Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 38
Filter
1.
Lang Speech Hear Serv Sch ; 54(1): 140-155, 2023 01 17.
Article in English | MEDLINE | ID: mdl-36332142

ABSTRACT

PURPOSE: Families and professionals often consider augmentative and alternative communication (AAC) a "last resort" for persons with communication challenges; however, speaking autistic adults have reported that they would have benefited from access to AAC as children. This tutorial discusses the history of this "last resort" practice and its perpetuation within the medical model of disability. The tutorial focuses on communication access, choice, and agency for autistic students. METHOD: We provide a brief overview of the AAC community and their preferred terminology, review the history of traditional approaches to research on AAC and autism, and then examine the relationship between disability models and ableism to views of spoken language as a priority of intervention. Studies on this topic are rare, and resisting ableism requires acknowledging and honoring disabled people's experiences and expertise. Therefore, we promote autistic expertise within the framework of evidence-based practice and discuss the experiences of autistic people and spoken language. Finally, we consider the role of the speech-language pathologist (SLP) in assessment and offer autistic-based strategies and recommendations for communication support. CONCLUSIONS: Speaking autistic students who could benefit from AAC may not have access to AAC due to the prioritization of spoken language and lack of awareness of the benefit of AAC. We recommend that SLPs and school-based professionals support and facilitate access, communicative choice, and agency by implementing multimodal communication strategies to include AAC use for autistic students regardless of their spoken language status. Promoting all types of communication and ensuring opportunities for communication across multiple modalities are paramount to a child's agency and self-determination, as is normalization of AAC.


Subject(s)
Autistic Disorder , Communication Aids for Disabled , Communication Disorders , Speech-Language Pathology , Adult , Child , Humans , Autistic Disorder/therapy , Communication , Communication Disorders/therapy , Speech-Language Pathology/education , Students
2.
Article in English | MEDLINE | ID: mdl-30283776

ABSTRACT

Hydrogels are an attractive class of biomaterials in tissue engineering due to their inherently compatible properties for cell culture. Gelatin methacryloyl (GelMA) has shown significant promise in the fields of tissue engineering and drug delivery, as its physical properties can be precisely tuned depending on the specific application. There is a growing appreciation for the interaction between biomaterials and cells of the immune system with the increasing usage of biomaterials for in vivo applications. Here, we addressed the current lack of information regarding the immune-modulatory properties of photocrosslinked GelMA. We investigated the ability of human mononuclear cells to mount inflammatory responses in the context of a GelMA hydrogel platform. Using lipopolysaccharide to stimulate a pro-inflammatory immune response, we found tumor necrosis factor-α (TNF-α) expression was suppressed in GelMA culture conditions. Our findings have important implications on the future use of GelMA, and potentially similar hydrogels, and highlight the significance of investigating the potential immune-modulatory properties of biomaterials.

3.
Am J Health Syst Pharm ; 75(19): 1478-1485, 2018 Oct 01.
Article in English | MEDLINE | ID: mdl-30131324

ABSTRACT

PURPOSE: The evolution and expansion of a school of pharmacy-sponsored resident teaching and learning program (RTLP) are described. SUMMARY: Since its establishment in 2012, Auburn University Harrison School of Pharmacy's RTLP has grown to include up to 12 residency programs in Alabama and on the Gulf Coast of Mississippi and Florida. Program requirements include seminar attendance, teaching experiences and observations, and development of an electronic teaching portfolio. Residents are provided support and guidance from an assigned faculty mentor and from chosen teaching mentors in each teaching activity. A program satisfaction survey was developed to assess residents' reasons for RTLP participation and their views on the manageability of program requirements, the level of residency program support received, the usefulness of seminar content, and other aspects of the program. Resident feedback has been used by RTLP coordinators to modify and refine program requirements. Major changes have included a switch to alternative information delivery mechanisms, clarification of mentor roles and responsibilities, and a transition from longitudinal seminars to intensive workshop days. At the end of the 2016-17 residency year, the RTLP had hosted a total of 66 residents from 12 different residency programs, with a 93.9% retention rate and a more than 3-fold increase in total resident enrollment. CONCLUSION: Evolution of a school of pharmacy-sponsored RTLP was essential to meet the growing needs of affiliated residency programs while optimizing faculty resources.


Subject(s)
Education, Pharmacy/organization & administration , Pharmacy Residencies/organization & administration , Schools, Pharmacy/organization & administration , Certification , Communication , Curriculum , Educational Measurement , Feedback , Humans , Information Management , Learning , Mentors , Program Evaluation , Teaching
4.
J Autism Dev Disord ; 48(9): 3144-3162, 2018 Sep.
Article in English | MEDLINE | ID: mdl-29691794

ABSTRACT

The advancing social-communication and play (ASAP) intervention was designed as a classroom-based intervention, in which the educational teams serving preschool-aged children with autism spectrum disorder are trained to implement the intervention in order to improve these children's social-communication and play skills. In this 4-year, multi-site efficacy trial, classrooms were randomly assigned to ASAP or a business-as-usual control condition. A total of 78 classrooms, including 161 children, enrolled in this study. No significant group differences were found for the primary outcomes of children's social-communication and play. However, children in the ASAP group showed increased classroom engagement. Additionally, participation in ASAP seemed to have a protective effect for one indicator of teacher burnout. Implications for future research are discussed.


Subject(s)
Autism Spectrum Disorder/psychology , Autism Spectrum Disorder/therapy , Communication , Early Intervention, Educational/methods , Play and Playthings/psychology , School Teachers/psychology , Autism Spectrum Disorder/diagnosis , Child, Preschool , Cluster Analysis , Female , Humans , Male , Social Behavior , Social Communication Disorder/diagnosis , Social Communication Disorder/psychology , Social Communication Disorder/therapy , Treatment Outcome
6.
Semin Speech Lang ; 39(2): 166-177, 2018 04.
Article in English | MEDLINE | ID: mdl-29558771

ABSTRACT

Children with autism may perceive friendship in a qualitatively different manner than their neurotypical peers. Yet, these friendships have been reported as satisfying to the child with autism spectrum disorder (ASD). Although many studies have identified lower quality of friendship in ASD, reduced reciprocity, and increased loneliness and depression, perhaps it is time to take a closer look at the perspective of autistic individuals and to identify how the broader community influences development of relationships and friendship. The World Health Organization's International Classification of Functioning framework aligns well with a social model of disability lens, which states that although individuals may be challenged by their health impairment, disability is created by barriers to access, agency, and independence in society. This article discusses how clinicians might examine ways to address disability within the home, school, and community to create opportunities for relationship and friendship development, while considering the definition of friendship from multiple perspectives.


Subject(s)
Autism Spectrum Disorder/psychology , Disabled Children/psychology , Friends/psychology , Interpersonal Relations , Social Behavior , Adolescent , Autism Spectrum Disorder/complications , Child , Communication Disorders/etiology , Communication Disorders/psychology , Humans , Peer Group , Social Support
7.
Lab Chip ; 16(22): 4319-4325, 2016 11 01.
Article in English | MEDLINE | ID: mdl-27731881

ABSTRACT

Culturing cells at the air-liquid interface (ALI) is essential for creating functional in vitro models of lung tissues. We present the use of direct-patterned laser-treated hydrophobic paper as an effective semi-permeable membrane, ideal for ALI cell culture. The surface properties of the paper are modified through a selective CO2 laser-assisted treatment to create a unique porous substrate with hydrophilic regions that regulate fluid diffusion and cell attachment. To select the appropriate model, four promising hydrophobic films were compared with each other in terms of gas permeability and long-term strength in an aqueous environment (wet-strength). Among the investigated substrates, parchment paper showed the fastest rate of oxygen permeability (3 times more than conventional transwell cell culture membranes), with the least variation in its dry and wet tensile strengths (124 MPa and 58 MPa, remaining unchanged after 7 days of submersion in PBS).The final paper-based platform provides an ideal, robust, and inexpensive device for generating monolayers of lung epithelial cells on-chip in a high-throughput fashion for disease modelling and in vitro drug testing.


Subject(s)
Cell Culture Techniques/instrumentation , Paper , Respiratory Mucosa/cytology , Tissue Array Analysis/instrumentation , Humans , Lab-On-A-Chip Devices , Mechanical Phenomena , Oxygen/metabolism , Permeability , Wettability
8.
Lang Speech Hear Serv Sch ; 45(4): 261-76, 2014 Oct.
Article in English | MEDLINE | ID: mdl-25091620

ABSTRACT

PURPOSE: Speech-language pathologists (SLPs) and behavior analysts are key members of school-based teams that serve children with autism spectrum disorders (ASD). Behavior analysts approach assessment and intervention through the lens of applied behavior analysis (ABA). ABA-based interventions have been found effective for targeting skills across multiple domains for children with ASD. However, some SLPs may be unfamiliar with the breadth of ABA-based interventions. The intent of this tutorial is to briefly introduce key ABA principles, provide examples of ABA-based interventions used within schools, and identify strategies for successful collaboration between behavior analysts and SLPs. METHOD: This tutorial draws from empirical studies of ABA-based interventions for children with ASD within school settings, as well as discussions in the extant literature about the use of behavior principles by SLPs and strategies for interdisciplinary collaboration. CONCLUSION: Given the prevalence of ASD at 1 in 68 children (Centers for Disease Control and Prevention, 2014) and the high cost of serving these children within schools (an average cost of 286% over regular education; Chambers, Shkolnik, & Perez, 2003), the need for effective, comprehensive service provision and efficiency within interdisciplinary teams is paramount. Communication, mutual understanding, and recognition of common ground between SLPs and behavior analysts can lead to successful collaboration.


Subject(s)
Behavior Therapy , Child Development Disorders, Pervasive/therapy , School Health Services , Social Skills , Child , Communication , Cooperative Behavior , Humans , Learning , Schools , Speech-Language Pathology , Students , United States
9.
Pharmacotherapy ; 34(5): e38-44, 2014 May.
Article in English | MEDLINE | ID: mdl-24877188

ABSTRACT

The American College of Clinical Pharmacy 2013 Educational Affairs Committee was charged with developing recommendations for the minimum qualifications required for clinical pharmacy practice faculty in United States colleges and schools of pharmacy with respect to education, postgraduate training, board certification, and other experiences. From a review of the literature, the committee recommends that clinical pharmacy practice faculty possess the following minimum qualifications, noting that, for some positions, additional qualifications may be necessary. Clinical pharmacy practice faculty should possess the Doctor of Pharmacy degree from an Accreditation Council for Pharmacy Education­accredited institution. In addition, faculty should have completed a postgraduate year one (PGY1) residency or possess at least 3 years of direct patient care experience. Faculty who practice in identified areas of pharmacotherapy specialization, as identified by American Society of Health-System Pharmacists postgraduate year two (PGY2) residency guidelines, should have completed a PGY2 residency in that area of specialty practice. Alternatively, faculty should have completed a minimum of a PGY1 residency and 1 additional year of practice, with at least 50% of time spent in their area of specialization, which is documented in a portfolio, or 4 years of direct patient care in their area of specialization, which is documented in a portfolio. Fellowship training or a graduate degree (e.g., Ph.D.) should be required for research-intensive clinical faculty positions. All faculty should obtain structured teaching experience during or after postgraduate training, preferably through a formal teaching certificate program or through activities documented in a teaching portfolio. A baseline record of scholarship should be obtained before hire as clinical pharmacy practice faculty through exposure in postgraduate programs or previous employment. Faculty should be board certified before hire or attain board certification within 2 years of hire through the Board of Pharmacy Specialties (BPS) or, if appropriate for the practice area, through a nonBPS-certifying agency. If no certification exists in the area of specialty, the faculty member should develop a portfolio with evidence of excellence in clinical practice, teaching, and scholarship.


Subject(s)
Clinical Competence/standards , Education, Pharmacy, Graduate/standards , Pharmacists/standards , Pharmacy Service, Hospital , Specialty Boards , Pharmacy Residencies , Pharmacy Service, Hospital/standards , Societies, Pharmaceutical , United States , Workforce
10.
Brain Stimul ; 7(1): 7-12, 2014.
Article in English | MEDLINE | ID: mdl-24527502

ABSTRACT

BACKGROUND: Depressive disorders are among the most commonly experienced mental health concerns and a leading cause of mortality in adolescence. Current treatment guidelines recommend the use of antidepressant medication, cognitive behavioral therapy or both treatments. Unfortunately 40­60% of adolescents fail to respond to these treatments, therefore a new effective alternative treatment modality would be of particular benefit. rTMS is effective in addressing treatment resistant depression in adults and investigation into its effectiveness with adolescent populations has begun. OBJECTIVE: To examine the existing literature regarding the efficacy and safety of rTMS treatment with adolescents experiencing depressive symptoms, especially research conducted since the last published review. METHODS: A systematic review was conducted in accordance with PRISMA guidelines. The databases of OVID PsycINFO, PubMed, Ovid Medline and Web of Science were searched for research utilizing rTMS treatment with adolescents experiencing depressive symptomology. RESULTS: The review identified seven studies that examined rTMS as a treatment for depressive symptomology in adolescence. Findings indicate rTMS is likely to be an effective treatment for young people with preliminary longitudinal results suggesting maintenance of effects 3 years post-treatment. Reported side effects have included headaches, scalp discomfort and single incidences of hypomania and seizure. All side effects were transitory and did not recur. CONCLUSION: Preliminary results suggest rTMS is an effective and well tolerated antidepressant treatment for adolescents with treatment resistant depressive symptomology. Further research allowing for comparison across studies is necessary to establish the efficacy of rTMS in adolescent depression.


Subject(s)
Depressive Disorder, Treatment-Resistant/therapy , Transcranial Magnetic Stimulation , Adolescent , Humans , Infant
11.
Pediatr Emerg Care ; 28(2): 109-14, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22270501

ABSTRACT

OBJECTIVES: The objective of the study was to describe analgesia utilization before and during the emergency department (ED) visit and assess factors associated with analgesia use in pediatric patients with isolated long-bone fractures. METHODS: This retrospective cohort study of patients aged 0 to 15 years with a diagnosis of an isolated long-bone fracture was conducted at a single, level I pediatric trauma center. Patients included were treated in the ED within 12 hours of injury and subsequently admitted to the hospital from January 2005 through August 2007. Pain medication received within the first hour after ED arrival was categorized based on prespecified standard doses as follows: adequate, inadequate, and no pain medication received. Cumulative logistic regression analysis assessed factors associated with analgesia use. RESULTS: There were 773 patients with isolated long-bone fracture included in the analysis. Overall, 10% of patients received adequate pain medicine; 31% received inadequate medicine; and 59% received no pain medicine within 1 hour of ED arrival. In multivariable analysis, children with younger age, longer time from injury to ED arrival, closed fractures, and upper-extremity fractures were less likely to receive adequate pain medicine during the ED visit. Of those transported by emergency medical services directly from the scene to the ED, 9 (10%) of 88 were given pain medication during transport. CONCLUSIONS: Pain management in pediatric patients following a traumatic injury has been recognized as an important component of care. This study suggests that alleviation of pain after traumatic injury requires further attention in both the prehospital and ED settings, especially among the youngest children.


Subject(s)
Acute Pain/drug therapy , Analgesics/therapeutic use , Emergencies , Emergency Service, Hospital/statistics & numerical data , Fractures, Bone/complications , Musculoskeletal Pain/drug therapy , Acute Pain/etiology , Adolescent , Child , Child, Preschool , Drug Utilization , Emergency Medical Services/statistics & numerical data , Female , Fractures, Closed/complications , Hospitalization , Humans , Infant , Male , Musculoskeletal Pain/etiology , Retrospective Studies , Risk Factors , Time Factors , Transportation of Patients
13.
J Palliat Med ; 14(2): 207-14, 2011 Feb.
Article in English | MEDLINE | ID: mdl-21281122

ABSTRACT

OBJECTIVE: We previously demonstrated that parents whose children die in a pediatric intensive care unit (PICU) have a high level of complicated grief symptoms 6 months after the death. In this study, we investigate the change in the extent of complicated grief symptoms among these parents between 6 and 18 months postdeath and identify factors predicting improvement. METHODS: One hundred thirty-eight parents of 106 children completed surveys at 6 and 18 months. Surveys included the Inventory of Complicated Grief (ICG), measures of grief avoidance, attachment, caregiving and social support, and demographics. Multivariable analysis was performed using generalized estimating equations to identify characteristics independently associated with improvement in ICG score. RESULTS: ICG scores were 33.4 ± 13.6 at 6 months and 28.0 ± 13.5 at 18 months, representing an improvement in ICG score of 5.4 + 8.0 (95% confidence interval [CI] 4.1-6.8, p < 0.001). Variables independently associated with greater improvement in ICG score included traumatic death and greater grief avoidance. Variables independently associated with less improvement included being the biological parent and having more responsive caregiving. Parents with one or two surviving children had more improvement in ICG score than those with no surviving children whereas parents with three or more surviving children had less improvement. CONCLUSION: Complicated grief symptoms decrease among parents between 6 and 18 months after their child's death in the PICU; however, high symptom levels persists for some. Better understanding of the trajectory of complicated grief will allow parents at risk for persistent distress to receive professional support.


Subject(s)
Adaptation, Psychological , Death , Grief , Intensive Care Units, Pediatric , Parents/psychology , Adult , Child , Child, Preschool , Data Collection , Female , Follow-Up Studies , Humans , Male , Middle Aged , Multivariate Analysis
14.
Biol Blood Marrow Transplant ; 17(9): 1383-8, 2011 Sep.
Article in English | MEDLINE | ID: mdl-21288495

ABSTRACT

Childhood obesity has more than tripled in the past 30 years. The prevalence of overweight and obese children has also increased in the pediatric cancer setting, causing substantial concern over proper chemotherapeutic dosing in this population. The purpose of this study was to determine if children with an increased body mass index (BMI) have an alteration in busulfan pharmacokinetics during hematopoietic stem cell transplant (HSCT) conditioning. We retrospectively reviewed data on busulfan pharmacokinetics (PK) on HSCT subjects (subjects were part of a prospective study previously reported by our group at Children's Memorial Hospital) to determine appropriateness of dosing. Subjects were divided into appropriate BMI categories (<25th percentile, 25th-85th percentile, ≥ 85th percentile) and busulfan PK dosing was analyzed (test dose, regimen dose, area under the curve [AUC], and clearance). The dosing based on PK test dose data of children with BMI ≥ 85% was compared against the package insert dosing recommendations of using adjusted ideal body weight (AIBW) in obese patients to determine which dosing schema was most accurate. Children with high BMIs had higher AUCs when dosing on actual weight then their normal or low BMI counterparts. This indicates that children with a high BMI require less drug (2.9 mg/kg using actual body weight) to achieve the same AUC as children with normal BMI (4.0 mg/kg) or low BMI (3.6 mg/kg). Using the recommended AIBW dosing schema, 53% of the patients with high BMIs would have had regimen dose AUCs ≥ 20% over/under the target; whereas with the PK test dose method, only 16% of the patients with high BMIs had regimen dose AUCs ≥ 20% over/under the target. PK testing continues to be the gold standard for busulfan dosing in children. Particular vigilance should be paid to PK monitoring in high BMI categories because of the potential risk of imprecise dosing when using the AIBW schema.


Subject(s)
Body Mass Index , Busulfan/administration & dosage , Drug Dosage Calculations , Hematopoietic Stem Cell Transplantation/methods , Adolescent , Area Under Curve , Busulfan/pharmacokinetics , Child , Child, Preschool , Drug Monitoring/methods , Female , Humans , Male , Myeloablative Agonists , Obesity , Retrospective Studies , Young Adult
15.
J Heart Lung Transplant ; 30(4): 395-401, 2011 Apr.
Article in English | MEDLINE | ID: mdl-21036067

ABSTRACT

BACKGROUND: Patients with congenital heart disease (CHD) now survive into adulthood and often present with end-stage heart failure (HF). HF management and approach to orthotopic heart transplant (OHT) may differ from adults without CHD. We sought to compare OHT waitlist characteristics and outcomes for these 2 groups. METHODS: The Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) database was used to identify adults (≥18 years) listed for OHT from 2005 to 2009. The cohort was divided into those with or without CHD. RESULTS: Of 9,722 adults included, 314 (3%) had CHD. Adults with CHD were younger (35 ± 13 vs 52 ± 12 years, p < 0.01) and more often had undergone prior cardiac surgery (85% vs. 34%, p < 0.01). Patients with CHD were less likely to have a defibrillator (44% vs 75%, p < 0.01) or ventricular assist device (5% vs 14%, p < 0.01) and were more likely to be listed at the lowest urgency status than patients without CHD (64% vs 44%, p < 0.01). Fewer CHD patients achieved OHT (53% vs 65%, p < 0.001). Although overall waitlist mortality did not differ between groups (10% vs 8%, p = 0.15), patients with CHD were more likely to experience cardiovascular death (60% vs 40%, p = 0.03), including sudden in 44% and due to HF in 16%. CONCLUSIONS: Despite lower urgency status, patients with CHD have greater cardiovascular mortality awaiting OHT than those without. Increased defibrillator use could improve survival to OHT, because sudden death is common. VAD support may benefit select patients, but experience in CHD is limited. Referral to specialized adult congenital heart centers can enhance utilization of device therapies and potentially improve waitlist outcomes.


Subject(s)
Heart Defects, Congenital/mortality , Heart Defects, Congenital/therapy , Heart Failure/mortality , Heart Transplantation/mortality , Adult , Defibrillators, Implantable , Female , Heart Failure/etiology , Heart-Assist Devices , Humans , Male , Middle Aged , Treatment Outcome , Waiting Lists
16.
Crit Care Med ; 39(1): 141-9, 2011 Jan.
Article in English | MEDLINE | ID: mdl-20935561

ABSTRACT

OBJECTIVES: To describe a large cohort of children with out-of-hospital cardiac arrest with return of circulation and to identify factors in the early postarrest period associated with survival. These objectives were for planning an interventional trial of therapeutic hypothermia after pediatric cardiac arrest. METHODS: A retrospective cohort study was conducted at 15 Pediatric Emergency Care Applied Research Network clinical sites over an 18-month study period. All children from 1 day (24 hrs) to 18 yrs of age with out-of-hospital cardiac arrest and a history of at least 1 min of chest compressions with return of circulation for at least 20 mins were eligible. MEASUREMENTS AND MAIN RESULTS: One hundred thirty-eight cases met study entry criteria; the overall mortality was 62% (85 of 138 cases). The event characteristics associated with increased survival were as follows: weekend arrests, cardiopulmonary resuscitation not ongoing at hospital arrival, arrest rhythm not asystole, no atropine or NaHCO3, fewer epinephrine doses, shorter duration of cardiopulmonary resuscitation, and drowning or asphyxial arrest event. For the 0- to 12-hr postarrest return-of-circulation period, absence of any vasopressor or inotropic agent (dopamine, epinephrine) use, higher lowest temperature recorded, greater lowest pH, lower lactate, lower maximum glucose, and normal pupillary responses were all associated with survival. A multivariate logistic model of variables available at the time of arrest, which controlled for gender, age, race, and asystole or ventricular fibrillation/ventricular tachycardia anytime during the arrest, found the administration of atropine and epinephrine to be associated with mortality. A second model using additional information available up to 12 hrs after return of circulation found 1) preexisting lung or airway disease; 2) an etiology of arrest drowning or asphyxia; 3) higher pH, and 4) bilateral reactive pupils to be associated with lower mortality. Receiving more than three doses of epinephrine was associated with poor outcome in 96% (44 of 46) of cases. CONCLUSIONS: Multiple factors were identified as associated with survival after out-of-hospital pediatric cardiac arrest with the return of circulation. Additional information available within a few hours after the return of circulation may diminish outcome associations of factors available at earlier times in regression models. These factors should be considered in the design of future interventional trials aimed to improve outcome after pediatric cardiac arrest.


Subject(s)
Cardiopulmonary Resuscitation/methods , Hemodynamics/physiology , Hospital Mortality , Out-of-Hospital Cardiac Arrest/mortality , Out-of-Hospital Cardiac Arrest/therapy , Adolescent , Age Factors , Blood Circulation/physiology , Cardiopulmonary Resuscitation/mortality , Child , Child, Preschool , Cohort Studies , Critical Care/methods , Emergency Medical Services , Female , Humans , Infant , Infant, Newborn , Intensive Care Units, Pediatric , Male , Out-of-Hospital Cardiac Arrest/diagnosis , Pediatrics , Prognosis , Recovery of Function , Retrospective Studies , Risk Assessment , Sex Factors , Survival Analysis , Treatment Outcome
17.
Pediatr Crit Care Med ; 12(5): 525-31, 2011 Sep.
Article in English | MEDLINE | ID: mdl-21057361

ABSTRACT

OBJECTIVES: Ascertainment of adrenal function assessing free rather that total cortisol may be beneficial for the diagnosis of critical illness-related cortisol insufficiency. We hypothesized that centrifugal ultrafiltration would provide timely free cortisol data that highly correlated with the gold standard, but logistically cumbersome, equilibrium dialysis technique when the free cortisol fractions were identically quantified by chemiluminescence immunoassay. We also hypothesized that free cortisol would correlate with illness severity in a large cohort of critically ill children. DESIGN: Prospective, multi-institutional, observational cohort investigation. SETTING: Seven pediatric intensive care units within the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. PATIENTS: One hundred sixty-five critically ill children across the spectrum of illness severity. INTERVENTIONS: Blood sampling. MEASUREMENTS AND MAIN RESULTS: Time to derive plasma free cortisol concentrations after centrifugal ultrafiltration or equilibrium dialysis fractionation with chemiluminescence immunoassay was approximately 2 vs. approximately 24 hrs, respectively. Using centrifugal ultrafiltration, mean plasma free cortisol was 4.1 ± 6.7 µg/dL (median, 1.6 µg/dL; range, 0.2-43.6 µg/L), representing an average of 15.2 ± 9.4% of total cortisol. Nearly 60% of subjects exhibited free cortisol <2 and 30% <0.8 µg/dL, previously suggested threshold concentrations for defining critical illness-related cortisol insufficiency. Plasma-free cortisol concentrations comparing centrifugal ultrafiltration vs. equilibrium dialysis fractionation demonstrated a strong correlation (R2 = 0.97). For free cortisol <2 µg/dL, Bland-Altman analysis revealed minimal negative bias for the centrifugal ultrafiltration technique. Illness severity assessed by Pediatric Risk of Mortality III correlated moderately with free cortisol and percent total cortisol as free cortisol. CONCLUSIONS: Determination of centrifugal ultrafiltration fractionated free cortisol was fast and results correlated highly with equilibrium dialysis fractionated free cortisol. Many children exhibited free cortisol <2 and <0.8 µg/dL but did not demonstrate clinical evidence of critical illness-related cortisol insufficiency. This study ascertains that real-time free cortisol quantification is feasible to potentially help guide clinical decision-making for cortisol replacement therapy in the pediatric intensive care unit.


Subject(s)
Critical Illness , Hydrocortisone/blood , Ultrafiltration/methods , Adolescent , Centrifugation , Child , Child, Preschool , Cohort Studies , Female , Humans , Infant , Male , Prospective Studies , Severity of Illness Index , United States , Young Adult
18.
Arch Pediatr Adolesc Med ; 164(11): 1045-51, 2010 Nov.
Article in English | MEDLINE | ID: mdl-21041597

ABSTRACT

OBJECTIVE: To investigate the extent of complicated grief symptoms and associated risk factors among parents whose child died in a pediatric intensive care unit. DESIGN: Cross-sectional survey conducted by mail and telephone. SETTING: Seven children's hospitals affiliated with the Collaborative Pediatric Critical Care Research Network from January 1, 2006, to June 30, 2008. PARTICIPANTS: Two hundred sixty-one parents from 872 families whose child died in a pediatric intensive care unit 6 months earlier. MAIN EXPOSURE: Assessment of potential risk factors, including demographic and clinical variables, and parent psychosocial characteristics, such as attachment style, caregiving style, grief avoidance, and social support. MAIN OUTCOME MEASURE: Parent report of complicated grief symptoms using the Inventory of Complicated Grief. Total scale range is from 0 to 76; scores of 30 or higher suggest complicated grief. RESULTS: Mean (SD) Inventory of Complicated Grief scores among parents were 33.7 (14.1). Fifty-nine percent of parents (95% confidence interval, 53%-65%) had scores of 30 or higher. Variables independently associated with higher symptom scores in multivariable analysis included being the biological mother or female guardian, trauma as the cause of death, greater attachment-related anxiety and attachment-related avoidance, and greater grief avoidance. CONCLUSIONS: Parents who responded to our survey experienced a high level of complicated grief symptoms 6 months after their child's death in the pediatric intensive care unit. However, our estimate of the extent of complicated grief symptoms may be biased because of a high number of nonresponders. Better understanding of complicated grief and its risk factors among parents will allow those most vulnerable to receive professional bereavement support.


Subject(s)
Grief , Intensive Care Units, Pediatric , Parents/psychology , Adult , Child , Cross-Sectional Studies , Female , Humans , Male , Psychiatric Status Rating Scales , Regression Analysis , Risk Factors , Social Support , United States
19.
J Am Pharm Assoc (2003) ; 50(4): 485-9, 2010.
Article in English | MEDLINE | ID: mdl-20621866

ABSTRACT

OBJECTIVE: To assess patient knowledge regarding acetaminophen dosing, toxicity, and recognition of acetaminophen-containing products. DESIGN: Descriptive, nonexperimental, cross-sectional study. SETTING: Alabama, January 2007 to February 2008. PATIENTS: 284 patients at four outpatient medical facilities. INTERVENTION: 12-item investigator-administered questionnaire. MAIN OUTCOME MEASURES: Degree of patient knowledge regarding acetaminophen safety, dosing recommendations, toxicity, alternative names and abbreviations, and products. RESULTS: Two-thirds of the 284 patients completing the survey reported current or recent use of pain, cold, or allergy medication. Of these, 25% reported knowing the active ingredient. Of patients, 46% and 13% knew that "acetaminophen" and "APAP," respectively, were synonymous with "Tylenol." Several patients (12%) believed that ingesting a harmful amount of acetaminophen was difficult or impossible. One-third of patients correctly identified the maximum daily dose, 10% reported a dose greater than 4 g, 25% were unsure of the dose, and 7% were unsure whether a maximum dose existed. One-half recognized liver damage as the primary toxicity. Results were similar between acetaminophen users and nonusers. CONCLUSION: Deficiencies were found in patient knowledge regarding acetaminophen recognition, dosing, and potential for toxicity. The development of effective educational initiatives is warranted to ensure patient awareness and limit the potential for acetaminophen overdose.


Subject(s)
Acetaminophen/administration & dosage , Acetaminophen/adverse effects , Analgesics, Non-Narcotic/administration & dosage , Analgesics, Non-Narcotic/adverse effects , Drug Labeling , Health Knowledge, Attitudes, Practice , Adult , Aged , Aged, 80 and over , Alabama , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Patient Education as Topic , Surveys and Questionnaires , Young Adult
20.
Accid Anal Prev ; 42(2): 445-51, 2010 Mar.
Article in English | MEDLINE | ID: mdl-20159065

ABSTRACT

This study compared violent death information reported in state-wide newspaper articles to the medical examiner reports collected for a state public health surveillance system-the National Violent Death Reporting System (NVDRS). While suicides accounted for 83% of deaths in the NVDRS database, more than three-quarters (79%) of violent deaths reported in newspaper articles were homicides. The majority of the suicide incidents were reported in 1-2 newspaper articles whereas the majority of homicide incidents were reported in 11-34 articles. For suicide incidents, the NVDRS reported more circumstances related to mental health problems while newspaper articles reported recent crisis more often. Results show that there is a mismatch in both frequency and type of information reported between a public health surveillance system (NVDRS) and newspaper reporting of violent deaths. As a result of these findings, scientists and other public health professionals may want to engage in media advocacy to provide newspaper reporters with timely and important health information related to the prevention and intervention of violent deaths in their community.


Subject(s)
Coroners and Medical Examiners , Homicide/statistics & numerical data , Newspapers as Topic/statistics & numerical data , Population Surveillance , Suicide/statistics & numerical data , Violence/statistics & numerical data , Cause of Death , Centers for Disease Control and Prevention, U.S./statistics & numerical data , Humans , Incidence , United States , Utah/epidemiology
SELECTION OF CITATIONS
SEARCH DETAIL
...