Publications by authors named "Melissa B Jones"

12 Publications

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Cefiderocol for the Treatment of Adult and Pediatric Patients with Cystic Fibrosis and Achromobacter xylosoxidans Infections.

Clin Infect Dis 2020 Dec 13. Epub 2020 Dec 13.

Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA.

Treatment options for Achromobacter xylosoxidans are limited. Eight cystic fibrosis patients with A. xylosoxidans were treated with 12 cefiderocol courses. Pre-treatment in vitro resistance was seen in 3/8 cases. Clinical response occurred after 11/12 treatment courses. However, microbiologic relapse was observed after 11/12 treatment courses, notably without emergence of resistance.
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http://dx.doi.org/10.1093/cid/ciaa1847DOI Listing
December 2020

Envisioning Distinctive Professional Identity for Critical Care Advanced Practice Providers: Fostering Integrative Transformation Beyond Orientation.

Pediatr Crit Care Med 2020 08;21(8):e581-e583

Section of Critical Care Medicine, Texas Children's Hospital, Houston, TX.

The roles played by nurse practitioners and physician assistants have expanded exponentially during the last decade. Although existing professional advancement models for nurse practitioners/physician assistants have led to enhanced integration in different patient care units, the development of a distinctive professional identity formation is lacking. This perspective proposes a new framework to guide the planning of an educational program that provides not only clinical knowledge and technical skills but also opportunities for enhancing leadership and research skills, along with strong career mentorship. Such a program will lead to formation of a distinctive identity for critical care nurse practitioners and physician assistants, which in turn can improve job satisfaction and employee retention.
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http://dx.doi.org/10.1097/PCC.0000000000002342DOI Listing
August 2020

Neurodevelopmental Outcomes Among Children With Congenital Heart Disease: At-Risk Populations and Modifiable Risk Factors.

World J Pediatr Congenit Heart Surg 2019 11 28;10(6):750-758. Epub 2019 Oct 28.

Department of Cardiac Nursing and the Center for Pediatric Nursing Research and Evidence-based Practice, Children's Hospital of Philadelphia, PA, USA.

As survivable outcomes among patients with complex congenital heart disease (cCHD) have continued to improve over the last several decades, more attention is being dedicated to interventions that impact not just survival but quality of life among patients with cCHD. In particular, patients with cCHD are at risk for impaired neurodevelopmental outcomes. In this review summarizing select presentations given at the 14th Annual Pediatric Cardiac Intensive Care Society's Annual Meeting in 2019, we discuss the neurodevelopmental phenotype of patients with cCHD, patients at greatest risk of impaired development, and three specific modifiable risk factors impacting development.
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http://dx.doi.org/10.1177/2150135119878702DOI Listing
November 2019

Clinical Correlates of Dream Enactment Behaviors in Previously Deployed OEF/OIF/OND Veterans: An Exploratory Analysis.

J Neuropsychiatry Clin Neurosci 2020 7;32(2):147-153. Epub 2019 Oct 7.

The Veterans Affairs (VA) South Central Mental Illness Research, Education and Clinical Center, Houston (Jones); the Michael E. DeBakey Veterans Affairs Medical Center, Houston (Jones, Jeevan, Agrawal, Sharafkaneh, Marsh, Jorge); the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jones, Marsh, Jorge); the Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston (Wang, Li); and the Department of Medicine, Pulmonary, Critical Medicine and Sleep Medicine Section, Baylor College of Medicine, Houston (Agrawal, Sharafkaneh).

Objective: Veterans with posttraumatic stress disorder (PTSD) frequently report dream enactment behavior (DEB). Although DEBs are associated with PTSD symptoms, their relationship with other sleep disorders, including REM behavior disorder, warrants reexamination of their clinical correlates.

Methods: The investigators used a cross-sectional, exploratory analysis to compare demographic and clinical characteristics of veterans endorsing regularly occurring DEB compared with those endorsing no or infrequent DEB. The participants comprised a convenience sample of servicemembers who were previously deployed to Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) and enrolled in an ongoing cohort study.

Results: Of the 78 eligible participants, 19 (24.4%) endorsed DEBs occurring at least once per week in the past month. Compared with participants who reported no or infrequent DEBs, participants with regularly occurring DEBs had poorer sleep quality, greater PTSD severity, a higher number of reported mild traumatic brain injuries (mTBI) with loss of consciousness, and a higher likelihood of being diagnosed with sleep disorders. After adjustment for global sleep quality, a significant association persisted between DEBs and the number of mTBI with loss of consciousness but not between DEBs and the severity of PTSD symptoms.

Conclusions: These results suggest that mTBI may disrupt neural circuits regulating sleep among OIF/OEF/OND veterans. Prospective, polysomnographic assessment of muscle tone and behavioral events during REM sleep is needed to characterize the physiology of DEBs in this population.
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http://dx.doi.org/10.1176/appi.neuropsych.19010009DOI Listing
November 2020

Hypoplastic left heart syndrome: from fetus to fontan.

Cardiol Young 2018 Nov 18;28(11):1275-1288. Epub 2018 Sep 18.

6Medical University of South Carolina,MUSC Children's Heart Center,Charleston, SC,USA.

The care of children with hypoplastic left heart syndrome is constantly evolving. Prenatal diagnosis of hypoplastic left heart syndrome will aid in counselling of parents, and selected fetuses may be candidates for in utero intervention. Following birth, palliation can be undertaken through staged operations: Norwood (or hybrid) in the 1st week of life, superior cavopulmonary connection at 4-6 months of life, and finally total cavopulmonary connection (Fontan) at 2-4 years of age. Children with hypoplastic left heart syndrome are at risk of circulatory failure their entire life, and selected patients may undergo heart transplantation. In this review article, we summarise recent advances in the critical care management of patients with hypoplastic left heart syndrome as were discussed in a focused session at the 12th International Conference of the Paediatric Cardiac Intensive Care Society held on 9 December, 2016, in Miami Beach, Florida.
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http://dx.doi.org/10.1017/S104795111800135XDOI Listing
November 2018

Acquired von Willebrand Syndrome: An Under-Recognized Cause of Major Bleeding in the Cardiac Intensive Care Unit.

World J Pediatr Congenit Heart Surg 2016 11;7(6):711-716

Division of Hematology, Children's National Health System, Washington, DC, USA.

Background: Acquired von Willebrand syndrome (AvWS) in the setting of congenital heart disease is an under-recognized cause of bleeding in the pediatric cardiac critical care unit.

Methods: Fourteen patients diagnosed with AvWS admitted to the cardiac intensive care unit at the Children's National Health System between December 2009 and September 2015 were identified with subsequent chart review and case analysis.

Results: Of the 14 patients included in this study, 4 patients were on ventricular-assist devices, 6 patients were on extracorporeal membrane oxygenation, and 4 were patients with congenital heart disease not receiving any mechanical circulatory support. All patients identified manifested persistent severe bleeding, despite appropriate management of anticoagulation and blood product administration based on the established protocols. Detailed hemostatic testing including quantitative von Willebrand factor (vWF) multimer analysis revealed decreased high-molecular-weight multimers (HMWMs) and absent ultra-HMWM, consistent with AvWS in all patients. Eight patients received treatment with vWF concentrate, one patient with desmopressin, and five recovered without specific treatment. Bleeding ceased in all but one patient.

Conclusions: Acquired von Willebrand syndrome is an uncommon but important cause of bleeding in pediatric patients with cardiac disease. A high index of clinical suspicion with knowledge of the characteristic clinical scenario in addition to low levels of vWF multimers is required to manage and diagnose AvWS. Although the optimal management of AvWS in this patient population is unclear, vWF concentrates are available and appear to be efficacious for controlling life-threatening bleeding.
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http://dx.doi.org/10.1177/2150135116658011DOI Listing
November 2016

Nursing Considerations in Pediatric Cardiac Critical Care.

Pediatr Crit Care Med 2016 08;17(8 Suppl 1):S383-7

1Children's National Health System, The George Washington University Medical Center, Washington, DC. 2Nemours Children's Hospital, Orlando, FL.

Objective: The objectives of this review are to describe the education and critical thinking skills that characterize pediatric critical care nursing and how these skills impact patient care and outcomes in pediatric cardiac critical care.

Data Source: MEDLINE and PubMed.

Conclusions: Pediatric cardiac critical care nurses manage complex and vulnerable patients requiring various levels of support. Effective care of these patients requires knowledge about the complex anatomy and physiology associated with congenital and acquired heart disease, as well as the effects of mechanical ventilation, mechanical circulatory support, and vasoactive medications. Strong physical examination skills, accurate interpretation of hemodynamic and laboratory data, active participation in bedside rounds, excellent communication skills, meticulous care of invasive monitoring catheters and tubes, and compassionate support of families are among the skills that distinguish a cardiac critical care nurse.
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http://dx.doi.org/10.1097/PCC.0000000000000856DOI Listing
August 2016

Perceptions of Bedside Cardiac Critical Care Registered Nurses on 24 Hour Attending Intensivist Coverage.

Congenit Heart Dis 2016 Jul 6;11(4):354-8. Epub 2016 Jun 6.

Departments of *Cardiothoracic Surgery and †Critical Care, Children's National Health System, Washington, DC, USA.

Objective: To elicit the perceptions of bedside critical care nurses toward continual in-house attending coverage and its effect on patient safety, communication, and nursing education.

Design: A 5-point Likert-type questionnaire was designed to evaluate the perception of bedside nurses in the pediatric cardiac intensive care unit (PCICU) toward the presence of a 24 hour in-house attending physician.

Setting: Single tertiary referral PCICU in Washington, DC SUBJECTS: The 46 PCICU nurses who participated in the study were separated into two groups based on exposure to the recent implementation of continual in-house attending coverage at our institution. Group one consisted of 14 nurses with only exposure to the new 24/7 in-house coverage while group two encompassed 32 nurses who had experienced both the new and old system (off-site on-demand attending physician).

Measurements And Main Results: Surveys demonstrated that both groups found that the new system has a positive impact on nursing education (median score of 5) as well as a positive impact on the communication between multidisciplinary teams and between care team and families (median score of 5). Nurses who experienced only the new system scored one point lower (median score of 4) regarding the effect of this staffing model on patient outcomes than nurses who had experienced both systems (median score of 5, P = .016). Between 83% and 98% of all 46 nurses who participated indicated they agree or strongly agree with each of the questions regarding the benefit of 24 hour in-house attending coverage.

Conclusion: Our study suggests that regardless of differences in experience, pediatric cardiac nurses believe the presence of an on-site intensivist to be beneficial to both nursing and patients.
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http://dx.doi.org/10.1111/chd.12381DOI Listing
July 2016

Hybrid Exclusion of HeartMate ІІ Left Ventricular Assist Device After Bridge to Recovery.

Ann Thorac Surg 2016 Jun;101(6):e193-4

Division of Cardiovascular Surgery, Children's National Health System, Washington, DC. Electronic address:

We present a hybrid technique of left ventricular assist device exclusion after bridge to recovery in a pediatric patient, using percutaneous occlusion of the outflow graft and surgical excision of driveline. This technique has the advantage of avoiding chest reentry and cardiopulmonary bypass.
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http://dx.doi.org/10.1016/j.athoracsur.2015.10.040DOI Listing
June 2016

Acquired von Willebrand syndrome in a child following Berlin Heart EXCOR Pediatric Ventricular Assist Device implantation: case report and concise literature review.

World J Pediatr Congenit Heart Surg 2014 Oct;5(4):592-8

Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA

The development of acquired von Willebrand syndrome (AVWS) after placement of a pulsatile-flow left ventricular assist device (LVAD) is rare and only recently recognized. We report the case of a young infant who was diagnosed with ventricular assist device (VAD)-related AVWS following implantation of a Berlin Heart EXCOR Pediatric Ventricular Assist Device (Berlin Heart Inc., The Woodlands, Texas, USA) for treatment of severe heart failure. Despite significant bleeding, the patient was successfully managed with von Willebrand factor-containing concentrate until VAD explantation led to definitive resolution of the AVWS. This case demonstrates that the possibility of this diagnosis should be considered in pediatric patients when extensive, nonsurgical bleeding is encountered after pulsatile-flow VAD implantation.
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http://dx.doi.org/10.1177/2150135114539521DOI Listing
October 2014

Implementation of an extracorporeal cardiopulmonary resuscitation simulation program reduces extracorporeal cardiopulmonary resuscitation times in real patients.

Pediatr Crit Care Med 2014 Nov;15(9):856-60

1Division of Critical Care Medicine, Children's National Health System, Washington, DC. 2Division of Cardiovascular Surgery, Children's National Health System, Washington, DC. 3Division of Critical Care Medicine and Cardiology, Children's National Health System, Washington, DC. 4Children's National Heart Institute, Children's National Health System, Washington, DC.

Objective: To determine if development of an extracorporeal cardiopulmonary resuscitation simulation program reduced extracorporeal cardiopulmonary resuscitation times in real patients

Design: : Before-after study.

Setting: Twenty-six bed pediatric cardiac ICU in a tertiary urban hospital.

Patients: Forty-three cardiac patients (aged 1 d to 16 yr) who received extracorporeal cardiopulmonary resuscitation.

Interventions: An interdisciplinary team collaborated to define the roles and clarify responsibilities of each individual involved in extracorporeal cardiopulmonary resuscitation. An "ideal rapid deployment" was defined and tested using simulation sessions. This included a task analysis, role creation, and multidisciplinary simulations, including structured debriefings and video review and the creation of a master checklist.

Measurements And Main Results: There were a total of 43 episodes of extracorporeal cardiopulmonary resuscitation during the study period, 16 (37%) of which occurred during the preintervention time period (from February 2009 to March 2010) and 27 (63%) during the postintervention time period (April 2010 to March 2013). The median deployment time in the preintervention time period was 51 minutes (interquartile range, 43-62 min), whereas the median deployment time in the postintervention time period was 40 minutes (interquartile range, 23-52 min) (p = 0.018).

Conclusions: There are no standard guidelines of how a team should coordinate the efforts of nursing, physicians, extracorporeal membrane oxygenation specialists, surgeons, respiratory therapists, patient care technicians, and unit clerks to emergently execute this complex procedure. Because time is of the essence, it is essential to develop a highly functioning and well-coordinated team with a standardized method of the procedure, its documentation, and communication. Simulation accomplished this for our program. Following these simulation exercises, not only was there a subjectively observed improved coordination and smoother deployment of extracorporeal membrane oxygenation in real-life extracorporeal cardiopulmonary resuscitation, but we have also demonstrated a significantly faster deployment of extracorporeal membrane oxygenation as compared with the presimulation era.
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http://dx.doi.org/10.1097/PCC.0000000000000234DOI Listing
November 2014

Two novel paradigms for the simultaneous assessment of conditioned taste aversion and food intake effects of anorexic agents.

Physiol Behav 2003 Sep;79(4-5):761-6

Department of Psychiatry, University of Cincinnati Medical Center, P.O. Box 670559, Cincinnati, OH 45267, USA.

The conditioned taste aversion (CTA) is routinely used to assess the aversive consequences of anorexic agents, including potential pharmacological therapies for obesity. In a typical CTA paradigm, rats briefly sampling a novel tastant (e.g., saccharin) are acutely administered with toxin (e.g., lithium chloride, LiCl). After as few as one taste-toxin pairing, rats will reliably avoid the novel tastant. This paradigm is frequently used for the assessment of possible aversive consequences of drugs that are candidates for pharmacological therapies. The degree to which the drug supports development of a CTA is interpreted as an index of its aversive properties. Difficulties with previous work include the inability to assess affects on food intake and CTA simultaneously, particularly during chronic drug administration. We report here two novel CTA paradigms for the assessment of appetitive and aversive consequences of anorexic agents, simultaneously. In the first experiment, animals receive an intraoral infusion of a novel and highly palatable tastant immediately prior to administration of increasing doses of LiCl. In the second experiment, rats were implanted intraperitoneally with osmotic minipumps that chronically delivered a low dose of LiCl for 7 days. LiCl did not affect short or long term food intake in either experiment. However, LiCl did support the development of a CTA in both paradigms. These results suggest that both the appetitive and aversive consequences of anorexic agents can be assessed simultaneously during either acute or chronic drug administration.
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http://dx.doi.org/10.1016/s0031-9384(03)00189-6DOI Listing
September 2003