticality Index values until hospital discharge. Deaths had higher Criticality Index values than survivors, steeper increases prior to the ICU, and worsening values in the ICU. Deaths had a variable course, especially those who died in non-ICU care locations, consistent with deaths associated with both active therapies and withdrawals/limitations of care.

Conclusions: Severity trajectories measured by the Criticality Index showed strong validity, reflecting the expected clinical course for five diverse patient groups.
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http://dx.doi.org/10.1097/PCC.0000000000002561DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790848PMC
January 2021

Paracetamol self-poisoning: Epidemiological study of trends and patient characteristics from the multicentre study of self-harm in England.

J Affect Disord 2020 11 19;276:699-706. Epub 2020 Jul 19.

Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust. Electronic address:

Background: Paracetamol is frequently used for intentional self-poisoning, especially in the UK, despite pack size restrictions introduced in 1998. Knowing more about paracetamol self-poisoning may identify further approaches to prevention.

Methods: We used data from the Multicentre Study of Self-harm in England for 2004-2014 to calculate incidence rates of presentations to Emergency Departments following self-poisoning with pure paracetamol alone. National estimates for England for 2011-2014 were extrapolated using indirect age-standardised rates. The characteristics of individuals taking paracetamol overdoses and the size of the overdoses were investigated.

Results: A third of 54,863 intentional overdoses presenting to the five Emergency Departments involved paracetamol without other drugs (N = 18,011), taken by 13,171 individuals (63.4% female).  The proportion of paracetamol self-poisonings was similar in the three centres. Extrapolation suggested there were approximately 50,000 paracetamol overdoses in England annually during 2011-2014. Females had higher rates of paracetamol overdose than males.  Males and older individuals took larger overdoses.  Nearly a quarter of individuals (24.2%) consumed more than 32 tablets. Alcohol was involved in 53.7% of paracetamol overdoses.

Limitations: Data were collected in three centres with predominantly urban populations. Extrapolation from local to national rates should be interpreted with caution.

Conclusions: Paracetamol overdose remains a major problem in the UK. It is more common in females and younger patients, but males and older patients consume larger overdoses. Consideration should be given to further restriction in pack sizes and sources of sales, in keeping with those of several other European countries.
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http://dx.doi.org/10.1016/j.jad.2020.07.091DOI Listing
November 2020

Restoring Immunization Services Provided by the Vaccines for Children Program in Puerto Rico After Hurricanes Irma and Maria, 2017-2019.

J Public Health Manag Pract 2020 Aug 6. Epub 2020 Aug 6.

Center for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention (CSTLTS, CDC), Atlanta, Georgia (Ms Luna-Pinto); Public Health Associate Program, CSTLTS, CDC, Atlanta, Georgia (Mr Yoerg); National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia (Mss Rijo and Alvarez, Mr Rodriguez, and Dr Patel); National Center for Preparedness and Response, CDC, Atlanta, Georgia (Dr Shapiro); and Immunizations Division, Puerto Rico Department of Health, San Juan, Puerto Rico (Drs Rivera and Cardona).

Context: In September 2017, Hurricanes Irma and Maria impacted Puerto Rico, causing significant disruption of immunization services and vaccine losses due to widespread infrastructure and electrical grid damage and resulting cold chain failures.

Objective: To describe posthurricane efforts undertaken to restore and strengthen immunization services provided by Puerto Rico's federally funded Vaccines for Children (VFC) Program, a network of clinics that provide vaccines to eligible children.

Design: Historical records were reviewed to characterize Puerto Rico's prehurricane immunization system. Site visits to assess VFC clinic posthurricane operational status were conducted by the Puerto Rico Department of Health, working with the Centers for Disease Control and Prevention and other partners. Infrastructure repair and acquisition of backup generators, temperature data loggers, and replacement vaccines were carried out to restore operations.

Results: Prior to the hurricanes, 224 VFC clinics throughout the island provided immunizations. An initial assessment 10 days after Hurricane Maria showed that only 11 (5%) of the clinics were operational. Reasons included ongoing power outages; difficulties in obtaining generator fuel; equipment or facility damage; and damaged vaccines. The VFC clinics were restored incrementally; 123 (55%) were operational by December 2017, 193 (86%) by May 2018, and 204 (91%) by May 2019. Long-term recovery activities are underway and focus on strengthening Puerto Rico's immunization system to withstand future disasters, including improving backup power systems.

Conclusion: Through coordinated efforts of the Puerto Rico Department of Health, the Centers for Disease Control and Prevention, and other partners, the operational status of VFC clinics posthurricanes was assessed and operations restored. Emergency plans for vaccine storage and handling, which called for alternative vaccine storage locations and backup generators, were inadequate to address disasters of the magnitude of Hurricanes Irma and Maria; such plans need to consider the possibility of large-scale disasters that result in long-term power outages.
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http://dx.doi.org/10.1097/PHH.0000000000001193DOI Listing
August 2020

Clinical characteristics and outcomes of COVID-19 in solid organ transplant recipients: A cohort study.

Am J Transplant 2020 11 28;20(11):3051-3060. Epub 2020 Jul 28.

Division of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan, USA.

Solid organ transplant recipients (SOTr) with coronavirus disease 2019 (COVID-19) are expected to have poorer outcomes compared to nontransplant patients because of immunosuppression and comorbidities. The clinical characteristics of 47 SOTr (38 kidneys and 9 nonkidney organs) were compared to 100 consecutive hospitalized nontransplant controls. Twelve of 47 SOTr managed as outpatients were subsequently excluded from the outcome analyses to avoid potential selection bias. Chronic kidney disease (89% vs 57% P = .0007), diabetes (66% vs 33% P = .0007), and hypertension (94% vs 72% P = .006) were more common in the 35 hospitalized SOTr compared to controls. Diarrhea (54% vs 17%, P < .0001) was more frequent in SOTr. Primary composite outcome (escalation to intensive care unit, mechanical ventilation, or in-hospital all-cause mortality) was comparable between SOTr and controls (40% vs 48%, odds ratio [OR] 0.72 confidence interval [CI] [0.33-1.58] P = .42), despite more comorbidities in SOTr. Acute kidney injury requiring renal replacement therapy occurred in 20% of SOTr compared to 4% of controls (OR 6 CI [1.64-22] P = .007). Multivariate analysis demonstrated that increasing age and clinical severity were associated with mortality. Transplant status itself was not associated with mortality.
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http://dx.doi.org/10.1111/ajt.16188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405160PMC
November 2020

Improving economic evaluations in stroke: A report from the ESO Health Economics Working Group.

Eur Stroke J 2020 Jun 27;5(2):184-192. Epub 2020 Jan 27.

School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK.

Introduction: Approaches to economic evaluations of stroke therapies are varied and inconsistently described. An objective of the European Stroke Organisation (ESO) Health Economics Working Group is to standardise and improve the economic evaluations of interventions for stroke.

Methods: The ESO Health Economics Working Group and additional experts were contacted to develop a protocol and a guidance document for data collection for economic evaluations of stroke therapies. A modified Delphi approach, including a survey and consensus processes, was used to agree on content. We also asked the participants about resources that could be shared to improve economic evaluations of interventions for stroke.

Results: Of 28 experts invited, 16 (57%) completed the initial survey, with representation from universities, government, and industry. More than half of the survey respondents endorsed 13 specific items to include in a standard resource use questionnaire. Preferred functional/quality of life outcome measures to use for economic evaluations were the modified Rankin Scale (14 respondents, 88%) and the EQ-5D instrument (11 respondents, 69%). Of the 12 respondents who had access to data used in economic evaluations, 10 (83%) indicated a willingness to share data. A protocol template and a guidance document for data collection were developed and are presented in this article.

Conclusion: The protocol template and guidance document for data collection will support a more standardised and transparent approach for economic evaluations of stroke care.
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http://dx.doi.org/10.1177/2396987319897466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313366PMC
June 2020

Medications for Children Receiving Intensive Care: A National Sample.

Pediatr Crit Care Med 2020 09;21(9):e679-e685

Division of Critical Care Medicine, Department of Pediatrics, Children's National Health System and George Washington University School of Medicine and Health Sciences, Washington, DC.

Objective: To examine medication administration records through electronic health record data to provide a broad description of the pharmaceutical exposure of critically ill children.

Design: Retrospective cohort study using the Cerner Health Facts database.

Setting: United States.

Patients: A total of 43,374 children 7 days old to less than 22 years old receiving intensive care with available pharmacy data.

Interventions: None.

Measurements And Main Results: A total of 907,440 courses of 1,080 unique medications were prescribed with a median of nine medications (range, 1-99; 25-75th percentile, 5-16) per patient. The most common medications were acetaminophen, ondansetron, and morphine. Only 45 medications (4.2%) were prescribed to more than 5% of patients, and these accounted for 442,067 (48.7%) of the total courses of medications. Each additional medication was associated with increased univariate risk of mortality (odds ratio, 1.05; 95% CI, 1.05-1.06; p < 0.001).

Conclusions: Children receiving intensive care receive a median of nine medications per patient and one quarter are prescribed at least than 16 medications. Only 45 medications were prescribed to more than 5% of patients, but these accounted for almost half of all medication courses.
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http://dx.doi.org/10.1097/PCC.0000000000002391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483286PMC
September 2020

Factors influencing sedentary behaviours after stroke: findings from qualitative observations and interviews with stroke survivors and their caregivers.

BMC Public Health 2020 Jun 19;20(1):967. Epub 2020 Jun 19.

Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Royal Infirmary, Bradford, BD9 6RJ, UK.

Background: Stroke survivors are more sedentary than healthy, age-matched controls, independent of functional capacity. Interventions are needed to encourage a reduction in overall sedentary time, and regular breaks in prolonged periods of sedentary behaviour. This study captured the views and experiences of stroke survivors and their caregivers related to sedentary behaviour after stroke, to inform the development of an intervention to reduce sedentary behaviour.

Methods: Mixed-methods qualitative study. Non-participant observations were completed in two stroke services, inclusive of inpatient and community settings in the United Kingdom. Semi-structured interviews were conducted with stroke survivors and their caregivers (if available) at six- or nine-months post-stroke. Underpinned by the capability, opportunity and motivation (COM-B) model of behaviour change, observational data (132 h) were analysed thematically and interview data (n = 31 stroke survivors, n = 12 caregivers) were analysed using the Framework approach.

Results: Observation participants differed in functional ability whereas stroke survivor interviewees were all ambulant. Six themes related to sedentary behaviour after stroke were generated: (1) sedentary behaviour levels and patterns after stroke; (2) the physical and social environment in the stroke service and in the home; (3) standing and movement capability after stroke; (4) emotion and motivation after stroke; (5) caregivers' influence on, and role in influencing stroke survivors' sedentary behaviour; and (6) intervening to reduce sedentary behaviour after stroke. Capability, opportunity and motivation were influenced by the impact of the stroke and caregivers' inclination to support sedentary behaviour reduction. Stroke survivors reported being more sedentary than they were pre-stroke due to impaired balance and co-ordination, increased fatigue, and reduced confidence in mobilising. Caregivers inclination to support stroke survivors to reduce sedentary behaviour depended on factors including their willingness to withdraw from the caregiver role, and their perception of whether the stroke survivor would act on their encouragement.

Conclusions: Many stroke survivors indicate being open to reducing sedentary behaviour, with appropriate support from stroke service staff and caregivers. The findings from this study have contributed to an intervention development process using the Behaviour Change Wheel (BCW) approach to develop strategies to reduce sedentary behaviour after stroke.
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http://dx.doi.org/10.1186/s12889-020-09113-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305625PMC
June 2020

Strategies for Optimizing the Supply of N95 Filtering Facepiece Respirators During the Coronavirus Disease 2019 (COVID-19) Pandemic.

Disaster Med Public Health Prep 2020 10 19;14(5):658-669. Epub 2020 May 19.

National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, PA.

N95 respirators are personal protective equipment most often used to control exposures to infections transmitted via the airborne route. Supplies of N95 respirators can become depleted during pandemics or when otherwise in high demand. In this paper, we offer strategies for optimizing supplies of N95 respirators in health care settings while maximizing the level of protection offered to health care personnel when there is limited supply in the United States during the 2019 coronavirus disease pandemic. The strategies are intended for use by professionals who manage respiratory protection programs, occupational health services, and infection prevention programs in health care facilities to protect health care personnel from job-related risks of exposure to infectious respiratory illnesses. Consultation with federal, state, and local public health officials is also important. We use the framework of surge capacity and the occupational health and safety hierarchy of controls approach to discuss specific engineering control, administrative control, and personal protective equipment measures that may help in optimizing N95 respirator supplies.
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http://dx.doi.org/10.1017/dmp.2020.160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303467PMC
October 2020

Strategies to Inform Allocation of Stockpiled Ventilators to Healthcare Facilities During a Pandemic.

Health Secur 2020 Mar/Apr;18(2):69-74. Epub 2020 Mar 20.

Lisa M. Koonin, DrPH, MN, MPH, is with Health Preparedness Partners, LLC, a subcontractor of General Dynamics Information Technology (GDIT); Danielle Moulia, MPH, is a Public Health Scientist with General Dynamics Information Technology (GDIT); and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; all in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA. Satish Pillai, MD, MPH, MS, is CDR, US Public Health Service, and Deputy Director, Division of Preparedness and Emerging Infections; and Emily B. Kahn, PhD, MPH, MA, is Senior Epidemiologist/Modeler, Division of Preparedness and Emerging Infections; both in the National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention.

During a severe pandemic, especially one causing respiratory illness, many people may require mechanical ventilation. Depending on the extent of the outbreak, there may be insufficient capacity to provide ventilator support to all of those in need. As part of a larger conceptual framework for determining need for and allocation of ventilators during a public health emergency, this article focuses on the strategies to assist state and local planners to allocate stockpiled ventilators to healthcare facilities during a pandemic, accounting for critical factors in facilities' ability to make use of additional ventilators. These strategies include actions both in the pre-pandemic and intra-pandemic stages. As a part of pandemic preparedness, public health officials should identify and query healthcare facilities in their jurisdiction that currently care for critically ill patients on mechanical ventilation to determine existing inventory of these devices and facilities' ability to absorb additional ventilators. Facilities must have sufficient staff, space, equipment, and supplies to utilize allocated ventilators adequately. At the time of an event, jurisdictions will need to verify and update information on facilities' capacity prior to making allocation decisions. Allocation of scarce life-saving resources during a pandemic should consider ethical principles to inform state and local plans for allocation of ventilators. In addition to ethical principles, decisions should be informed by assessment of need, determination of facilities' ability to use additional ventilators, and facilities' capacity to ensure access to ventilators for vulnerable populations (eg, rural, inner city, and uninsured and underinsured individuals) or high-risk populations that may be more susceptible to illness.
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http://dx.doi.org/10.1089/hs.2020.0028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7194315PMC
April 2020

Sedation, Analgesia, and Neuromuscular Blockade: An Assessment of Practices From 2009 to 2016 in a National Sample of 66,443 Pediatric Patients Cared for in the ICU.

Pediatr Crit Care Med 2020 09;21(9):e599-e609

Division of Critical Care Medicine, Department of Pediatrics, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC.

Objectives: To describe the pharmaceutical management of sedation, analgesia, and neuromuscular blockade medications administered to children in ICUs.

Design: A retrospective analysis using data extracted from the national database Health Facts.

Setting: One hundred sixty-one ICUs in the United States with pediatric admissions.

Patients: Children in ICUs receiving medications from 2009 to 2016.

Exposure/intervention: Frequency and duration of administration of sedation, analgesia, and neuromuscular blockade medications.

Measurements And Main Results: Of 66,443 patients with a median age of 1.3 years (interquartile range, 0-14.5), 63.3% (n = 42,070) received nonopioid analgesic, opioid analgesic, sedative, and/or neuromuscular blockade medications consisting of 83 different agents. Opioid and nonopioid analgesics were dispensed to 58.4% (n = 38,776), of which nonopioid analgesics were prescribed to 67.4% (n = 26,149). Median duration of opioid analgesic administration was 32 hours (interquartile range, 7-92). Sedatives were dispensed to 39.8% (n = 26,441) for a median duration of 23 hours (interquartile range, 3-84), of which benzodiazepines were most common (73.4%; n = 19,426). Neuromuscular-blocking agents were dispensed to 17.3% (n = 11,517) for a median duration of 2 hours (interquartile range, 1-15). Younger age was associated with longer durations in all medication classes. A greater proportion of operative patients received these medication classes for a longer duration than nonoperative patients. A greater proportion of patients with musculoskeletal and hematologic/oncologic diseases received these medication classes.

Conclusions: Analgesic, sedative, and neuromuscular-blocking medications were prescribed to 63.3% of children in ICUs. The durations of opioid analgesic and sedative medication administration found in this study can be associated with known complications, including tolerance and withdrawal. Several medications dispensed to pediatric patients in this analysis are in conflict with Food and Drug Administration warnings, suggesting that there is potential risk in current sedation and analgesia practice that could be reduced with practice changes to improve efficacy and minimize risks.
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http://dx.doi.org/10.1097/PCC.0000000000002351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483172PMC
September 2020

EMMPRIN/CD147 plays a detrimental role in clinical and experimental ischemic stroke.

Aging (Albany NY) 2020 03 19;12(6):5121-5139. Epub 2020 Mar 19.

The University of Texas Health Science Center at Houston and the McGovern Medical School, Houston, TX 77030, USA.

Background: Ischemic stroke is a devastating disease, often resulting in death or permanent neurological deficits. EMMPRIN/CD147 is a plasma membrane protein that induces the production of matrix metalloproteinases (MMPs), which contribute to secondary damage after stroke by disrupting the blood brain barrier (BBB) and facilitating peripheral leukocyte infiltration into the brain.

Results: CD147 surface expression increased significantly after stroke on infiltrating leukocytes, astrocytes and endothelial cells, but not on resident microglia. Inhibition of CD147 reduced MMP levels, decreased ischemic damage, and improved functional, cognitive and histological outcomes after experimental ischemic stroke in both young and aged mice. In stroke patients, high levels of serum CD147 24 hours after stroke predicted poor functional outcome at 12 months. Brain CD147 levels were correlated with MMP-9 and secondary hemorrhage in post-mortem samples from stroke patients.

Conclusions: Acute inhibition of CD147 decreases levels of MMP-9, limits tissue loss, and improves long-term cognitive outcomes following experimental stroke in aged mice. High serum CD147 correlates with poor outcomes in stroke patients. This study identifies CD147 as a novel, clinically relevant target in ischemic stroke.
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http://dx.doi.org/10.18632/aging.102935DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138568PMC
March 2020

Understanding the relationship between GP training and improved patient care - a qualitative study of GP educators.

Educ Prim Care 2020 05 27;31(3):145-152. Epub 2020 Feb 27.

Medical School, University College London.

Introduction: Previous research has highlighted the benefits of receiving care in a postgraduate GP training practice including improved patient satisfaction, more appropriate secondary care usage, cancer diagnosis, and antibiotic prescribing. Whilst the influence of being registered in a postgraduate GP training practice on patient outcomes is modest relative to other factors such as deprivation, disease burden, demography, and ethnicity, the reasons for this benefit is not clear.

Aim: This study explores how GP trainers perceive engagement with clinical education influences patient care.

Methods: Socio-cultural theories were used as a framework for guiding the research. Semi-structured interviews were conducted with 11 GP educators. Interviews were recorded and transcribed verbatim. Data analysis involved thematic analysis.

Results: GP educators identified four overarching themes that, for them, seemed to explain how clinical education mediates its influence on patient care. These included: influencing through (i) educational leadership; (ii) learners; (iii) the educational process; and (iv) educational standards.

Discussion: Findings suggest that GP trainees have a significant effect on the learning environment, professional development of GP trainers, and patient care. The nature of the relationship between GP trainers and trainees appears far more bilateral than acknowledged in the apprenticeship model.
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http://dx.doi.org/10.1080/14739879.2020.1729252DOI Listing
May 2020