Publications by authors named "Israel Green-Hopkins"

11 Publications

  • Page 1 of 1

Search at Your Own Risk: Online Health Queries and Your Patient.

J Emerg Med 2019 10;57(4):571-572

Department of Emergency Medicine, UCSF Benioff Children's Hospital, San Francisco, California.

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http://dx.doi.org/10.1016/j.jemermed.2019.06.044DOI Listing
October 2019

A Toddler with Spontaneous Pneumomediastinum.

Clin Pract Cases Emerg Med 2017 Nov 3;1(4):411-412. Epub 2017 Oct 3.

University of California, San Francisco, Zuckerberg San Francisco General Hospital, Department of Emergency Medicine, San Francisco, California.

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http://dx.doi.org/10.5811/cpcem.2017.5.33987DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5965229PMC
November 2017

Use of Ondansetron for Vomiting After Head Trauma: Does It Mask Clinically Significant Traumatic Brain Injury?

Pediatr Emerg Care 2020 Aug;36(8):e433-e437

Division of Emergency Medicine, Boston Children's Hospital, Department of Emergency Medicine, Harvard Medical School, Boston, MA.

Objectives: We describe ondansetron use in children with head injury evaluated in pediatric emergency departments and its association with return visits and late diagnoses of intracranial injuries requiring intervention.

Methods: Children ages 6 months to 18 years discharged without neuroimaging from 35 pediatric emergency departments with a diagnosis of head injury from 2009 to 2013 were identified retrospectively from the Pediatric Health Information System. We evaluated the rates of ondansetron use during the study period and of the association of ondansetron treatment with the diagnosis of intracranial injury, skull fracture, and return visits within 72 hours requiring admission or operative intervention.

Results: We identified 218,904 encounters during the study period. Of these, 5894 patients (2.8%) were given ondansetron. There was significant variation in the use of ondansetron during the index visit between hospitals (0.1%-5.7%), and ondansetron use significantly increased over the study period. Return visits within 72 hours were more likely for patients treated with ondansetron during the index visit (3.7% vs 1.9%; adjusted odds ratio, 1.99; 95% confidence interval, 1.7-2.4). These patients were more likely to be admitted than those not treated initially with ondansetron (7% vs 4%; adjusted odds ratio, 1.97; 95% confidence interval, 1.09-3.55). There were no significant differences in rates of skull fractures, intracranial injury, intensive care unit admission, or operative intervention between groups.

Conclusions: Ondansetron use during an initial emergency department visit for head trauma in children not requiring neuroimaging is associated with a higher likelihood of return within 72 hours and subsequent admission. There were no differences in rates of missed skull fractures, intracranial injury, intensive care admission, or operative intervention for groups who were and were not treated with ondansetron; however, this study was underpowered to detect significant differences in these categories. Future investigations with greater numbers would be required to confidently assess these critical differences.
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http://dx.doi.org/10.1097/PEC.0000000000001315DOI Listing
August 2020

From development to implementation-A smartphone and email-based discharge follow-up program for pediatric patients after hospital discharge.

Healthc (Amst) 2016 Jun 14;4(2):109-15. Epub 2016 Jan 14.

Department of Medicine, Boston Children's Hospital, United States.

The purpose of this case study was to investigate opportunities to electronically enhance the transitions of care for both patients and providers and to describe the process of development and implementation of such tools. We describe the current challenges and fragmentation of care for pediatric patients and families being discharged from inpatient stays, and review barriers to change in practice. Care transitions vary in the complexity of the clinical and social scenarios and no one-size-fits-all approach works for every patient, provider or hospital system. A substantial challenge that providers who are designing and implementing digital tools for patients surrounds the complexity in building such tools to apply to such broad populations. Our case study provides a framework using a multidisciplinary approach, brainstorming and rapid digital prototyping to build an in-house electronic discharge follow-up platform. In describing this process, we review design and implementation measures that may further support digital tool development in other areas.
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http://dx.doi.org/10.1016/j.hjdsi.2015.11.003DOI Listing
June 2016

Comparison Between Direct and Video-assisted Laryngoscopy for Intubations in a Pediatric Emergency Department.

Acad Emerg Med 2016 08 1;23(8):870-7. Epub 2016 Aug 1.

Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.

Objectives: The objective was to compare video-assisted laryngoscopy (VAL) to direct laryngoscopy (DL) on success rate and complication rate of intubations performed in a pediatric emergency department (ED).

Methods: This is a retrospective cohort study of attempted intubations of children aged 0-18 years in a pediatric ED between 2004 and 2014 with first attempt by an ED provider. In VAL, the laryngoscopist attempts direct visualization of the glottis with a C-MAC video laryngoscope while the video monitor is used for real-time guidance by a supervisor, back-up visualization for the laryngoscopist should the direct view be inadequate, and confirmation of endotracheal tube passage through the vocal cords. We performed univariate comparisons of intubations using DL to intubations using VAL on rates of first-pass success, complications, and whether the patient was successfully intubated by an ED provider. We then created a logistic regression model to adjust for provider experience level, difficult airway characteristics, and indications for intubation to compare intubations using DL to intubations using VAL for each outcome.

Results: We identified 452 endotracheal intubations of 422 unique patients, of which 445 intubations had a first attempt by an ED provider. Six intubations were excluded due to insufficient information available in the record. Of the included intubations, 240 (55%) were attempted with DL and 199 (45%) with VAL. The overall first-pass success rate was 71% in the DL group and 72% in the VAL group. After adjustment for covariates, the first-pass success rate was similar between laryngoscopy approaches (adjusted odds ratio = 1.23, 95% confidence interval = 0.78 to 1.94).

Conclusions: We found no difference between DL and VAL with regard to first-pass intubation success rate, complication rate, or rate of successful intubation by ED providers for children undergoing intubation in a pediatric ED.
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http://dx.doi.org/10.1111/acem.13015DOI Listing
August 2016

Using Video-recorded Laryngoscopy to Evaluate Laryngoscopic Blade Approach and Adverse Events in Children.

Acad Emerg Med 2015 Nov 15;22(11):1283-9. Epub 2015 Oct 15.

Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.

Objectives: Using recordings of endotracheal intubation attempts obtained with a video-enabled laryngoscope with Miller and Macintosh blades, the authors sought to evaluate the association between laryngoscopic approach (right-sided vs. midline) and intubation success, as well as adverse event rates in the pediatric emergency department (ED).

Methods: This was a retrospective cohort study of children younger than 21 years who underwent endotracheal intubation with a C-MAC video laryngoscope in a tertiary care ED between August 2009 and May 2013. The primary outcome was successful endotracheal intubation on the first attempt. The secondary outcomes included time to intubation, video-recorded adverse events (oropharyngeal mucosal injury and aspiration), and physiologic adverse events. Multivariate regression models were used to determine the relationship between laryngoscope blade position and outcome measures adjusted for patient and provider factors.

Results: The cohort consisted of complete video recordings for 105 of 143 (73%) patient encounters with intubations. The first-pass success rate did not significantly differ based on laryngoscopic approach (adjusted odds ratio [aOR] = 0.76, 95% confidence interval [CI] = 0.29 to 2.0). Among patients successfully intubated on the first attempt, the median time to intubation was longer for the right-sided approach compared to the midline approach (42 seconds vs. 31.5 seconds; p < 0.05). The odds of mucosal injury and aspiration were higher among patients intubated using a right-sided approach compared to a midline approach (aOR = 4.1, 95% CI = 1.2 to 14.5; aOR = 7.7, 95% CI = 1.5 to 39.5, respectively). Rates of physiologic adverse events did not differ based on approach.

Conclusions: First-pass success rate did not differ based upon laryngoscopic approach type; however, a right-sided approach was associated with a longer time to intubation, as well as higher rates of mucosal injury and aspiration among patients undergoing video-enabled intubation in a pediatric ED.
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http://dx.doi.org/10.1111/acem.12799DOI Listing
November 2015

Endotracheal Intubation In Pediatric Patients Using Video Laryngoscopy: An Evidence-Based Review.

Pediatr Emerg Med Pract 2015 Aug;12(8):1-22; quiz 22-3

Endotracheal intubation of pediatric patients is an infrequent, though high-risk, procedure in emergency medicine. Emergency clinicians should be aware of available approaches to assist with successful intubation in pediatric patients. Video laryngoscopy involves the utilization of optical and video technology to facilitate indirect visualization of laryngeal structures during intubation. This technology can be advantageous when intubating patients with normal or difficult airways, and it is increasingly being used in the care of patients in the emergency department. A number of pediatric devices are now available, each with benefits as well as limitations and nuances in technique for use. This evidence-based review describes the emergence of video laryngoscopy into the pediatric and emergency medicine settings. A summary of the existing data on video laryngoscopy use in routine and difficult airways is included, and practical instruction on the use of 3 specific devices approved for use in pediatric patients is provided.
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August 2015

Cardiac troponin T as a screening test for myocarditis in children.

Pediatr Emerg Care 2012 Nov;28(11):1173-8

Department of Medicine, Harvard Medical School, Boston, MA, USA.

Objective: The objective of this study was to define the test characteristics of cardiac troponin T (cTnT) in pediatric patients who presented with suspected myocarditis.

Methods: We performed a retrospective cohort study of all patients at a large urban children's hospital 21 years or younger who had a cTnT test sent for evaluation for myocarditis over a 13-month period. Patients were excluded if they had any history of heart disease or cardiac arrest before presentation, or the cTnT was sent for reasons other than concern for myocarditis. Positive cases of myocarditis were defined by characteristic pathology findings, magnetic resonance imaging results, or diagnosis of the attending cardiologist at time of discharge.

Results: Six hundred fifty-two patients had cTnT sent during the study period. Two hundred sixty were excluded because of prior history of heart disease, and 171 had the test sent for reasons other than concern for myocarditis. Of the 221 patients included in the study, 49 had an initial positive cTnT (≥0.01 ng/mL), whereas 172 had a negative test result. Eighteen cases of myocarditis were identified. All patients with myocarditis had an elevated cTnT at presentation. Using a cutoff value of 0.01 ng/mL or greater as a positive test, cTnT had a sensitivity of 100% (95% confidence interval [CI], 78%-100%), with a negative predictive value of 100% (CI, 97%-100%), and a specificity of 85% (CI, 79%-89%), with positive predictive value of 37% (CI, 24%-52%), in the diagnosis of myocarditis.

Conclusions: In children without preexisting heart disease, a cTnT level of less than 0.01 ng/mL can be used to exclude myocarditis.
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http://dx.doi.org/10.1097/PEC.0b013e318271736cDOI Listing
November 2012

Brief Report: Question-Asking and Collateral Language Acquisition in Children with Autism.

J Autism Dev Disord 2010 Apr;40(4):509-15

Koegel Autism Center, Graduate School of Education, University of California at Santa Barbara, Santa Barbara, CA 93106-9490, USA.

The literature suggests children with autism use communication primarily for requests and protests, and almost never for information-seeking. This study investigated whether teaching "Where" questions using intrinsic reinforcement procedures would produce the generalized use of the question, and whether concomitant improvements in related language structures, provided as answers to the children's questions, would occur. In the context of a multiple baseline across participants design, data showed that the children could rapidly acquire and generalize the query, and that there were collateral improvements in the children's use of language structures corresponding to the answers to the questions the children asked. The results are discussed in the context of teaching child initiations to improve linguistic competence in children with autism.
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http://dx.doi.org/10.1007/s10803-009-0896-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2837164PMC
April 2010

Cerebellar ataxia following prolonged use of metronidazole: case report and literature review.

Int J Infect Dis 2008 Nov 3;12(6):e111-4. Epub 2008 Jun 3.

Department of Internal Medicine, Monmouth Medical Center, 300 Second Avenue, Long Branch, NJ 07740, USA.

Cerebellar toxicity is a rare adverse event in patients treated with metronidazole. Here, we present a patient who developed cerebellar toxicity accompanied by objective abnormalities on magnetic resonance imaging, and review the literature on this unusual reaction. Discontinuation of metronidazole almost always results in resolution of symptoms and structural lesions.
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http://dx.doi.org/10.1016/j.ijid.2008.03.006DOI Listing
November 2008

Priming as a Method of Coordinating Educational Services for Students With Autism.

Lang Speech Hear Serv Sch 2003 Jul;34(3):228-235

University of California, Santa Barbara.

Purpose: The importance of coordination of educational services has been well documented in the literature. For students with disabilities, coordinated programs result in more rapid acquisition of targeted behaviors and the increased likelihood of long-term maintenance of gains. The purpose of this study was to assess whether "priming" or exposing students with autism and disruptive behaviors to school assignments before their presentation in class would affect academic performance and problem behaviors.

Method: Two students diagnosed with autism who attended general education classrooms, both of whom exhibited numerous disruptive behaviors and low academic performance, participated in this study. A repeated reversals design was used to monitor student progress.

Results: The results demonstrated decreases in problem behavior and increases in academic responding when priming sessions occurred.

Clinical Implications: Application is discussed in terms of a mechanism for speech-language pathologists to assist classroom teachers with a systematic educational coordination plan that can quickly produce improved school performance.
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http://dx.doi.org/10.1044/0161-1461(2003/019)DOI Listing
July 2003