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  • Online Resource  (3)
  • SAGE Publications  (3)
  • 1
    Online Resource
    Online Resource
    Congenital Diaphragmatic Hernia Repair at the Bedside or Operating Theater
    SAGE Publications ; 2022
    In:  The American Surgeon Vol. 88, No. 8 ( 2022-08), p. 1814-1821
    Details
    In: The American Surgeon, SAGE Publications, Vol. 88, No. 8 ( 2022-08), p. 1814-1821
    Abstract: For critically ill congenital diaphragmatic hernia (CDH) patients on high frequency oscillatory ventilation (HFOV), extracorporeal membrane oxygenation (ECMO), and/or inhaled nitric oxide (iNO), operative repair in the neonatal intensive care unit (NICU) has been proposed to avoid complications during transport to an operating room (OR). This study compared neonates with CDH who received herniorrhaphy in the NICU or OR, with a subgroup analysis considering only patients supported with ECMO. Methods Patients admitted to the NICU in the first 2 weeks of life at a free-standing children’s hospital between July 2004 and September 2021 were examined. Patients were categorized according to location of CDH repair, and impact on operative complications and survival was compared. Results 185 patients were admitted to the NICU with posterolateral CDH and received operative repair. 48 cases were operated on at the bedside in the NICU and 137 in the OR. Patients repaired in the NICU had higher use of HFOV, pulmonary vasodilators, and ECMO (all P 〈 .001). Children repaired in the NICU experienced significantly higher in-hospital death and overall mortality ( P 〈 .001). However, in multivariate analysis, repair location was not a significant predictor of survival to discharge in patients receiving ECMO. No significant difference in surgical site infection was detected for operative location ( P = .773). Discussion Congenital diaphragmatic hernia repair in the NICU occurred more frequently among higher risk patients who experienced worse survival. The rate of surgical site infection appeared similar overall and across subgroups suggesting adequate sterility and technique for bedside procedures, when necessary, despite restricted access to advanced operative equipment.
    Type of Medium: Online Resource
    ISSN: 0003-1348 , 1555-9823
    URL: Article
    DOI: 10.1177/00031348221084941
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
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    Online Resource
  • 2
    Online Resource
    Online Resource
    The Developing Balance of Thrombosis and Hemorrhage in Pediatric Surgery: Clinical Implications of Age-Related Changes in Hemostasis
    SAGE Publications ; 2020
    In:  Clinical and Applied Thrombosis/Hemostasis Vol. 26 ( 2020-01-01), p. 107602962092909-
    Details
    In: Clinical and Applied Thrombosis/Hemostasis, SAGE Publications, Vol. 26 ( 2020-01-01), p. 107602962092909-
    Abstract: Bleeding and thrombosis in critically ill infants and children is a vexing clinical problem. Despite the relatively low incidence of bleeding and thrombosis in the overall pediatric population relative to adults, these critically ill children face unique challenges to hemostasis due to extreme physiologic derangements, exposure of blood to foreign surfaces and membranes, and major vascular endothelial injury or disruption. Caring for pediatric patients on extracorporeal support, recovering from solid organ transplant or invasive surgery, and after major trauma is often complicated by major bleeding or clotting events. As our ability to care for the youngest and sickest of these children increases, the gaps in our understanding of the clinical implications of developmental hemostasis have become increasingly important. We review the current understanding of the development and function of the hemostatic system, including the complex and overlapping interactions of coagulation proteins, platelets, fibrinolysis, and immune mediators from the neonatal period through early childhood and to young adulthood. We then examine scenarios in which our ability to effectively measure and treat coagulation derangements in pediatric patients is limited. In these clinical situations, adult therapies are often extrapolated for use in children without taking age-related differences in pediatric hemostasis into account, leaving clinicians confused and impacting patient outcomes. We discuss the limitations of current coagulation testing in pediatric patients before turning to emerging ideas in the measurement and management of pediatric bleeding and thrombosis. Finally, we highlight opportunities for future research which take into account this developing balance of bleeding and thrombosis in our youngest patients.
    Type of Medium: Online Resource
    ISSN: 1076-0296 , 1938-2723
    URL: Article
    DOI: 10.1177/1076029620929092
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2230591-9
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  • 3
    Online Resource
    Online Resource
    Virtual research visits and direct-to-consumer genetic testing in Parkinson’s disease
    SAGE Publications ; 2015
    In:  DIGITAL HEALTH Vol. 1 ( 2015-01), p. 205520761559299-
    Details
    In: DIGITAL HEALTH, SAGE Publications, Vol. 1 ( 2015-01), p. 205520761559299-
    Abstract: The purpose of this study was to conduct a proof-of-concept study to evaluate remote recruitment and assessment of individuals (“virtual research visits”) with Parkinson's disease who have pursued direct-to-consumer genetic testing. Methods Participants in 23andMe’s “Parkinson’s Research Community” were contacted by 23andMe. Fifty willing participants living in 23 states underwent a remote, standardized assessment including cognitive and motor tests by a neurologist via video conferencing and then completed a survey. Primary outcomes assessed were (a) proportion of participants who completed the remote assessments; (b) level of agreement (using Cohen’s kappa coefficient) of patient-reported data with that of a neurologist; and (c) interest in future virtual research visits. Results The self-reported diagnosis of Parkinson’s disease was confirmed in all cases ( k = 1.00). The level of agreement for age of symptom onset ( k = 0.97) and family history ( k = 0.85) was very good but worse for falling ( k = 0.59), tremor ( k = 0.56), light-headedness ( k = 0.31), and urine control ( k = 0.15). Thirty-eight (76%) of the 50 participants completed a post-assessment survey, and 87% of respondents said they would be more or much more willing to participate in future clinical trials if they could do research visits remotely. Conclusion Remote clinical assessments of individuals with known genotypes were conducted nationally and rapidly from a single site, confirmed self-reported diagnosis, and were received favorably. Direct-to-consumer genetic testing and virtual research visits together may enable characterization of genotype and phenotype for geographically diverse populations.
    Type of Medium: Online Resource
    ISSN: 2055-2076 , 2055-2076
    URL: Article
    DOI: 10.1177/2055207615592998
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
    detail.hit.zdb_id: 2819396-9
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