Adherence to Endotracheal Tube Depth Guidelines and Incidence of Malposition in Infants and Children.
Female; Humans; pediatrics; Male; Ohio; Random Allocation; Incidence; Chi-Square Distribution; Child; Guideline Adherence/*statistics & numerical data; Infant; intubation; Medical Errors/*statistics & numerical data; NRP; PALS; Radiography/*statistics & numerical data; Trachea/diagnostic imaging; tracheal tube malposition; United States; Odds Ratio; Intensive Care Units; Hospitals; Guideline Adherence; Radiography; Intubation; ROC Curve; Confidence Intervals; Inpatients; Human; Chi Square Test; Descriptive Statistics; P-Value; Data Analysis Software; Practice Guidelines; Retrospective Design; Preschool; Thoracic; Intratracheal/adverse effects/standards/*statistics & numerical data; Intratracheal – Standards – United States; Pediatric – Ohio
BACKGROUND: Adherence to guidelines for endotracheal tube (ETT) insertion depth may not be sufficient to prevent malposition or harm to the patient. To obtain an estimate of ETT malpositioning, we evaluated initial postintubation chest radiographs and hypothesized that many ETTs in multiple intubation settings would be malpositioned despite adherence to Pediatric Advanced Life Support and Neonatal Resuscitation Program guidelines. METHODS: In a random subset (randomization table) of 2,000 initial chest radiographs obtained from January 1, 2009, to May 5, 2012, we recorded height, weight, age, sex, ETT inner diameter, and cm marking at the lip from the electronic health record. Chest radiographs of poor quality and with spinal or skeletal deformities were excluded. We defined adherence to Pediatric Advanced Life Support or Neonatal Resuscitation Program guidelines as the difference between predicted and actual ETT markings at the lip as +/- 0.25, +/- 0.50, or +/- 1.0 cm for ETTs of 2.5-4, 4.5-6.0, or \textgreater6.5 mm inner diameter, respectively. We defined the proper position as the ETT tip being below the thoracic inlet (superior border of the clavicular heads) and \textgreater/=1 cm above the carina. Descriptive statistics reported demographics, guideline adherence, and malposition incidence. The chi-square test was used to assess relationships among intubation setting, malposition, and depth guideline adherence (P \textless .05, significant). RESULTS: We reviewed 507 records, 477 of which met inclusion criteria and had sufficient data for analysis. Fifty-six percent of the subjects were male, with median (interquartile range) age 15.2 (3.4-59.4) months, and 330 ETTs (69%) were malpositioned: 39 above the thoracic inlet, and 291 \textless 1 cm above the carina. Of 79 ETTS (17%) that adhered to depth guidelines, 56 (74%) were malpositioned. Three-hundred seventy-three ETTs (83%) did not meet guidelines. Two-hundred sixty-four (68%) were malpositioned. The intubation setting did not influence malposition or guideline adherence (P = .54). CONCLUSIONS: In infants and children, a high proportion of ETTs were malpositioned on the first postintubation chest radiograph, with little influence of guideline adherence.
Volsko Teresa A; McNinch Neil L; Prough Donald S; Bigham Michael T
Respiratory Care
2018
2018-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.4187/respcare.06024" target="_blank" rel="noreferrer noopener">10.4187/respcare.06024</a>
Factors affecting missed appointment rates for pediatric patients insured by medicaid in a traditional hospital-based resident clinic and hospital-owned practice settings.
*Appointments and Schedules; *Medicaid; *Pediatrics; Chi-Square Distribution; Continuity of Patient Care; Hospitals; Humans; Office Visits/*statistics & numerical data; Pediatric/*statistics & numerical data; United States
Missed appointment rates (MAR) of pediatric patients insured by Medicaid and seen in a traditional hospital-based continuity (teaching) clinic were compared to the rates for the same patients after their care had been transitioned to a community practice. The hypothesis is that when rewarded with shorter waiting times, a less chaotic environment, and more pediatrician continuity, the MAR for patients insured by Medicaid would be lower in the practice setting than it had been in continuity clinic. The MAR decreased from 33% in the continuity clinic in 1999 to 18% in the community practice in 2001 (p\textless0.01). It was also hypothesized that the MAR for patients insured by Medicaid would be higher in practices with a higher percentage of Medicaid appointments. Among 15 hospital-owned pediatric practices, the MAR for patients insured by Medicaid was positively correlated with the percentage of total appointments that were made by patients insured by Medicaid (correlation coefficient 0.706 [p\textless0.01]).
Specht Elizabeth M; Powell Keith R; Dormo Cynthia A
Clinical pediatrics
2004
2004-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/000992280404300810" target="_blank" rel="noreferrer noopener">10.1177/000992280404300810</a>
The effect of race on outcomes of surgical or nonsurgical treatment of patients in the Spine Patient Outcomes Research Trial (SPORT).
Adult; African Americans/statistics & numerical data; Aged; Chi-Square Distribution; Disability Evaluation; European Continental Ancestry Group/statistics & numerical data; Female; Humans; Male; Middle Aged; Outcome Assessment (Health Care)/*statistics & numerical data; Randomized Controlled Trials as Topic; Recovery of Function; Retrospective Studies; Spinal Diseases/*ethnology/*surgery/therapy; Spine/pathology/physiopathology/*surgery; Surveys and Questionnaires
STUDY DESIGN: Retrospective review of the data collected prospectively through the Spine Patient Outcomes Research Trial (SPORT). OBJECTIVE: To determine the effect that race or ethnicity had on outcomes after spine surgery in the 3 arms of SPORT. SUMMARY OF BACKGROUND DATA: There is a dearth of research regarding the effect of race or ethnicity on outcome after treatment of spinal disorders. METHODS: All participants from the 3 arms of the SPORT were evaluated in an as-treated analysis, with patients categorized as white, black, or other. Baseline and operative characteristics of the groups were compared using the chi test and analysis of variance. Differences in the changes between baseline and
Schoenfeld Andrew J; Lurie Jon D; Zhao Wenyan; Bono Christopher M
Spine
2012
2012-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/BRS.0b013e318251cc78" target="_blank" rel="noreferrer noopener">10.1097/BRS.0b013e318251cc78</a>
Single versus multiple fractions of repeat radiation for painful bone metastases: a randomised, controlled, non-inferiority trial.
*Dose Fractionation; *Radiotherapy; Aged; Analgesics – Therapeutic Use; Analgesics/therapeutic use; Australia; Bone Neoplasms; Bone Neoplasms – Complications; Bone Neoplasms – Radiotherapy; Bone Neoplasms/complications/*radiotherapy/*secondary; Brief Pain Inventory; Canada; Cauda Equina; Chi Square Test; Chi-Square Distribution; Clinical Assessment Tools; Clinical Trials; Computer-Assisted; Computer-Assisted – Adverse Effects; Computer-Assisted/adverse effects; Europe; Female; Fractures; Funding Source; Human; Humans; Intention to Treat Analysis; Israel; Logistic Models; Logistic Regression; Male; Middle Age; Middle Aged; New Zealand; Odds Ratio; Pain – Diagnosis; Pain – Drug Therapy; Pain – Etiology; Pain – Radiotherapy; Pain Measurement; Pain/diagnosis/drug therapy/*etiology/*radiotherapy; Questionnaires; Radiation; Radiation Dosage; Radiotherapy; Radiotherapy Planning; Risk Factors; Scales; Spinal Cord Compression – Etiology; Spinal Cord Compression/etiology; Spontaneous – Etiology; Spontaneous/etiology; Surveys and Questionnaires; Time Factors; Treatment Outcome; Treatment Outcomes
BACKGROUND: Although repeat radiation treatment has been shown to palliate pain in patients with bone metastases from multiple primary origin sites, data for the best possible dose fractionation schedules are lacking. We aimed to assess two dose fractionation schedules in patients with painful bone metastases needing repeat radiation therapy. METHODS: We did a multicentre, non-blinded, randomised, controlled trial in nine countries worldwide. We enrolled patients 18 years or older who had radiologically confirmed, painful (ie, pain measured as \textgreater/=2 points using the Brief Pain Inventory) bone metastases, had received previous radiation therapy, and were taking a stable dose and schedule of pain-relieving drugs (if prescribed). Patients were randomly assigned (1:1) to receive either 8 Gy in a single fraction or 20 Gy in multiple fractions by a central computer-generated allocation sequence using dynamic minimisation to conceal assignment, stratified by previous radiation fraction schedule, response to initial radiation, and treatment centre. Patients, caregivers, and investigators were not masked to treatment allocation. The primary endpoint was overall pain response at 2 months, which was defined as the sum of complete and partial pain responses to treatment, assessed using both Brief Pain Inventory scores and changes in analgesic consumption. Analysis was done by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00080912. FINDINGS: Between Jan 7, 2004, and May 24, 2012, we randomly assigned 425 patients to each treatment group. 19 (4%) patients in the 8 Gy group and 12 (3%) in the 20 Gy group were found to be ineligible after randomisation, and 140 (33%) and 132 (31%) patients, respectively, were not assessable at 2 months and were counted as missing data in the intention-to-treat analysis. In the intention-to-treat population, 118 (28%) patients allocated to 8 Gy treatment and 135 (32%) allocated to 20 Gy treatment had an overall pain response to treatment (p=0.21; response difference of 4.00% [upper limit of the 95% CI 9.2, less than the prespecified non-inferiority margin of 10%]). In the per-protocol population, 116 (45%) of 258 patients and 134 (51%) of 263 patients, respectively, had an overall pain response to treatment (p=0.17; response difference 6.00% [upper limit of the 95% CI 13.2, greater than the prespecified non-inferiority margin of 10%]). The most frequently reported acute radiation-related toxicities at 14 days were lack of appetite (201 [56%] of 358 assessable patients who received 8 Gy vs 229 [66%] of 349 assessable patients who received 20 Gy; p=0.011) and diarrhoea (81 [23%] of 357 vs 108 [31%] of 349; p=0.018). Pathological fractures occurred in 30 (7%) of 425 patients assigned to 8 Gy and 20 (5%) of 425 assigned to 20 Gy (odds ratio [OR] 1.54, 95% CI 0.85-2.75; p=0.15), and spinal cord or cauda equina compressions were reported in seven (2%) of 425 versus two (\textless1%) of 425, respectively (OR 3.54, 95% CI 0.73-17.15; p=0.094). INTERPRETATION: In patients with painful bone metastases requiring repeat radiation therapy, treatment with 8 Gy in a single fraction seems to be non-inferior and less toxic than 20 Gy in multiple fractions; however, as findings were not robust in a per-protocol analysis, trade-offs between efficacy and toxicity might exist. FUNDING: Canadian Cancer Society Research Institute, US National Cancer Institute, Cancer Council Australia, Royal Adelaide Hospital, Dutch Cancer Society, and Assistance Publique-Hopitaux de Paris.
Chow Edward; van der Linden Yvette M; Roos Daniel; Hartsell William F; Hoskin Peter; Wu Jackson S Y; Brundage Michael D; Nabid Abdenour; Tissing-Tan Caroline J A; Oei Bing; Babington Scott; Demas William F; Wilson Carolyn F; Meyer Ralph M; Chen Bingshu E; Wong Rebecca K S
The Lancet. Oncology
2014
2014-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/S1470-2045(13)70556-4" target="_blank" rel="noreferrer noopener">10.1016/S1470-2045(13)70556-4</a>
Low thigh muscle mass is associated with coronary artery stenosis among
*Computed Tomography Angiography; *Tomography; Aged; Atherosclerotic; Body Composition; Chi-Square Distribution; Coronary Angiography/*methods; Coronary Artery Disease/*diagnostic imaging/epidemiology/pathology; Coronary artery stenosis; Coronary atherosclerosis; Coronary Stenosis/*diagnostic imaging/epidemiology/pathology; Coronary Vessels/*diagnostic imaging/pathology; Cross-Sectional Studies; HIV Infections/diagnosis/*epidemiology; HIV-infection; Humans; Male; Middle Aged; Multivariate Analysis; Muscle; Muscle mass; Odds Ratio; Plaque; Predictive Value of Tests; Prevalence; Prospective Studies; Risk Factors; Sarcopenia; Sarcopenia/*diagnostic imaging/epidemiology/physiopathology; Skeletal/*diagnostic imaging/physiopathology; Thigh; United States/epidemiology; X-Ray Computed
BACKGROUND: HIV-infected individuals are at increased risk for both sarcopenia and cardiovascular disease. Whether an association between low muscle mass and subclinical coronary artery disease (CAD) exists, and if it is modified by HIV serostatus, are unknown. METHODS: We performed cross-sectional analysis of 513 male MACS participants (72% HIV-infected) who underwent mid-thigh computed tomography (CT) and non-contrast cardiac CT for coronary artery calcium (CAC) during 2010-2013. Of these, 379 also underwent coronary CT angiography for non-calcified coronary plaque (NCP) and obstructive coronary stenosis \textgreater/=50%. Multivariable-adjusted Poisson regression was used to estimate prevalence risk ratios of associations between low muscle mass (\textless20th percentile of the
Tibuakuu Martin; Zhao Di; Saxena Ankita; Brown Todd T; Jacobson Lisa P; Palella Frank J Jr; Witt Mallory D; Koletar Susan L; Margolick Joseph B; Guallar Eliseo; Korada Sai Krishna C; Budoff Matthew J; Post Wendy S; Michos Erin D
Journal of cardiovascular computed tomography
2018
2018-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jcct.2018.01.007" target="_blank" rel="noreferrer noopener">10.1016/j.jcct.2018.01.007</a>