bluuebunny/crossref_metadata_2025_split huggingface dataset:
Case Volume and Revisits in Children Undergoing Gastrostomy Tube Placement
Authors: Arca Marjorie J. , Rangel Shawn J. , Hall Matt , Rothstein David H. , Blakely Martin L. , Minneci Peter C. , Shah Samir S. , Heiss Kurt F. , Snyder Charles L. , Berman Loren , Browne Marybeth , Vinocur Charles D. , Raval Mehul V. , Goldin Adam B. 
Published: January 2017

ABSTRACTObjectives:Emergency department (ED) visits and hospital readmissions are common after gastrostomy tube (GT) placement in children. We sought to characterize interhospital variation in revisit rates and explore the association between this outcome and hospital‐specific GT case volume.Patients and Methods:We conducted a retrospective cohort study from 38 hospitals using the Pediatric Health Information System database. Patients younger than 18 years who had a GT placed in 2010 to 2012 were assessed for a GT‐related (mechanical or infectious) ED visit or inpatient readmission at 30 and 90 days after discharge from GT placement. Risk‐adjusted rates were calculated using generalized linear mixed‐effects models accounting for hospital clustering and relevant demographic and clinical attributes, then compared across hospitals.Results:A total of 15,642 patients were included. A median of 468 GTs were placed in all the 38 hospitals during 3 years (range: 83–891), with a median of 11.4 GT placed per 1000 discharges (range: 2.4–16.7). Median ED visit for each hospital at 30 days after discharge was 8.2% (range: 3.7%–17.2%) and 14.8% at 90 days (range: 6.3%–26.1%). Median inpatient readmissions for each hospital at 30 days after discharge was 3.5% (range: 0.5%–10.5%) and 5.9% at 90 days (range: 1.0%–18.5%). Hospital‐specific GT placement per 1000 discharges (rate of GT placement) was inversely correlated with ED visit rates at 30 (P = 0.007) and 90 days (P = 0.020). The adjusted 30‐ and 90‐day readmission rate and the adjusted 30‐ and 90‐day ED return rates decreased with increasing GT insertion rate (P < 0.001).Conclusion:Higher hospital GT insertion rates are associated with lower ED revisit rates but not inpatient readmissions.
Utility of Gastric and Duodenal Biopsies During Follow‐up Endoscopy in Children With Eosinophilic Esophagitis
Authors: Kaur Sunpreet , Rosen John M. , Kriegermeier Alyssa A. , Wechsler Joshua B. , Kagalwalla Amir F. , Brown Jeffrey B. 
Published: January 2017

ABSTRACTObjectives:Eosinophilic esophagitis (EoE) is a chronic antigen‐mediated immune disorder of the esophagus. Consensus guidelines recommend obtaining esophageal, gastric, and duodenal biopsies at diagnostic endoscopy when EoE is suspected. The utility of repeated gastric and duodenal biopsies during follow‐up endoscopy in patients previously diagnosed with EoE is not established. The aim of the present study was to explore the role of gastric and duodenal biopsies in children with an established diagnosis of EoE undergoing repeat endoscopy to assess histological response to treatment.Methods:Retrospective chart review of children diagnosed with EoE at a tertiary care center was conducted. A total of 160 patients with EoE with demographic clinical, endoscopic, and histological data at diagnosis and follow‐up endoscopy were included. The frequency of gastric and duodenal biopsies at follow‐up endoscopy with abnormal histology and their correlation to endoscopic findings was determined.Results:At follow‐up endoscopy, 83% (132/160) of patients had gastric and 74% (118/160) had duodenal biopsies. Histology was normal in 81% of gastric and 92% of duodenal biopsies. The most frequent gastric abnormalities were chemical and inactive chronic gastritis. The most frequent duodenal abnormality was villous blunting with increased intraepithelial lymphocytes. Two patients with normal gastric and duodenal histology progressed to eosinophilic gastroenteritis at follow‐up endoscopy.Conclusions:Gastric and duodenal biopsies obtained in EoE patients during follow‐up endoscopy show pathology in a minority of patients, increase costs, and may add potential risk of adverse events. Large multicenter, prospective studies of endoscopic practice during follow‐up of EoE are warranted to provide evidence supporting best practices.
Refinement of a Conceptual Model for Adolescent Readiness to Engage in End-of-Life Discussions
Authors: Bell Cynthia J. , Zimet Gregory D. , Hinds Pamela S. , Broome Marion E. , McDaniel Anna M. , Mays Rose M. , Champion Victoria L. 
Published: January 2017

Background:
Adolescents living with incurable cancer require ongoing support to process grief, emotions, and information as disease progresses including treatment options (phase 1 clinical trials and/or hospice/palliative care). Little is known about how adolescents become ready for such discussions.

Objective:
The purpose of this study was to explore the process of adolescent readiness for end-of-life preparedness discussions, generating a theoretical understanding for guiding clinical conversations when curative options are limited.

Methods:
We explored 2 in-depth cases across time using case-study methodology. An à priori conceptual model based on current end-of-life research guided data collection and analysis. Multiple sources including in-depth adolescent interviews generated data collection on model constructs. Analysis followed a logical sequence establishing a chain of evidence linking raw data to study conclusions. Synthesis and data triangulation across cases and time led to theoretical generalizations. Initially, we proposed a linear process of readiness with 3 domains: a cognitive domain (awareness), an emotional domain (acceptance), and a behavioral domain (willingness), which preceded preparedness.

Results:
Findings led to conceptual model refinement showing readiness is a dynamic internal process that interacts with preparedness. Current awareness context facilitates the type of preparedness discussions (cognitive or emotional). Furthermore, social constraint inhibits discussions.

Conclusions:
Data support theoretical understanding of the dynamism of readiness. Future research that validates adolescent conceptualization will ensure age-appropriate readiness representation.

Implications for Practice:
Understanding the dynamic process of readiness for engaging in end-of-life preparedness provides clinician insight for guiding discussions that facilitate shared decision making and promote quality of life for adolescents and their families.
Symptom Characteristics Among Hospitalized Children and Adolescents With Cancer
Authors: Linder Lauri A. , Al-Qaaydeh Sharifa , Donaldson Gary 
Published: January 2017

Background:
Studies addressing physical and psychosocial symptoms among hospitalized children and adolescents with cancer are limited. Understanding commonly occurring symptoms and their associated characteristics across the hospitalization is needed to guide symptom management strategies.

Objective:
This study described the symptom experience of hospitalized children and adolescents with cancer. The study explored the frequencies of individual symptoms and the severity, duration, and associated distress of symptoms during the course of the hospitalization.

Methods:
Participants completed the Memorial Symptom Assessment Scale 7–12 during each 12-hour shift of the 3-day/3-night data collection period.

Results:
Participants were 50 children and adolescents (mean age, 12.6 years; range, 7.1–18.6 years) receiving inpatient chemotherapy. Participants reported a mean of 2.75 symptoms at each assessment point and a mean of 5.42 different symptoms during their hospitalization. Mixed model analyses identified a significant fixed effect for study day, with participants reporting fewer symptoms (F = 8.4, P < .01), less symptom severity (F = 5.81, P < .01), and shorter duration (F = 6.67, P < .01) on day 3 relative to days 1 and 2. A fixed effect for study day was not present for symptom distress.

Conclusions:
Children and adolescents receiving inpatient chemotherapy experience multiple physical and psychosocial symptoms of moderate or greater severity and duration throughout the course of their hospitalization. Symptoms of greatest severity may not be those that are most distressing to the patient.

Implications for Practice:
Ongoing assessment that incorporates the multidimensional nature of symptoms is needed. Prioritizing interventions for symptoms that are most distressing to the patient may support a more meaningful, patient-centric approach to care.
Early Fluid Overload Prolongs Mechanical Ventilation in Children With Viral-Lower Respiratory Tract Disease*
Authors: Ingelse Sarah A. , Wiegers Hanke M. G. , Calis Job C. , van Woensel Job B. , Bem Reinout A. 
Published: January 2017

Objectives:
Viral-lower respiratory tract disease is common in young children worldwide and is associated with high morbidity. Acute respiratory failure due to viral-lower respiratory tract disease necessitates PICU admission for mechanical ventilation. In critically ill patients in PICU settings, early fluid overload is common and associated with adverse outcomes such as prolonged mechanical ventilation and increased mortality. It is unclear, however, if this also applies to young children with viral-lower respiratory tract disease induced acute respiratory failure. In this study, we aimed to investigate the relation of early fluid overload with adverse outcomes in mechanically ventilated children with viral-lower respiratory tract disease in a retrospective dataset.

Design:
Retrospective cohort study.

Setting:
Single, tertiary referral PICU.

Patients:
One hundred thirty-five children (< 2 yr old) with viral-lower respiratory tract disease requiring mechanical ventilation admitted to the PICU of the Academic Medical Center, Amsterdam between 2008 and 2014.

Interventions:
None.

Measurements and Main Results:
The cumulative fluid balance on day 3 of mechanical ventilation was compared against duration of mechanical ventilation (primary outcome) and daily mean oxygen saturation index (secondary outcome), using uni- and multivariable linear regression. In 132 children, the mean cumulative fluid balance on day 3 was + 97.9 (49.2) mL/kg. Higher cumulative fluid balance on day 3 was associated with a longer duration of mechanical ventilation in multivariable linear regression (β = 0.166; p = 0.048). No association was found between the fluid status and oxygen saturation index during the period of mechanical ventilation.

Conclusions:
Early fluid overload is an independent predictor of prolonged mechanical ventilation in young children with viral-lower respiratory tract disease. This study suggests that avoiding early fluid overload is a potential target to reduce duration of mechanical ventilation in these children. Prospective testing in a clinical trial is warranted to support this hypothesis.
Readmission and Late Mortality After Critical Illness in Childhood*
Authors: Hartman Mary E. , Saeed Mohammed J. , Bennett Tellen , Typpo Katri , Matos Renee , Olsen Margaret A. 
Published: January 2017

Objectives:
Little is known about the ongoing mortality risk and healthcare utilization among U.S. children after discharge from a hospitalization involving ICU care. We sought to understand risks for hospital readmission and trends in mortality during the year following ICU discharge.

Design:
Retrospective observational cohort study.

Setting:
This study was performed using administrative claims data from 2006-2013 obtained from the Truven Health Analytics MarketScan Database.

Subjects:
We included all children in the dataset admitted to a U.S. ICU less than or equal to 18 years old.

Interventions:
The primary outcome was nonelective readmission in the year following discharge. Risk of rehospitalization was determined using a Cox proportional hazards model.

Measurements and Main Results:
We identified 109,130 children with at least one ICU admission in the dataset. Over three quarters of the index ICU admissions (78.6%) had an ICU length of stay less than or equal to 3 days, and the overall index hospitalization mortality rate was 1.4%. In multivariate analysis, risk of nonelective readmission for children without cancer was higher with longer index ICU admission length of stay, younger age, and several chronic and acute conditions. By the end of the 1-year observation period, 36.0% of children with an index ICU length of stay greater than or equal to 14 days had been readmitted, compared with only 13.9% of children who had an index ICU length of stay equals to 1 day. Mortality in the year after ICU discharge was low overall (106 deaths per 10,000 person-years of observation) but was high among children with an initial index ICU admission length of stay greater than or equal to 14 days (599 deaths per 10,000 person-years).

Conclusions:
Readmission after ICU care is common. Further research is needed to investigate the potentially modifiable factors affecting likelihood of readmissions after discharge from the ICU. Although late mortality was relatively uncommon overall, it was 10-fold higher in the year after ICU discharge than in the general U.S. pediatric population.
The Severity of Hypoxic-Ischemic Encephalopathy Correlates With Multiple Organ Dysfunction in the Hypothermia Era
Authors: Alsina Miguel , Martín-Ancel Ana , Alarcon-Allen Ana , Arca Gemma , Gayá Francisco , García-Alix Alfredo 
Published: January 2017

Objectives:
The objectives are to 1) determine whether there is a positive correlation between the severity of hypoxic-ischemic encephalopathy and multiple organ dysfunction and 2) evaluate the organ dysfunction pattern in infants with hypoxic-ischemic encephalopathy in the hypothermia era.

Design:
Retrospective observational study of prospective data collected between April 2009 and December 2012.

Setting:
The study took place in the neonatal ICU of Hospital Sant Joan de Déu–Hospital Clínic of Barcelona.

Patients:
Prospective consecutive newborns with greater than or equal to 36 weeks of gestation, greater than or equal to 1,800 g of weight at birth, and a diagnosis of hypoxic-ischemic encephalopathy was included.

Interventions:
Severity of hypoxic-ischemic encephalopathy was established before starting controlled hypothermia. Six organ systems and 23 clinical and laboratory variables were studied by means of an asymmetrical grading scale. Data were recorded daily during the first 72 hours of life.

Measurements and Main Results:
Seventy-nine patients were studied. All presented with multiple organ dysfunction on day 1. There were differences in the number of affected organs on day 1 according to hypoxic-ischemic encephalopathy stage (p < 0.001). Scale scores correlated positively with the severity of hypoxic-ischemic encephalopathy (area under the curve ranged from 0.77 to 0.87 on every day studied). There were significant differences in the severity of dysfunction of each organ system among the three hypoxic-ischemic encephalopathy stages (p < 0.05). Although the most frequently involved were hepatic and pH and electrolyte imbalance, the most severely affected were the respiratory and cardiovascular systems.

Conclusions:
In the hypothermia era, multiple organ dysfunction continues to be almost universal in newborns with hypoxic-ischemic encephalopathy. There is a high correlation between the severity of hypoxic-ischemic encephalopathy and multiple organ dysfunction during the first 3 days of life. A high index of suspicion of relevant multiple organ dysfunction is required in infants admitted with a diagnosis of severe hypoxic-ischemic encephalopathy. Patients with moderate hypoxic-ischemic encephalopathy present wide variability in the severity of multiple organ dysfunction. In the absence of multiple organ dysfunction, a perinatal hypoxic-ischemic origin of acute severe neonatal encephalopathy should be carefully reconsidered.
Pediatric HIV Disclosure Intervention Improves Knowledge and Clinical Outcomes in HIV-Infected Children in Namibia
Authors: Beima-Sofie Kristin M. , Brandt Laura , Hamunime Ndapewa , Shepard Mark , Uusiku James , John-Stewart Grace C. , O'Malley Gabrielle 
Published: January 2017

Objectives:
Using routinely collected data, we evaluated a nationally implemented intervention to assist health care workers and caregivers with HIV disclosure to children. We assessed the impact of the intervention on child's knowledge and health outcomes.

Methods:
Data were abstracted from national databases and patient charts for HIV-infected children aged 7–15 years attending 4 high-volume HIV clinics in Namibia. Disclosure rates, time to disclosure, and HIV knowledge in 314 children participating in the intervention were analyzed. Logistic regression was used to identify correlates of partial vs. full disclosure. Paired t-tests and McNemar tests were used to compare adherence and viral load (VL) before versus after intervention enrollment.

Results:
Among children who participated in the disclosure intervention, 11% knew their HIV status at enrollment and an additional 38% reached full disclosure after enrollment. The average time to full disclosure was 2.5 years (interquartile range: 1.2–3 years). Children who achieved full disclosure were more likely to be older, have lower VLs, and have been enrolled in the intervention longer. Among children who reported incorrect knowledge regarding why they take their medicine, 83% showed improved knowledge after the intervention, defined as knowledge of HIV status or adopting intervention-specific language. On comparing 0–12 months before vs. 12–24 months after enrollment in the intervention, VL decreased by 0.5 log10 copies per milliliter (N = 42, P = 0.004), whereas mean adherence scores increased by 10% (N = 88, P value < 0.001).

Conclusions:
This HIV disclosure intervention demonstrated improved viral suppression, adherence, and HIV knowledge and should be considered for translation to other settings.
Nevirapine Pharmacokinetics and Safety in Neonates Receiving Combination Antiretroviral Therapy for Prevention of Vertical HIV Transmission
Authors: Lau Elaine , Brophy Jason , Samson Lindy , Kakkar Fatima , Campbell Douglas M. , Yudin Mark H. , Murphy Kellie , Seto Winnie , Colantonio David , Read Stanley E. , Bitnun Ari 
Published: January 2017

Background:
Nevirapine (NVP)-based combination antiretroviral therapy is routinely prescribed to infants deemed at high risk of vertical HIV infection in our centers. We evaluated NVP pharmacokinetics and safety of this regimen.

Methods:
Neonates were recruited prospectively between September 2012 and April 2015 or enrolled retrospectively if treated similarly before prospective study initiation. NVP was dosed at 150 mg/m2 daily for 14 days, then twice daily for 14 days. NVP levels were drawn at weeks 1, 2, and 4 [target trough (NVP-T): 3–8 mg/L].

Results:
Thirty-three neonates were included (23 prospectively). Median gestational age (GA) and birth weight were 38 weeks (32–41 weeks) and 2.9 kg (1.5–4.2 kg), respectively. Median NVP-Ts were 8.2 mg/L (1.6–25.1 mg/L), 3.5 mg/L (1.6–6.8 mg/L), and 4.3 mg/L (0.1–19.9 mg/L) at weeks 1, 2, and 4, respectively. The proportions with therapeutic NVP-T were 42%, 61%, and 73% at these same timepoints. Median apparent oral clearance (CL/F) increased from 0.05 L·kg−1·h−1 (0.01–0.50 L·kg−1·h−1) at week 2 to 0.18 L·kg−1·h−1 (0.01–0.78 L·kg−1·h−1) at week 4. Increased drug exposure [area under the curve (AUCτ)] correlated with younger GA (r = 0.459, P = 0.032) and lower birth weight (r = 0.542, P = 0.009). The most common adverse events potentially attributable to combination antiretroviral therapy were transient asymptomatic hyperlactatemia (26%), anemia (24.7%), and neutropenia (22.1%).

Conclusions:
Treatment dose NVP was generally well-tolerated and associated with normalization of trough levels over time in most cases without dose adjustment. Lower empiric dosing is recommended for infants <34 weeks of GA. Routine therapeutic drug monitoring may not be required for infants ≥34 weeks of GA.
Outcomes following electrographic seizures and electrographic status epilepticus in the pediatric and neonatal ICUs
Authors: Pinchefsky Elana F. , Hahn Cecil D. 
Published: January 2017

Purpose of review
Increasing recognition of electrographic seizures and electrographic status epilepticus in critically ill neonates and children has highlighted the importance of identifying their potential contributions to neurological outcomes to guide optimal management.

Recent findings
Recent studies in children and neonates have found an independent association between increasing seizure burden and worse short-term and long-term outcomes, even after adjusting for other important contributors to outcome such as seizure cause and illness severity. The risk of worse neurological outcome has been shown to increase above a seizure burden threshold of 12–13 min/h, which is considerably lower than the conventional definition of status epilepticus of 30 min/h. Randomized controlled trials in neonates have demonstrated that electroencephalography-targeted therapy can successfully reduce seizure burden, but due to their small size these trials have not been able to demonstrate that more aggressive electroencephalography-targeted treatment of both subclinical and clinical seizures results in improved outcome.

Summary
Despite mounting evidence for an independent association between increasing seizure burden and worse outcome, further study is needed to determine whether early seizure identification and aggressive antiseizure treatment can improve neurodevelopmental outcomes.
Cognition in epilepsy: current clinical issues of interest
Authors: Witt Juri-Alexander , Helmstaedter Christoph 
Published: January 2017

Purpose of review
This review provides an update and summary of recent neuropsychological findings in epilepsy focusing on three major clinical topics among the many developments in the field. We will critically outline the current state with regard to cognition in new-onset epilepsies, social cognition in epilepsy, and the long-term outcome of epilepsy surgery and the cognitive outcomes of superselective surgical procedures.

Recent findings
Current studies indicate that neuropsychological impairments are prevalent already at the onset of epilepsy and even before, social cognition (i.e., emotion recognition and theory of mind) is impaired in different epilepsy populations, the long-term outcome of epilepsy surgery is mostly characterized by a stable or even improved cognitive status, and superselective epilepsy surgeries are associated with a promising neuropsychological outcome.

Summary
The high prevalence of cognitive deficits around epilepsy onset challenges the assumption that epilepsy is the major cause of cognitive problems and calls for early neuropsychological diagnostics. Social cognition seems to be a relevant domain that is not yet routinely considered in epilepsy. The cognitive long-term outcome of epilepsy surgery is mostly positive. Stereotactic thermocoagulation and gamma knife surgery appear to be cognitively safe procedures.