Publications by authors named "Lauren Pischel"

16 Publications

  • Page 1 of 1

A Brewing Back Pain.

N Engl J Med 2021 Jul;385(1):66-72

From the Department of Medicine, Section of Infectious Diseases (L.P.), the Division of Cardiac Surgery (A.G.), the Department of Internal Medicine and Pediatrics (R.A.M.), and the Department of Internal Medicine, Section of Hematology (A.I.L.), Yale School of Medicine, the Department of Epidemiology of Microbial Diseases, Yale School of Public Health (L.P.), and the Department of Infection Prevention, Yale New Haven Health (R.A.M.), New Haven, and Hartford Hospital, Hartford (J.M.) - all in Connecticut.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1056/NEJMcps2034802DOI Listing
July 2021

Bartonellosis in transplant recipients: A retrospective single center experience.

World J Transplant 2021 Jun;11(6):244-253

Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, United States.

Background: Bartonellosis is a rare but challenging condition to diagnose with a spectrum of clinical presentations in the immunocompromised host.

Aim: To further characterize the presentation of () infections in solid organ and hematopoietic stem cell transplant recipients.

Methods: We conducted a single-center retrospective study of all testing for 5012 transplant recipients receiving care at a single institution between 2011 and 2018.

Results: We identified 38 patients who underwent testing for , and three of 38 were found to have bartonellosis. Two of the patients were renal transplant recipients who presented with visceral bartonellosis and symptoms concerning for post-transplant lymphoproliferative disorder. One autologous stem cell transplant recipient presented with cat scratch disease. We detail the clinical courses of these three cases and review the literature concerning the clinical presentations, differential diagnosis, and limitations of diagnostic tests for infections in transplant recipients.

Conclusion: Although the incidence of infection in transplant recipients is unknown, it merits inclusion in the differential diagnosis for fever of unknown origin in this population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5500/wjt.v11.i6.244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8218350PMC
June 2021

Strategies to increase uptake of maternal pertussis vaccination.

Expert Rev Vaccines 2021 Jul 21:1-18. Epub 2021 Jul 21.

Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, Connecticut, USA.

Introduction: Pertussis is a highly contagious respiratory disease that results in disproportionate morbidity and mortality in infants who have yet to receive the primary diphtheria-tetanus-pertussis vaccine series. In the preceding decades numerous countries began to pursue either prenatal vaccination of pregnant women or postpartum vaccination of caregivers to protect infants. Despite proven benefit, maternal uptake of pertussis vaccine continues to remain suboptimal.

Areas Covered: Many studies have been conducted to address the suboptimal uptake of maternal pertussis vaccination. This systematic review was undertaken to systematically identify those studies, highlight the most successful strategies and find the knowledge gaps that need to be filled over the coming years to improve vaccine uptake. Twenty-five studies were identified from six different databases.

Expert Opinion: Five different interventions were shown to be successful in promoting uptake of pertussis vaccination: (1) standing orders, (2) opt-in orders, (3) provider education, (4) on-site vaccination and (5) interactive patient education. Three major knowledge gaps were also identified that need to be filled over the coming years: (1) lack of studies in low- and middle-income countries, (2) lack of studies targeting midwives and/or home birth and (3) lack of studies on the process of vaccine communication.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14760584.2021.1940146DOI Listing
July 2021

Cost-effectiveness of tocilizumab in severe COVID-19: to see or not to see.

Clin Infect Dis 2021 May 17. Epub 2021 May 17.

Section of Hematology, Yale School of Medicine, New Haven, Connecticut, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/cid/ciab459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8194546PMC
May 2021

Race and ethnicity do not impact eligibility for remdesivir: A single-center experience.

PLoS One 2021 6;16(5):e0250735. Epub 2021 May 6.

Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America.

As the Coronavirus-2019 (COVID-19) pandemic continues, multiple therapies are rapidly being evaluated for efficacy in clinical trials. Clinical trials should be racially and ethnically representative of the population that will eventually benefit from these medications. There are multiple potential barriers to racial and ethnic minority enrollment in clinical trials, one of which could be that inclusion and exclusion criteria select for certain racial or ethnic groups disproportionately. In this observational cohort study at a single health care system, we examined if there were differences in eligibility for treatment with remdesivir based on clinical trial criteria for racial and ethnic minorities compared to non-Hispanic Whites. 201 electronic medical record charts were reviewed manually. Self-identified Whites were older than other racial or ethnic groups. At the time of presentation, Black, Latinx, and White participants met inclusion criteria for remdesivir at similar rates (72%, 80%, and 73% respectively), and exclusion criteria at similar rates (43%, 38% and 49% for Black, Latinx and White participants respectively). In this study, there was no difference in eligibility for remdesivir based on race or ethnicity alone.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250735PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101938PMC
May 2021

Fast Development of High-Quality Vaccines in a Pandemic.

Chest 2021 07 20;160(1):e1-e3. Epub 2021 Apr 20.

Department of Medicine, Section of Infectious Diseases, Orange, CT; Yale School of Public Health, Orange, CT; Yale Institute of Global Health, Orange, CT; Yale School of Nursing, Orange, CT.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.chest.2021.03.063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102080PMC
July 2021

Improving diagnosis by feedback and deliberate practice: one-on-one coaching for diagnostic maturation.

Diagnosis (Berl) 2021 Feb 3. Epub 2021 Feb 3.

Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.

Reflective practice is essential for the ongoing maturation of clinicians and requires regular self-evaluation in association with ongoing mentoring and feedback. Currently, most resident physicians do not have access to educational experiences that fulfill these needs. We present a novel model for structured one-on-one longitudinal coaching using the principles of deliberate practice to improve diagnostic skills. This is an easily implementable educational model that can be replicated in residencies across the country to improve clinical reasoning. Skills learned through this program have the potential not only to bolster the academic approach to patients but to also directly improve the clinical assessment and care of patients under the trainee's care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/dx-2020-0129DOI Listing
February 2021

Diagnosis of oesophageal mucormycosis managed with medical therapy alone.

BMJ Case Rep 2020 Oct 22;13(10). Epub 2020 Oct 22.

Yale University School of Medicine, Yale New Haven Health System, New Haven, Connecticut, USA.

Mucormycosis is an invasive mould that can cause aggressive infection, particularly in immunocompromised patients. Though oesophageal mucormycosis is relatively rare, it remains an elusive and devastating manifestation of this disease. The management is also challenging, due to surgical morbidity and contraindications such as thrombocytopenia in immunocompromised hosts. In this report, we present the case of a 60-year-old Lebanese man with newly diagnosed acute myeloid leukaemia who developed oesophageal mucormycosis after induction chemotherapy with idarubicin/cytarabine (7+3). The diagnosis was made when the patient developed febrile neutropenia and odynophagia. CT scan of the chest revealed a thickened oesophagus. Oesophagogastroduodenoscopy with biopsy, histopathology and PCR were performed, resulting in the diagnosis of The patient was successfully treated with liposomal amphotericin B and salvage posaconazole therapy without surgical intervention. We reviewed the clinical characteristics of the six published oesophageal mucormycosis reports from the literature.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2020-236869DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7583061PMC
October 2020

Tocilizumab Treatment for Cytokine Release Syndrome in Hospitalized Patients With Coronavirus Disease 2019: Survival and Clinical Outcomes.

Chest 2020 10 15;158(4):1397-1408. Epub 2020 Jun 15.

Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT.

Background: Tocilizumab, an IL-6 receptor antagonist, can be used to treat cytokine release syndrome (CRS), with observed improvements in a coronavirus disease 2019 (COVID-19) case series.

Research Question: The goal of this study was to determine if tocilizumab benefits patients hospitalized with COVID-19.

Study Design And Methods: This observational study of consecutive COVID-19 patients hospitalized between March 10, 2020, and March 31, 2020, and followed up through April 21, 2020, was conducted by chart review. Patients were treated with tocilizumab using an algorithm that targeted CRS. Survival and mechanical ventilation (MV) outcomes were reported for 14 days and stratified according to disease severity designated at admission (severe, ≥ 3 L supplemental oxygen to maintain oxygen saturation > 93%). For tocilizumab-treated patients, pre/post analyses of clinical response, biomarkers, and safety outcomes were assessed. Post hoc survival analyses were conducted for race/ethnicity.

Results: Among the 239 patients, median age was 64 years; 36% and 19% were black and Hispanic, respectively. Hospital census increased exponentially, yet MV census did not. Severe disease was associated with lower survival (78% vs 93%; P < .001), greater proportion requiring MV (44% vs 5%; P < .001), and longer median MV days (5.5 vs 1.0; P = .003). Tocilizumab-treated patients (n = 153 [64%]) comprised 90% of those with severe disease; 44% of patients with nonsevere disease received tocilizumab for evolving CRS. Tocilizumab-treated patients with severe disease had higher admission levels of high-sensitivity C-reactive protein (120 vs 71 mg/L; P < .001) and received tocilizumab sooner (2 vs 3 days; P < .001), but their survival was similar to that of patients with nonsevere disease (83% vs 91%; P = .11). For tocilizumab-treated patients requiring MV, survival was 75% (95% CI, 64-89). Following tocilizumab treatment, few adverse events occurred, and oxygenation and inflammatory biomarkers (eg, high-sensitivity C-reactive protein, IL-6) improved; however, D-dimer and soluble IL-2 receptor (also termed CD25) levels increased significantly. Survival in black and Hispanic patients, after controlling for age, was significantly higher than in white patients (log-rank test, P = .002).

Interpretation: A treatment algorithm that included tocilizumab to target CRS may influence MV and survival outcomes. In tocilizumab-treated patients, oxygenation and inflammatory biomarkers improved, with higher than expected survival. Randomized trials must confirm these findings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.chest.2020.06.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7831876PMC
October 2020

The Letter.

Authors:
Lauren Pischel

Ann Intern Med 2018 07;169(2):126

Yale Internal Medicine, New Haven, Connecticut (L.P.).

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7326/M18-0627DOI Listing
July 2018

Triclosan and triclocarban exposure and thyroid function during pregnancy-A randomized intervention.

Reprod Toxicol 2017 12 20;74:143-149. Epub 2017 Sep 20.

Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford School of Medicine, Stanford, CA, 94305, United States; Division of Epidemiology, Department of Health Research and Policy, Stanford School of Medicine, Stanford, CA 94305, United States.

Triclosan and triclocarban (TCs) are broad-spectrum microbicides found in household and personal wash products. We sought to determine whether TC exposure from wash products or urinary triclosan level modified thyroid function during pregnancy or anthropometric measurements at birth. A randomized intervention of wash products with or without TCs, including toothpaste, enrolled pregnant women from 20 weeks' gestation. Urinary triclosan, TSH, T4 and T3 were assessed at enrollment, 36weeks' gestation and/or post-delivery; anthropometric measures at birth were ascertained from medical records. 78 and 76 mothers were assigned to the TC-containing and no-TC-containing product arms, respectively. No differences were observed in any thyroid function measure at any time point or in any anthropometric measurement at birth between either exposure arms or lowest and highest urinary triclosan quartile groups. TCs from wash products, primarily liquid and bar soaps, did not affect thyroid function measures during pregnancy or babies' anthropometric measures at delivery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.reprotox.2017.09.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5718922PMC
December 2017

Reply to "Triclocarban and Health: the Jury Is Still Out".

mSphere 2016 Nov-Dec;1(6). Epub 2016 Nov 2.

Department of Medicine, Stanford University School of Medicine, Stanford, California, USA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1128/mSphere.00255-16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5093150PMC
November 2016

Crossover Control Study of the Effect of Personal Care Products Containing Triclosan on the Microbiome.

mSphere 2016 May-Jun;1(3). Epub 2016 May 18.

Department of Medicine, Stanford University School of Medicine, Stanford, California, USA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA.

Commonly prescribed antibiotics are known to alter human microbiota. We hypothesized that triclosan and triclocarban, components of many household and personal care products (HPCPs), may alter the oral and gut microbiota, with potential consequences for metabolic function and weight. In a double-blind, randomized, crossover study, participants were given triclosan- and triclocarban (TCS)-containing or non-triclosan/triclocarban (nTCS)-containing HPCPs for 4 months and then switched to the other products for an additional 4 months. Blood, stool, gingival plaque, and urine samples and weight data were obtained at baseline and at regular intervals throughout the study period. Blood samples were analyzed for metabolic and endocrine markers and urine samples for triclosan. The microbiome in stool and oral samples was then analyzed. Although there was a significant difference in the amount of triclosan in the urine between the TCS and nTCS phases, no differences were found in microbiome composition, metabolic or endocrine markers, or weight. Though this study was limited by the small sample size and imprecise administration of HPCPs, triclosan at physiologic levels from exposure to HPCPs does not appear to have a significant or important impact on human oral or gut microbiome structure or on a panel of metabolic markers. IMPORTANCE Triclosan and triclocarban are commonly used commercial microbicides found in toothpastes and soaps. It is unknown what effects these chemicals have on the human microbiome or on endocrine function. From this randomized crossover study, it appears that routine personal care use of triclosan and triclocarban neither exerts a major influence on microbial communities in the gut and mouth nor alters markers of endocrine function in humans.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1128/mSphere.00056-15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4888890PMC
June 2016

Meanwhile.

Authors:
Lauren Pischel

J Med Humanit 2017 Jun;38(2):213

Stanford School of Medicine, MSIV, Stanford, CA, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10912-015-9366-0DOI Listing
June 2017

Galvanizing medical students in the administration of influenza vaccines: the Stanford Flu Crew.

Adv Med Educ Pract 2015 1;6:471-7. Epub 2015 Jul 1.

Stanford University School of Medicine, Stanford, CA, USA.

Many national organizations call for medical students to receive more public health education in medical school. Nonetheless, limited evidence exists about successful servicelearning programs that administer preventive health services in nonclinical settings. The Flu Crew program, started in 2001 at the Stanford University School of Medicine, provides preclinical medical students with opportunities to administer influenza immunizations in the local community. Medical students consider Flu Crew to be an important part of their medical education that cannot be learned in the classroom. Through delivering vaccines to where people live, eat, work, and pray, Flu Crew teaches medical students about patient care, preventive medicine, and population health needs. Additionally, Flu Crew allows students to work with several partners in the community in order to understand how various stakeholders improve the delivery of population health services. Flu Crew teaches students how to address common vaccination myths and provides insights into implementing public health interventions. This article describes the Stanford Flu Crew curriculum, outlines the planning needed to organize immunization events, shares findings from medical students' attitudes about population health, highlights the program's outcomes, and summarizes the lessons learned. This article suggests that Flu Crew is an example of one viable service-learning modality that supports influenza vaccinations in nonclinical settings while simultaneously benefiting future clinicians.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/AMEP.S70294DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4492543PMC
July 2015

Antibodies to PfSEA-1 block parasite egress from RBCs and protect against malaria infection.

Science 2014 May;344(6186):871-7

Center for International Health Research, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA. Department of Pathology and Laboratory Medicine, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI 02906, USA.

Novel vaccines are urgently needed to reduce the burden of severe malaria. Using a differential whole-proteome screening method, we identified Plasmodium falciparum schizont egress antigen-1 (PfSEA-1), a 244-kilodalton parasite antigen expressed in schizont-infected red blood cells (RBCs). Antibodies to PfSEA-1 decreased parasite replication by arresting schizont rupture, and conditional disruption of PfSEA-1 resulted in a profound parasite replication defect. Vaccination of mice with recombinant Plasmodium berghei PbSEA-1 significantly reduced parasitemia and delayed mortality after lethal challenge with the Plasmodium berghei strain ANKA. Tanzanian children with antibodies to recombinant PfSEA-1A (rPfSEA-1A) did not experience severe malaria, and Kenyan adolescents and adults with antibodies to rPfSEA-1A had significantly lower parasite densities than individuals without these antibodies. By blocking schizont egress, PfSEA-1 may synergize with other vaccines targeting hepatocyte and RBC invasion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1126/science.1254417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4184151PMC
May 2014
-->