694 results on '"O'Brien, Sarah H"'
Search Results
202. Treatment of Acute Childhood Idiopathic Thrombocytopenic Purpura (ITP): A Cost-Utility Analysis.
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O’Brien, Sarah H., primary, Ritchey, A. Kim, primary, and Smith, Kenneth J., primary
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- 2005
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- View/download PDF
203. Contraception-Related Venous Thromboembolism in Adolescents.
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O'Brien, Sarah H.
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THROMBOEMBOLISM , *CONTRACEPTION , *VAGINAL rings (Contraceptives) , *CONTRACEPTIVE drugs , *VARICOSE veins , *PHYSIOLOGY - Abstract
Venous thromboembolism (VTE) is a rare but serious complication of combined hormonal contraception. While the absolute risk of VTE is low in adolescents, thrombotic events in contraception users younger than the age of 20 years account for 5 to 10% of total contraception-related VTE events in population studies, because of the high frequency of contraception use in adolescents. An increased risk of VTE exists not only with oral contraceptives, but also the contraceptive patch and vaginal ring. Most adolescents who experience contraception-related VTE have additional transient or inherited thrombotic risk factors at the time of VTE. Although the presence of inherited thrombophilia impacts the risk of contraception-related VTE, thrombophilia screening before contraception prescribing should be targeted only to high-risk populations. Pediatric institutions, caregivers, and young women need to be aware of the risk of VTE with estrogen-containing contraception, and maintain a high index of suspicion for this complication in women using these agents. [ABSTRACT FROM AUTHOR]
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- 2014
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204. Pharmacokinetics and pharmacodynamics of anticoagulants in paediatric patients.
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Yee, Donald L, O'Brien, Sarah H, and Young, Guy
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Given the rising incidence of thrombotic complications in paediatric patients, understanding of the pharmacologic behaviour of anticoagulant drugs in children has gained importance. Significant developmental differences between children and adults in the haemostatic system and pharmacologic parameters for individual drugs highlight potentially unique aspects of anticoagulant pharmacology in this special and vulnerable population. This review focuses on pharmacologic information relevant to the dosing of unfractionated heparin, low molecular weight heparin, warfarin, bivalirudin, argatroban and fondaparinux in paediatric patients. The bulk of clinical experience with paediatric anticoagulation rests with the first three of these agents, each of which requires higher bodyweight-based dosing for the youngest patients, compared with adults, in order to achieve comparable pharmacodynamic effects, likely related to an inverse correlation between age and bodyweight-normalized clearance of these drugs. Whether extrapolation of therapeutic ranges targeted for adult patients prescribed these agents is valid for children, however, is unknown and a high priority for future research. Novel oral anticoagulants, such as dabigatran, rivaroxaban and apixaban, hold promise for future use in paediatrics but require further pharmacologic study in infants, children and adolescents. [ABSTRACT FROM AUTHOR]
- Published
- 2013
205. Contributors
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Abrahm, Janet L., Abrams, Charles S., Abrams, Donald I., Ackerman, Steven J., Adams, Sharon, Adewoye, Adeboye H., Allen, Carl, Ambinder, Richard F., Anasetti, Claudio, Anastasi, John, Anderson, Julia A., Andreeff, Michael, Antin, Joseph H., Antony, Aśok C., Apostolakis, Stavros, Armstrong, Scott A., Arnold, Donald M., Artz, Andrew S., Awan, Farrukh T., Banchereau, Jacques, Barker, Juliet N., Baum, Linda G., Benson, Don M., Jr., Benz, Edward J., Jr., Berliner, Nancy, Bhagat, Govind, Bhalla, Kapil N., Bhardwaj, Nina, Bhatia, Ravi, Bhatia, Smita, Blinderman, Craig D., Bollard, Catherine M., Brenner, Malcolm K., Brittenham, Gary M., Brodsky, Robert A., Broxmeyer, Hal E., Brummel-Ziedins, Kathleen, Buadi, Francis K., Butterfield, Joseph H., Byrd, John C., Caimi, Paolo F., Caligiuri, Michael A., Campagnaro, Erica, Canaani, Jonathan, Canavan, Michelle, Cantor, Alan B., Carcao, Manuel, Carroll, Michael C., Carty, Shannon A., Champlin, Richard E., Chan, Anthony K.C., Choate, Jacquelyn D., Chung, Peter, Chute, John P., Cines, Douglas B., Clark, David B., Coates, Thomas D., Cogle, Christopher R., Connell, Nathan T., Cooke, Elizabeth, Cooley, Sarah, Corradini, Paolo, Creager, Mark A., Creger, Richard J., Cromwell, Caroline, Cunningham, Regina S., Cushing, Melissa M., Cutler, Corey, Dahl, Gary V., Dang, Chi V., Danial, Nika N., Dave, Sandeep S., DeAngelo, Daniel J., Desai, Madhav V., Dey, Bimalangshu R., Diehl, Volker, Dinauer, Mary C., Diz-Küçükkaya, Reyhan, Donato, Michele L., Dorshkind, Kenneth, Dotti, Gianpietro, Dror, Yigal, Dunleavy, Kieron, Ebert, Benjamin L., Eck, Michael J., Eichenauer, Dennis A., Eikelboom, John W., Engert, Andreas, Ershler, William B., Esmon, Charles T., Esmon, Naomi L., Evans, William E., Faderl, Stefan, Ferrara, James L.M., Filipovich, Alexandra Hult, Freedman, Melvin H., Fuller, Stephen J., Gailani, David, Gallagher, Patrick G., Gardner, Lawrence B., Gee, Adrian P., Gerson, Stanton L., Gertz, Morie A., Giardina, Patricia J., Golan, Karin, Golub, Todd R., Gottschalk, Stephen, Grant, Steven, Green, David L., Gribben, John G., Guitart, Joan, Gur-Cohen, Shiri, Gurbuxani, Sandeep, Gutierrez, Alejandro, Hari, Parameswaran, Harlan, John M., Hartwig, John H., Hayman, Suzanne R., Hayward, Catherine P.M., Hebbel, Robert P., Heslop, Helen E., Hillyer, Christopher D., Hockenbery, David M., Hoffman, Ronald, Horowitz, Mary, Horwitz, Edwin M., Hromas, Robert A., Huang, Franklin W., Isenman, David E., Italiano, Joseph E., Jr., Jaffe, Elaine S., Jagannath, Sundar, Jäger, Ulrich, Jain, Nitin, James, Paula, Jeha, Sima, Jordan, Michael B., Josephson, Cassandra, Jung, Moonjung, Kager, Leo, Kamdar, Kala Y., Kanakry, Jennifer A., Kantarjian, Hagop M., Karafin, Matthew S., Karsan, Aly, Katz, Louis M., Kaufman, Randal J., Kaufman, Richard M., Keller, Frank G., Kelly, Kara M., Kelton, John, Kessler, Craig M., Key, Nigel S., Khandoga, Alexander G., Khanna-Gupta, Arati, Klein, Harvey G., Kollet, Orit, Konkle, Barbara A., Kontoyiannis, Dimitrios P., Koreth, John, Koretzky, Gary A., Kremyanskaya, Marina, Küppers, Ralf, Kuzel, Timothy M., Kwak, Larry W., Lakshmanan, Viswanathan, Landier, Wendy, Lapid, Kfir, Lapidot, Tsvee, Larson, Peter J., Lechner, Klaus, Lee, Andrea, Lee, William M.F., Levi, Marcel, Lewis, Russell E., Liebman, Howard A., Lillicrap, David, Lim, Wendy, Lin, Thomas S., Lindblad, Robert, Lip, Gregory Y.H., Little, Jane A., Loh, Mignon L., Look, A. Thomas, López, José A., Luscinskas, Francis W., Macartney, Christine A., Maciejewski, Jaroslaw P., Maitta, Robert W., Majhail, Navneet S., Manches, Olivier, Mandle, Robert, Mann, Kenneth G., Manno, Catherine S., Marchi, Enrica, Mariani, Guglielmo, Marincola, Francesco M., Marks, Peter W., Mascarenhas, John, Massberg, Steffen, Mauch, Peter M., McCorkle, Ruth, McCrae, Keith R., McEver, Rodger P., McGrath, Emer, McKinney, Matthew S., Meacham, Amy, Menitove, Jay E., Merlini, Giampaolo, Migliaccio, Anna Rita, Miller, Jeffrey S., Mims, Martha P., Mondoro, Traci Heath, Moorehead, Paul, Munshi, Nikhil C., Najfeld, Vesna, Nazi, Ishac, Neff, Anne T., Ness, Paul M., Ng, Andrea K., Notarangelo, Luigi D., O'Brien, Sarah H., O'Connor, Owen A., Donghaile, Diarmaid Ó, O'Donnell, Martin, Otis, Stavroula, Ou, Zhishuo, Pai, Sung-Yun, Palucka, Karolina, Pande, Reena L., Papayannopoulou, Thalia, Pardanani, Animesh, Paredes, Nethnapha, Patriquin, Christopher, Petersdorf, Effie W., Pittaluga, Stefania, Plow, Edward F., Ponce, Doris M., Popolo, Laura, Powell, Leland D., Price, Elizabeth A., Pui, Ching-Hon, Puigserver, Pere, Quintás-Cardama, Alfonso, Rak, Janusz, Ramos, Carlos A., Rand, Jacob H., Ravandi, Farhad, Rawlings, David J., Reddy, Pavan, Reding, Mark T., Rhee, Charles, Rice, Lawrence, Riese, Matthew J., Ritchey, Arthur Kim, Rivella, Stefano, Roberts, David J., Romaguera, Jorge E., Roman, Elizabeth, Rooney, Cliona M., Rosen, Steven T., Rosenthal, David S., Rosovsky, Rachel, Rowley, Scott D., Rydz, Natalia, Sadler, J. Evan, Sandlund, John T., Jr., Sauk, Steven, Saunthararajah, Yogen, Scadden, David, Schaefer, Kristen G., Schiffman, Fred J., Schmaier, Alvin H., Schrier, Stanley L., Schuchman, Edward H., Scullion, Bridget Fowler, Selvaggi, Kathy J., Shaheen, Montaser, Shaz, Beth H., Sheehan, Andrea M., Shelburne, Samuel A., Shlomchik, Mark J., Shurin, Susan B., Silberstein, Leslie E., Silberstein, Lev, Silverstein, Roy L., Sloan, Steven R., Smith, Franklin O., Smith, James, Snyder, Edward L., Soff, Gerald A., Spitzer, Thomas R., Steinberg, Martin H., Stock, Wendy, Stone, Richard M., Storry, Jill R., Strauss, Ronald G., Stroncek, David F., Szczepiorkowski, Zbigniew M., Tiu, Ramon V., Toltl, Lisa J., Toms, Angela, Tormey, Christopher A., Treon, Steven P., Tulpule, Anil, Vedantham, Suresh, Verneris, Michael R., Vichinsky, Elliott P., von Andrian, Ulrich H., Wagner, Andrew J., Wang, Ena, Wang, Jia-huai, Wang, Michael, Warkentin, Theodore E., Wasserstein, Melissa P., Wei, Michael C., Weinstein, Howard J., Weisdorf, Daniel J., Weitz, Jeffrey I., Westhoff, Connie M., Wiley, James S., Williams, David A., Wilson, Wyndham H., Wolfe, Joanne, Wolgast, Lucia R., Wood, Deborah, Wu, YanYun, Yee, Donald L., Young, Ken H., Young, Neal S., Zeldenrust, Steven R., Zhang, Liang, and Zhou, Ming-Ming
- Published
- 2013
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206. Development of a pediatric-specific clinical probability tool for diagnosis of venous thromboembolism: a feasibility study
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Kerlin, Bryce A., Stephens, Julie A., Hogan, Mark J., Smoyer, William E., and O'Brien, Sarah H.
- Abstract
Background:Pediatric venous thromboembolism (VTE) is an increasingly common, difficult to diagnose problem. Clinical probability tools (CPT) for adults estimate VTE likelihood, but are not available for children. We hypothesized that a pediatric-specific CPT is feasible.Methods:Radiology reports were utilized to identify children imaged for suspected VTE. Relevant signs, symptoms, and comorbidity variables, identified from published literature, were extracted from corresponding medical records. Variables associated with pediatric VTE were incorporated into a multivariate logistic regression to create a pilot CPT which was confirmed on a separate cohort.Results:A total of 389 subjects meeting inclusion criteria were identified: 91 with VTE and 298 without. Univariate analysis revealed male gender (odds ratio (OR) = 2.96; P < 0.001), asymmetric extremity (OR = 1.76; P = 0.033), central venous catheter utilization and/or dysfunction (OR = 2.51; P < 0.001), and cancer (OR = 2.35; P = 0.014) as VTE predictive variables. Documentation of an alternate diagnosis was inversely related to VTE (OR = 0.42; P = 0.004). Receiver operating characteristic analysis of the derived CPT demonstrated reasonable ability to discriminate VTE probability in the training cohort (area under the curve (AUC) = 0.73; P < 0.001) and moderate discrimination in a separate validation cohort of 149 children (AUC = 0.64; P = 0.011).Conclusion:A pediatric-specific VTE CPT is feasible, would facilitate early diagnosis, and could lead to improved outcomes.
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- 2015
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207. Length of stay and treatment-related complications are similar in pediatric and AYA patients with bone sarcoma in United States children's hospitals.
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Audino, Anthony N., Yeager, Nicholas D., Asti, Lindsey, Miao, Yongjie, and O'Brien, Sarah H.
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- 2013
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208. Pediatric venous thromboembolism in the United States: A tertiary care complication of chronic diseases.
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Setty, Bhuvana A., O'Brien, Sarah H., and Kerlin, Bryce A.
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- 2012
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209. Young adults with SCD in US children's hospitals: Are they different from adolescents?
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Dickerson, Amanda K., Klima, Jennifer, Rhodes, Melissa M., and O'Brien, Sarah H.
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- 2012
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210. In the absence of central venous catheter, risk of venous thromboembolism is low in critically injured children, adolescents, and young adults: evidence from the National Trauma Data Bank.
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O'Brien, Sarah H. and Candrilli, Sean D.
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- 2011
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211. Caregivers' perspectives on barriers to transcranial doppler screening in children with sickle-cell disease.
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Bollinger, Lindsay M., Nire, Kidan G., Rhodes, Melissa M., Chisolm, Deena J., and O'Brien, Sarah H.
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- 2011
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212. In the absence of a central venous catheter, risk of venous thromboembolism is low in critically injured children, adolescents, and young adults Evidence from the National Trauma Data Bank
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O'Brien, Sarah H. and Candrilli, Sean D.
- Abstract
To describe the incidence and risk factors of venous thromboembolism in a large sample of critical care pediatric, adolescent, and young adult trauma patients.
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- 2011
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213. Closing Knowledge Gaps Among Parents of Children with Sickle Cell Trait
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Beeman, Chase, Abrams, Mary Ann, Zajo, Kristin, Stanek, Joseph R, Martinez-Mendez, Alexandra, O'Brien, Sarah H., and Creary, Susan E
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Background
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- 2021
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214. Universal Thrombophilia Screening Not Cost-Effective for Determining Duration of Anticoagulation in Pediatric Patients.
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O'Brien, Sarah H. and Smith, Kenneth J.
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- 2007
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215. Trends in Anemia, Iron, Therapy, and Transfusion in Hospitalized Pediatric Patients with Inflammatory Bowel Disease.
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Jacobson-Kelly, Amanda E., Stanek, Joseph R., Powers, Jacquelyn M., Dotson, Jennifer L., and O'Brien, Sarah H.
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Objective: To evaluate trends in diagnosis and management of iron deficiency anemia using a large national children's hospital database in pediatric patients admitted with inflammatory bowel disease (IBD).Study Design: In this retrospective multicenter cohort study, we used the Pediatric Health Information System de-identified administrative database. Patients age <21 years with ≥2 admissions with International Classification of Disease, Ninth Revision and Tenth Revision codes for Crohn's disease or ulcerative colitis from 2012 to 2018 were included. We extracted data regarding diagnoses of anemia and/or iron deficiency, and receipt of oral iron, intravenous (IV) iron, and/or blood transfusion. Data were analyzed descriptively.Results: We identified 8007 unique patients meeting study criteria for a total of 28 260 admissions. The median age at admission was 15.4 years. A diagnosis of anemia was documented in 29.8% of admissions and iron studies were performed in 12.6%. IV iron was given in 6.3% of admissions and blood transfusions in 7.4%. The prevalence of the diagnosis of anemia among IBD admissions increased from 24.6% in 2012 to 32.4% in 2018 (P < .0001). There was a steady increase in the proportion of IBD admissions that used IV iron, from 3.5% in 2012 to 10.4% in 2018 (P < .0001), and the proportion of admissions with red cell transfusions decreased over time from 9.4% to 4.4% (P < .0001).Conclusions: Iron deficiency anemia is prevalent among pediatric patients with IBD admitted to US children's hospitals. From 2012 to 2018, there was an increase in the use of inpatient IV iron for the treatment of iron deficiency anemia and a decrease in transfusions. [ABSTRACT FROM AUTHOR]- Published
- 2020
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216. Mobile Application Measurement of Menstrual Cycle Characteristics and Their Association with Dysmenorrhea and Activity Limitation in Early Adolescents.
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Bala, Natasha S., Vesely, Sara K., Bonny, Andrea E., Chisholm, Jennifer C., Sezgin, Emre, Beeman, Chase, McCracken, Kate, and O'Brien, Sarah H.
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MENSTRUAL cycle , *MOBILE apps , *DYSMENORRHEA , *MENORRHAGIA , *MENSTRUATION - Abstract
Real-time tracking of menstrual bleeding is a barrier to research due to limitations with traditional data collection tools. This prospective cohort study utilized a mobile application (TDot app) in young adolescents aged 10-14 years to assess the relationship between heavy menstrual bleeding (HMB), dysmenorrhea, and activity limitation. Menstrual cycles were captured over six months in real-time using the Pictorial Blood loss Assessment Chart (PBAC). A median PBAC score of >100 was used to identify participants with HMB. Participants also completed a modified WaLIDD (Working ability, Location, Intensity, Days of pain, Dysmenorrhea) scale. Impact of menses on daily activities was collected for each cycle. A total of 160 participants enrolled and 100 (63%) participants with ≥3 cycles recorded in the mobile app were analyzed. HMB was noted in 41% of participants. Median modified WaLIDD score was significantly higher in participants with HMB than those without HMB (p=0.01). No significant differences were found in activity limitations between participants with and without HMB (p=0.34). Median modified WaLIDD score for participants with activity limitation was significantly higher than those without activity limitation (p=0.01). Utilizing mobile app technology, we were able to gather real-time menstrual outcome data from young adolescents on heaviness of flow, dysmenorrhea and activity limitations. While we did not find that patients with HMB were more likely to have activity limitations, we did find that those with limitations had modestly higher dysmenorrhea scores. Future studies should focus on identifying additional variables that impact activity limitation during menstruation. [ABSTRACT FROM AUTHOR]
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- 2024
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217. Treatment of Acute Childhood Idiopathic Thrombocytopenic Purpura (ITP): A Cost-Utility Analysis.
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O'Brien, Sarah H., Ritchey, A. Kim, and Smith, Kenneth J.
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- 2005
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218. Prevalence of Hand Dermatitis in Inpatient Nurses at a United States Hospital.
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Lampel, Heather P., Patel, Nisha, Boyse, Kathryn, O'Brien, Sarah H., and Zirwas, Matthew J.
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ATOPIC dermatitis ,OCCUPATIONAL dermatitis ,SKIN inflammation ,NURSES ,INTENSIVE care units ,DISEASES - Abstract
Background: Hand dermatitis is a significant problem among inpatient nurses. Accurate population-based data on the prevalence and risk factors for hand dermatitis in this group are lacking. Objective: To determine the prevalence of hand dermatitis in inpatient nurses at a US hospital. Methods: Each nursing unit in a single hospital was visited twice by a single physician. All nurses working at the time of each visit were questioned and examined. No nurses were enrolled twice. Results: Fifty-five percent (92 of 167) of the nurses had hand dermatitis. Among intensive care unit (ICU) nurses, the prevalence was 65% (35 of 54); among non-lCU nurses, the prevalence was 50% (57 of 113). In nurses with self-reported atopic dermatitis, the prevalence was 71% (12 of 17); in nurses without self-reported atopic dermatitis, it was 53% (80 of 150). Data collection on variables such as hand hygiene and glove use relied on subject recall and was considered unreliable. There was a low prevalence of atopic patients. Conclusions: Hand dermatitis affects over 50% of inpatient nurses. Hand dermatitis appears to be more common in the ICU setting and in nurses with a self-reported history of atopy. [ABSTRACT FROM AUTHOR]
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- 2007
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219. A Multidimensional Electronic Hydroxyurea Adherence Intervention for Children With Sickle Cell Disease: Single-Arm Before-After Study.
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Creary, Susan, Chisolm, Deena, Stanek, Joseph, Hankins, Jane, and O'Brien, Sarah H
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SICKLE cell anemia ,DIRECTLY observed therapy ,ELECTRONIC health records ,PATIENT compliance ,MONETARY incentives ,FETAL hemoglobin - Abstract
Background: Hydroxyurea is a disease-modifying medication for patients with sickle cell disease (SCD). Despite demonstrated efficacy, hydroxyurea nonadherence in clinical practice is common and results in worse health outcomes for nonadherent patients. Mobile Directly Observed Therapy (Mobile DOT) is a pilot-tested, electronic, multidimensional hydroxyurea adherence intervention for children with SCD. Mobile DOT includes sending daily text message reminders to patients to take hydroxyurea, patients recording and sending daily videos that capture their hydroxyurea administrations for the research team to review and track adherence, providing personalized feedback to patients about their adherence, and providing small monetary incentives to patients if they achieve high hydroxyurea adherence. Objective: This study aimed to determine if Mobile DOT increases hydroxyurea adherence in children with SCD and to explore its impact on hematologic and clinical outcomes. Methods: This was a single-arm, 6-month intervention study of patients with SCD on hydroxyurea who were aged ≤19 years and reported having access to an electronic device. Participants' hydroxyurea adherence when they received Mobile DOT was compared with their adherence 6 months before and after receiving Mobile DOT. Participants' medication possession ratio (MPR) was calculated from their pharmacy dispensing records and was used to measure adherence. Laboratory and clinical outcomes were abstracted from participants' electronic medical records. Infrequently hospitalized patients who received at least 160 days of the intervention were considered to be engaged participants. Results: Of 91 patients who were approached, 55 enrolled and 34 engaged with Mobile DOT. The median age of the engaged participants was 10 years (range 2-18.8 years), and 21 (62%, 21/34) participants were male, 28 (82%, 21/34) had hemoglobin SS SCD, and 19 (56%, 19/34) were prescribed hydroxyurea for at least a year before enrollment. With Mobile DOT, engaged participants' median MPR increased from 61.7% to 84.4% (P <.001) and significantly more (67% vs 30%; P =.002) achieved ≥80% hydroxyurea adherence compared with baseline values. Engaged participants' mean fetal hemoglobin (HgbF) levels and mean corpuscular volumes (MCV) improved significantly after 6 months of Mobile DOT (P =.04 and P =.001, respectively), but their adherence, HgbF levels, and MCV returned to baseline values during the 6 months after the intervention. Hospitalizations and the clinical outcomes that were measured occurred infrequently during the study. Nonengagement was associated with being female and having a recent SCD complication. In addition, having insufficient electronic data, being unable to quickly complete Mobile DOT each day, and not perceiving that Mobile DOT was beneficial may have further decreased engagement. Conclusions: Mobile DOT shows promise as an effective intervention for some children with SCD. Modifications that may improve recruitment, reduce attrition, and increase engagement were identified and could increase the impact that Mobile DOT has on children with SCD. Trial Registration: ClinicalTrials.gov NCT02578017; https://clinicaltrials.gov/ct2/show/NCT02578017 [ABSTRACT FROM AUTHOR]
- Published
- 2019
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220. Anti-Factor Xa-Based Monitoring of Unfractionated Heparin: Clinical Outcomes in a Pediatric Cohort.
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Saini, Surbhi, Folta, Ashley N., Harsh, Katherine L., Stanek, Joseph R., Dunn, Amy L., O'Brien, Sarah H., and Kumar, Riten
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Objectives: To assess clinical outcomes in children treated with unfractionated heparin and monitored using an anti-factor Xa (Anti-FXa)-based nomogram. We also sought to assess the correlation between activated partial thromboplastin time (APTT) and Anti-FXa.Study Design: This was a single-center, observational cohort study conducted over a 20-month period that included all pediatric patients (<21 years) who received therapeutic unfractionated heparin and were monitored using an anti-FXa-based nomogram.Results: In total, 95 patients met prespecified inclusion criteria, and 1098 pairs of APTT and Anti-FXa measurements were performed. The median unfractionated heparin dose required to reach therapeutic Anti-FXa goal was significantly greater in infants compared with older children (P <.0001). The median time to achieve therapeutic Anti-FXa was 10 hours (range 2-96 hours) and was significantly shorter in patients who received a bolus compared with those who did not (P = .03). Five (5.3%) major bleeding events were noted. Age, peak Anti-FXa, peak APTT, lowest platelet count, and fibrinogen were not predictive of major and clinically relevant nonmajor bleeds. Moderate correlation between the APTT and Anti-FXa (r = 0.75; 95% CI 0.72-0.77) assays was appreciated.Conclusions: Using an anti-FXa-based nomogram to monitor unfractionated heparin in children is feasible. Although moderate correlation was observed between the APTT and Anti-FXa assays, the APTT frequently overestimated heparin activity. Safety and efficacy of an Anti-FXa nomogram needs further validation. [ABSTRACT FROM AUTHOR]- Published
- 2019
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221. Treatment-Related Outcomes in Paget-Schroetter Syndrome-A Cross-Sectional Investigation.
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Kumar, Riten, Harsh, Katherine, Saini, Surbhi, O'Brien, Sarah H., Stanek, Joseph, Warren, Patrick, Giver, Jean, Go, Michael R., and Kerlin, Bryce A.
- Abstract
Objective: To investigate treatment-related outcomes, namely radiological clot resolution, post-thrombotic syndrome (PTS), and health related quality-of-life (HRQoL) scores, in children with Paget-Schroetter syndrome (PSS) undergoing multidisciplinary management, including anticoagulation and decompressive rib-resection surgery, with or without thrombolytic therapy.Study Design: We identified all patients treated for PSS at our institution between the years 2010 and 2017. Baseline clinical and radiologic data were abstracted from medical records. Two validated survey instruments to quantify PTS and HRQoL were mailed to eligible patients. Standard statistical methods were used to summarize these measures.Results: In total, 22 eligible patients were identified; 10 were treated with thrombolysis followed by anticoagulation and rib resection, and 12 were treated with anticoagulation and rib resection alone. Nineteen patients responded to the survey instruments. Median age at deep vein thrombosis diagnosis and survey completion were 16.3 and 20.4 years, respectively. Nineteen of 22 patients had thrombus resolution on radiologic follow-up. Fourteen of 19 survey respondents reported signs/symptoms of PTS of which the majority (12/14) reported mild PTS. Aggregate total, physical, and psychosocial HRQoL scores reported were 90.6, 96.7, and 93.3, respectively. Thrombolytic therapy was not associated with a significant improvement in radiologic, clinical or HRQoL outcomes.Conclusions: Most patients with PSS had complete thrombus resolution on imaging. Only 11% of survey respondents reported moderate PTS. The entire cohort reported excellent HRQoL scores. The role for thrombolytic therapy in the management of childhood PSS remains incompletely elucidated. [ABSTRACT FROM AUTHOR]- Published
- 2019
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222. How I approach iron deficiency with and without anemia.
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Powers, Jacquelyn M. and O'Brien, Sarah H.
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- 2019
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223. Clinicians' perspectives on barriers and facilitators to sperm banking in adolescent males with cancer: a mixed-methods study.
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Nahata, Leena, Liles, Sophia M., Gerhardt, Cynthia A., Housten, Ashley J., Jalili, Dona, O'Brien, Sarah H., Vadaparampil, Susan T., and Quinn, Gwendolyn P.
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SPERM banks , *TEENAGE boys , *MEDICAL personnel , *FERTILITY preservation , *CHILD patients - Abstract
Purpose: To examine processes, barriers, and facilitators to sperm banking counseling and decision-making for adolescent males newly diagnosed with cancer from the perspective of clinicians who completed Oncofertility communication training. We also identify opportunities for improvement to inform future interventions and implementation. Methods: A survey (N=104) and subsequent focus groups (N=15) were conducted with non-physician clinicians practicing in pediatric oncology who completed Oncofertility communication training. Results: Most survey participants were confident in communicating about the impact of cancer on fertility (n=87, 83.7%) and fertility preservation options (n=80, 76.9%). Most participants reported never/rarely using a sperm banking decision tool (n=70, 67.3%), although 98.1% (n=102) said a decision tool with a family-centered approach would be beneficial. Primary themes in the subsequent focus groups included variable processes/workflows (inconsistent approaches to consult initiation; involvement of adolescents, caregivers, and various clinician types; assessment of puberty/sexual experience), structural and psychosocial barriers (cost and logistics, developmental, cultural, clinical acuity/prognosis), and facilitators (educational materials, alternative options for banking). Opportunities and strategies for improvement (including fertility preservation in existing research protocols; additional staffing/resources; oncologist education and buy-in; and development of decision tools) were informed by challenges identified in the other themes. Conclusion: Barriers to adolescent sperm banking remain, even among clinicians who have completed Oncofertility training. Although training is one factor necessary to facilitate banking, structural and psychosocial barriers persist. Given the complexities of offering sperm banking to pediatric populations, continued efforts are needed to mitigate structural barriers and develop strategies to facilitate decision-making before childhood cancer treatment. [ABSTRACT FROM AUTHOR]
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- 2023
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224. Response to Comment on O'Brien et al. Hormonal Contraception and Risk of Thromboembolism in Women With Diabetes. Diabetes Care 2017;40:233-238.
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O'Brien, Sarah H., Vesely, Sara K., and Schwarz, Eleanor Bimla
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THROMBOEMBOLISM , *DIABETES in women , *COMPARATIVE studies , *CONTRACEPTION , *DIABETES , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *EVALUATION research , *RELATIVE medical risk - Published
- 2017
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225. Coagulation Kinetics in Adolescent Females Initiating Combined Oral Contraceptives
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Haamid, Fareeda W., Kerlin, Bryce A., O'Brien, Sarah H., Manos, Brittny E., Waller, Amanda P., and Bonny, Andrea E.
- Abstract
Objectives:The objective of this pilot study was to evaluate the effect of combined oral contraceptives (COC) on rotational thromboelastometry (ROTEM®) and Technothrombin®TGA (thrombin generation assay) coagulation kinetics, as a surrogate marker of thrombotic risk, in adolescent females. The epidemiology of risk factors associated with contraception-related venous thromboembolism (VTE) in adolescents is not well defined. Estrogen contained in COC produces activated protein C resistance thus increasing the risk of thrombosis. The risk of COC-related VTE is significantly impacted by duration of COC use. The highest risk of COC-related VTE is during the first 6 to 12 months in first-time users. Furthermore, the risk of contraception-related VTE is higher for obese women as compared with non-obese women. Recent evidence found that endogenous thrombin potential (ETP) increased during COC initiation, but have not followed users longitudinally.
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- 2017
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226. A Review of Hormonal Contraception and Venous Thromboembolism in Adolescents.
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Woods, Gary M., Kerlin, Bryce A., O'Brien, Sarah H., and Bonny, Andrea E.
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THROMBOEMBOLISM , *CONTRACEPTION complications , *HORMONES , *BLOOD coagulation , *ADOLESCENT gynecology , *RARE diseases - Abstract
Background The number of adolescents who are prescribed hormonal contraception (HC) for contraceptive and noncontraceptive indications is increasing. Approximately 1 of 4 female adolescents will use some form of HC by age 19 years. Venous thromboembolism (VTE) is a rare, but life-threatening complication associated with HC use. Although adolescents aged 15 to 19 years have the lowest absolute HC-associated VTE risk, they still account for 5.9% of HC-associated VTE. The absolute HC-associated VTE risk for those younger than 15 years of age is not well described. Objective The objectives of this report are to describe the current literature regarding HC-associated VTE in adolescents, to review the coagulation cascade and in vivo coagulation, to highlight differences between the adolescent and adult coagulation profiles, to discuss coagulation profile changes related to HC use, and to identify knowledge deficits for future study. Conclusion The mechanisms and confounding variables that lead to HC-associated VTE in all adolescents are not well understood because many large HC studies exclude female adolescents younger than 18 years of age. Because of the paucity of data in this age group, observational studies and randomized controlled trials of VTE risk in adolescents on varying forms of HC are needed. Studies should include female adolescents across the entire adolescent age span (12-21 years) to better understand HC-associated VTE risk in this population. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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227. Intrauterine Device Outcomes in Young Women with Heavy Menstrual Bleeding: Comparing Patients with and without Inherited Bleeding Disorders.
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Kendel, Nicole E., Zia, Ayesha, Rosenbaum, Lucy E., Stanek, Joseph R., Haamid, Fareeda W., Christian-Rancy, Myra, and O'Brien, Sarah H.
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MENORRHAGIA , *INTRAUTERINE contraceptives , *YOUNG women , *PEDIATRIC clinics , *TEENAGE girls - Abstract
To evaluate the use of intrauterine devices (IUDs) in two young women's hematology clinics and compare adverse events in adolescents with and without inherited bleeding disorders (BDs) Retrospective multicenter cohort study from February 2014 through February 2020 Young women's hematology clinics at Nationwide Children's Hospital in Columbus, Ohio, and Children's Medical Center in Dallas, Texas Female patients evaluated for heavy menstrual bleeding (HMB) who underwent IUD placement Rates of IUD expulsion, malposition, and ongoing HMB requiring additional medical treatment We identified 43 patients with BDs and 35 patients without BDs who underwent placement of an IUD for HMB. The mean age was 14.9 years (range 11.0-21.4 years) at the time of presentation and 15.8 years (range 11.0-21.4 years) at IUD placement. Those with BDs were younger at the time of IUD insertion. Most patients (90%) had previously failed other methods to control HMB. The annual rate of IUD adverse events was 0.25 per year of use, and all adverse events occurred in the first 20 months after placement. There were no significant differences in adverse IUD events in patients with and without BDs, although those without BDs requested IUD removal more frequently. In this cohort of adolescent females, the presence of a BD was not associated with a higher IUD expulsion rate. IUD placement should be considered a first-line option for adolescents with BDs who experience HMB. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
228. A health literate approach to address health disparities: a virtual program for parents of children with sickle cell trait.
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Abrams, Mary Ann, Zajo, Kristin N., Beeman, Chase M., O'Brien, Sarah H., Chan, Peter K., Shen, Yvette, McCorkle, Ben, Johnson, Latrice, Chisolm, Deena, Barnard-Kirk, Toyetta, Mahan, John D., Christian-Rancy, Myra, and Creary, Susan E.
- Subjects
- *
HEALTH education , *STAKEHOLDER analysis , *VIDEOCONFERENCING , *HEALTH literacy , *COMMUNICATION , *RESEARCH funding , *DESCRIPTIVE statistics , *HEALTH equity , *SICKLE cell trait , *VIDEO recording - Abstract
Approximately 8% of African Americans born annually have sickle cell trait (SCT), a public health concern that may contribute to health disparities if individuals with SCT do not know it and lack access to understandable information about reproductive implications. Pre-pandemic, Ohio offered in-person SCT education for parents of SCT-affected children but many did not attend. Those with limited health literacy (HL) were less likely to achieve high knowledge. We used a HL-focused evaluation of this education to develop a virtual program (SCTaware) to communicate clear, actionable information and promote knowledge retention. Seven English-speaking parents, three with limited HL, were recruited in 2019 for in-person session videotaping and SCT knowledge assessments. Clinicians, HL experts, educators, genetic counselors, and parent stakeholders reviewed sessions, assessments, and accompanying visuals. Evaluators: observed parents asked few questions; noted undefined technical terms, closed questions, key concept omission, and limited explanation of visuals scoring low for understandability, actionability, and clarity; and developed SCTaware for individual videoconference delivery (knowledge objectives; plain language guide; HL-informed communication strategies; new visuals scoring highly for understandability, actionability, and clarity; narrated post-education version; standardized educator training). Using a HL-focused evaluation, our diverse team created a promising virtual SCT education program addressing a common issue affecting populations at risk for disparities. Given virtual education will likely continue post-pandemic and limited HL is common, this approach may replicable for other public health education programs, especially those transitioning to virtual formats, to convey clear, actionable information and promote health equity. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
229. Diagnosis and Management of an Infant with Microthrombocytopenia
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Rose, Melissa J., Jacobson-Kelly, Amanda, Dunn, Amy L., editor, Kerlin, Bryce A., editor, O'Brien, Sarah H., editor, Rose, Melissa J., editor, and Kumar, Riten, editor
- Published
- 2020
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230. Recognition and Management of Congenital Platelet Granule Disorders
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Woods, Gary M., Kumar, Riten, Dunn, Amy L., editor, Kerlin, Bryce A., editor, O'Brien, Sarah H., editor, Rose, Melissa J., editor, and Kumar, Riten, editor
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- 2020
- Full Text
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231. Care of a Toddler with Epistaxis and Bernard-Soulier Syndrome
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Rose, Melissa J., Jacobson-Kelly, Amanda, Dunn, Amy L., editor, Kerlin, Bryce A., editor, O'Brien, Sarah H., editor, Rose, Melissa J., editor, and Kumar, Riten, editor
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- 2020
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232. Caring for an Infant with Heelstick Bleeding
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Woods, Gary M., Kumar, Riten, Dunn, Amy L., editor, Kerlin, Bryce A., editor, O'Brien, Sarah H., editor, Rose, Melissa J., editor, and Kumar, Riten, editor
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- 2020
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233. Approach to a Child with Epistaxis and Macrothrombocytopenia
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Woods, Gary M., Kumar, Riten, Dunn, Amy L., editor, Kerlin, Bryce A., editor, O'Brien, Sarah H., editor, Rose, Melissa J., editor, and Kumar, Riten, editor
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- 2020
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234. A Preteen Female with Fatigue and Incidental Finding of Thrombocytopenia
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Rose, Melissa J., Jacobson-Kelly, Amanda, Dunn, Amy L., editor, Kerlin, Bryce A., editor, O'Brien, Sarah H., editor, Rose, Melissa J., editor, and Kumar, Riten, editor
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- 2020
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235. Approach to a Patient with Sudden Onset of Mucocutaneous Bleeding and Thrombocytopenia
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Rose, Melissa J., Jacobson-Kelly, Amanda, Dunn, Amy L., editor, Kerlin, Bryce A., editor, O'Brien, Sarah H., editor, Rose, Melissa J., editor, and Kumar, Riten, editor
- Published
- 2020
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236. Recognition and Care of a Newborn with FXIII Deficiency
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Kerlin, Bryce A., Dunn, Amy L., editor, Kerlin, Bryce A., editor, O'Brien, Sarah H., editor, Rose, Melissa J., editor, and Kumar, Riten, editor
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- 2020
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237. Approach to Mucosal Bleeding in an Adolescent with FXI Deficiency
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Sharma, Ruchika, Kerlin, Bryce A., Dunn, Amy L., editor, Kerlin, Bryce A., editor, O'Brien, Sarah H., editor, Rose, Melissa J., editor, and Kumar, Riten, editor
- Published
- 2020
- Full Text
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238. Diagnosis and Management of FVII Deficiency
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Sharma, Ruchika, Kerlin, Bryce A., Dunn, Amy L., editor, Kerlin, Bryce A., editor, O'Brien, Sarah H., editor, Rose, Melissa J., editor, and Kumar, Riten, editor
- Published
- 2020
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- View/download PDF
239. Manifestations and Treatment of Congenital Fibrinogen Deficiency
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Sharma, Ruchika, Kerlin, Bryce A., Dunn, Amy L., editor, Kerlin, Bryce A., editor, O'Brien, Sarah H., editor, Rose, Melissa J., editor, and Kumar, Riten, editor
- Published
- 2020
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240. Management of an Infant with Hemophilia A
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Saini, Surbhi, Dunn, Amy L., Dunn, Amy L., editor, Kerlin, Bryce A., editor, O'Brien, Sarah H., editor, Rose, Melissa J., editor, and Kumar, Riten, editor
- Published
- 2020
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- View/download PDF
241. Approach to a Child with Hemophilia B and Anaphylaxis to Factor IX
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Saini, Surbhi, Dunn, Amy L., Dunn, Amy L., editor, Kerlin, Bryce A., editor, O'Brien, Sarah H., editor, Rose, Melissa J., editor, and Kumar, Riten, editor
- Published
- 2020
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242. Diagnosis and Management of a Patient with Newly Diagnosed Hemophilia B
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Saini, Surbhi, Dunn, Amy L., Dunn, Amy L., editor, Kerlin, Bryce A., editor, O'Brien, Sarah H., editor, Rose, Melissa J., editor, and Kumar, Riten, editor
- Published
- 2020
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243. Clinical Care of a Child with Hemophilia A and Inhibitors
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Saini, Surbhi, Dunn, Amy L., Dunn, Amy L., editor, Kerlin, Bryce A., editor, O'Brien, Sarah H., editor, Rose, Melissa J., editor, and Kumar, Riten, editor
- Published
- 2020
- Full Text
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244. Emergency Department Evaluation of Abnormal Uterine Bleeding in US Children's Hospitals.
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Kendel, Nicole E., Stanek, Joseph R., Haamid, Fareeda W., Powers, Jacquelyn M., and O'Brien, Sarah H.
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CHILDREN'S hospitals , *HOSPITAL emergency services , *UTERINE hemorrhage , *HEALTH information systems , *SEXUALLY transmitted diseases , *BLACK people - Abstract
To assess initial evaluation patterns of patients presenting to the Emergency Department (ED) with abnormal uterine bleeding (AUB) including differences by race Retrospective multicenter cohort study from October 2015 through September 2020 Forty-seven children's hospitals submitting data to the Pediatric Health Information System Female patients aged 8-21 with an ED encounter with AUB as the primary diagnosis code Proportion of visits with at least 1 laboratory assessment for the evaluation of anemia, iron deficiency, and/or hemostatic disorders We identified 17,759 unique patients with AUB seen in the ED who met inclusion criteria. Median age was 16.3 years (IQR, 14.1-17.8 years). Most encounters (n = 11,576, 65.2%) included evaluation for anemia, but only 6.8% (n = 1,215) included assessment for iron deficiency and 26.2% (n = 4,654) for hemostatic disorders. Black patients accounted for 34.7% (n = 6,155) of AUB encounters yet constituted only 25% of all ED encounters (n = 198,192). Black patients with AUB were less likely to undergo bleeding disorder evaluation (OR = 0.76; 95% CI, 0.69-0.83) but more likely to receive evaluation for sexually transmitted infections (OR = 1.63; 95% CI, 1.48-1.80) compared with White patients, despite controlling for age and concomitant pain. In a national cohort of adolescents presenting to the ED with AUB, evaluations for anemia and hemostatic disorders were infrequently performed, and racial differences existed regarding initial assessment. Further studies are needed to understand the factors underlying racial differences in hematologic testing and the impact of this disparity on health outcomes for females with AUB. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
245. Study protocol for fertility preservation discussions and decisions: A family-centered psychoeducational intervention for male adolescents and emerging adults newly diagnosed with cancer and their families.
- Author
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Stanek, Charis, Theroux, Charleen I., Olsavsky, Anna L., Hill, Kylie N., Rausch, Joseph R., O'Brien, Sarah H., Quinn, Gwendolyn P., Gerhardt, Cynthia A., and Nahata, Leena
- Subjects
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FERTILITY preservation , *TEENAGE boys , *YOUNG adults , *CANCER diagnosis , *RESEARCH protocols , *EUGENICS , *RANDOMIZED controlled trials - Abstract
Many childhood cancer survivors desire biological children but are at risk for infertility after treatment. One option for mitigating risk is the use of fertility preservation prior to gonadotoxic therapy. Adolescents and emerging adults may rely on their parents to help them decide whether to use fertility preservation. While this is often a collaborative process, it is currently unknown how parents can optimally support adolescents and emerging adults through this decision. To address this gap, we developed a family-centered, psychoeducational intervention to prompt adolescents and emerging adults to reflect on their future parenthood goals and attitudes towards fertility preservation, as well as to prompt their parents (or other caregivers) to reflect on their own and their child's perspectives on the topic. In this randomized controlled trial, families will be randomized to either the standard of care control group (fertility consult) or the intervention group. After their fertility consult, adolescents and emerging adults and parents in the intervention group will complete a fertility preservation values clarification tool and then participate in a guided conversation about their responses and the fertility preservation decision. The primary expected outcome of this study is that participation in the intervention will increase the use of fertility preservation. The secondary expected outcome is an improvement in decision quality. Chi-square analyses and t-tests will evaluate primary and secondary outcomes. The goal of this intervention is to optimize family-centered fertility preservation decision-making in the context of a new cancer diagnosis to help male adolescents and emerging adults achieve their future parenthood goals. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
246. Impact of a novel family-centered values clarification tool on adolescent sperm banking attempts at the time of a new cancer diagnosis.
- Author
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Nahata, Leena, Dattilo, Taylor M., Olsavsky, Anna L., Lipak, Keagan G., Whiteside, Stacy, Yeager, Nicholas D., Audino, Anthony, Klosky, James L., Rausch, Joseph, Saraf, Amanda, O'Brien, Sarah H., Quinn, Gwendolyn P., and Gerhardt, Cynthia A.
- Subjects
- *
TEENAGERS , *SPERM banks , *TEENAGE boys , *CANCER diagnosis , *FERTILITY preservation , *CORD blood - Abstract
Purpose: Over half of males experience fertility impairment after childhood cancer therapy, which often causes psychosocial distress. Yet, fertility preservation (FP) remains underutilized. The goals of this study were to determine the feasibility and impact of implementing a family-centered FP values clarification tool on sperm banking attempts among adolescent males newly diagnosed with cancer, and identify key determinants of banking attempts. Methods: A prospective pilot study was conducted among families of males (12–25 years old), prior to cancer therapy. Thirty-nine of 41 families agreed to participate (95%); 98 participants (32 adolescents, 37 mothers, 29 fathers) completed the Family-centered Adolescent Sperm banking values clarification Tool (FAST). Analyses assessed the impact of the FAST on banking attempts and examined associations between demographic/medical characteristics, FAST subscales (perceived threat, benefits, barriers), and banking attempts. Results: Twenty-three (59%) adolescents attempted to bank, compared to 8 adolescents (33%) during baseline assessment (p=.04). Significant associations were identified between banking attempts and adolescents' report of perceived threat (rpb=.45, p=.01) and benefits (rpb=.57, p=.01). Only mothers' proxy reports of adolescent perceived threat (rpb=.42, p=.01) and benefits (rpb=.47, p=.003) were associated with banking attempts, while fathers' self-reported perceived benefits (rpb=.43, p=.03), self-reported barriers (rpb=.49, p=.01), and proxy reports of adolescent perceived threat (rpb=.38, p=.04) and benefits (rpb=.59, p=.02) were associated with banking attempts. Conclusion: Adolescent sperm banking attempt rates significantly increased after implementation of a family-centered FP values clarification tool prior to cancer treatment. Findings underscore the importance of targeting both adolescents and their parents, particularly fathers, in FP efforts. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
247. Contraception-Related Venous Thromboembolism in a Pediatric Institution
- Author
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Pillai, Prasanth, Bonny, Andrea E., and O'Brien, Sarah H.
- Subjects
- *
CONTRACEPTION , *THROMBOEMBOLISM risk factors , *CHILDREN'S hospitals , *BODY mass index , *YOUNG women , *ELECTRONIC health records , *RETROSPECTIVE studies , *DISEASES - Abstract
Abstract: Study Objective: To define the thrombotic risk factors of young women presenting to a children''s hospital with hormonal contraception-related venous thromboembolism (VTE). We hypothesized that the majority of patients would have additional risk factors for VTE. Design: Clinical and laboratory data obtained retrospectively from electronic medical records concerning history of presentation, body mass index (BMI), medical and family history, medication profile, and relevant laboratory studies. Setting: Nationwide Children''s Hospital in Columbus, Ohio, November 2008-May 2012. Participants: Twenty-six female patients, age 12-21 years, admitted for hormonal contraception-related VTE. Results: Fifty-seven VTE cases were reviewed, and 26 were identified as contraception-related VTE. 96% of patients had at least 1 additional risk factor for VTE, and 42% of patients had 2 or more additional risk factors. 50% patients had a BMI ≥25 kg/m2. 35% of patients had a positive family history of VTE in a first or second-degree relative. 27% of patients were subsequently diagnosed with an inherited thrombophilia, 5 of whom had a positive family history. Conclusion: In a small population of adolescents presenting to a children''s hospital with contraception-related VTE, the majority of patients had multiple risk factors for VTE. Obesity was the most common additional risk factor (50%) identified in our study population. More research is needed regarding the impact of obesity on contraception-related VTE in young women, and whether the presence of obesity should influence thrombophilia screening practices prior to prescribing contraception. [Copyright &y& Elsevier]
- Published
- 2013
- Full Text
- View/download PDF
248. Conducting reproductive research during a new childhood cancer diagnosis: ethical considerations and impact on participants.
- Author
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Nahata, Leena, Morgan, Taylor L., Lipak, Keagan G., Clark, Olivia E., Yeager, Nicholas D., O'Brien, Sarah H., Whiteside, Stacy, Audino, Anthony N., Gerhardt, Cynthia A., and Quinn, Gwendolyn P.
- Subjects
- *
CHILDHOOD cancer , *BEHAVIORAL ethics , *TEENAGE boys , *BEHAVIORAL research , *CANCER diagnosis , *DEMOGRAPHIC surveys - Abstract
Purpose: Research among adults shows benefits and low perceived burden of engaging in behavioral research. However, questions remain regarding the ethics of conducting behavioral research in pediatric populations during sensitive situations, including during a new life-threatening diagnosis or at end-of-life. We examined reactions to participating in a behavioral reproductive research study among male adolescents newly diagnosed with cancer and their parents, as a step towards optimizing fertility preservation utilization in a population where future infertility is common. Methods: Pediatric literature regarding the ethics of behavioral research was reviewed. In our pilot, forty-four participants (19 mothers, 11 fathers, 14 male adolescents newly diagnosed with cancer) from 20 families completed demographic questionnaires and a fertility preservation decision tool developed by the study team. Qualitative interviews exploring the impact of study participation were subsequently conducted. Verbatim transcripts were coded for thematic content using the constant comparison method. Results: Literature review showed positive reactions to research participation among youth/caregivers. In our pilot study, 89% (n = 17) of mothers, 64% (n = 7) of fathers, and 71% (n = 10) of adolescents reported at least one benefit of participating. Eleven percent (n = 2) of mothers, 36% (n = 4) of fathers, and 29% (n = 4) of adolescents said they were not affected; none of the participants reported a negative effect. Conclusion: Consistent with prior literature, our study suggests behavioral reproductive research prior to cancer treatment can offer direct benefits to participants and society, without increasing burden. These findings will inform future interventions to improve long-term psychosocial and reproductive outcomes for youth with cancer. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
249. Increased Health Care Utilization and Costs during Allogeneic Hematopoietic Cell Transplantation for Acute Leukemia and Myelodysplastic Syndromes in Adolescents and Young Adults Compared with Children: A Multicenter Study.
- Author
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Rangarajan, Hemalatha G., Smith, Lauren C., Stanek, Joseph R., Hall, Matthew, Abu-Arja, Rolla, Auletta, Jeffery J., and O'Brien, Sarah H.
- Subjects
- *
ADOLESCENCE , *ACUTE leukemia , *MYELODYSPLASTIC syndromes , *MEDICAL care costs , *CELL transplantation , *YOUNG adults - Abstract
• Compared with children (age <15 years), adolescents and young adults (AYA; age 15 to 39 years) with acute leukemias and myelodysplastic syndromes have greater hematopoietic cell transplantation (HCT)-related costs and rates of health care utilization. • Although the median hospital length of stay was similar in children and AYA HCT recipients, the median cost per hospital day was significantly higher in AYA. • Factors driving increased costs included older age, use of cord blood, unrelated donors, occurrence of graft-versus-host disease, any infection, use of dialysis, and mechanical ventilation. Allogeneic hematopoietic cell transplantation (HCT) is a curative option for patients with acute leukemia and myelodysplastic syndromes (MDS) but is associated with significant cost. Compared with children (age <15 years), adolescents and young adults (AYA; age 15 to 39 years) undergoing HCT have an increased risk for transplantation-related complications. However, whether such complications translate into increased resource utilization and costs during HCT remains unknown. Therefore, we conducted a multicenter database study using the Pediatric Health Information System database, an administrative database containing resource utilization data from 49 US tertiary children's hospitals to compare inpatient costs and resource utilization in children and AYA undergoing HCT for acute leukemia and MDS. The International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify HCT recipients and transplantation-related complications occurring up to 1 year post-HCT. We identified 1693 HCT recipients at pediatric centers between January 2010 and September 2014. Eighty percent of the total costs (from admission for HCT up to 1 year post-HCT) occurred during the initial transplantation admission. During initial admission, although AYA and children had a similar median length of stay (LOS) of 43 days, AYA incurred significantly greater adjusted costs ($338,458 versus $275,723; P <.001) and costs per hospital day ($7122 versus $5838; P <.001). Median total costs and costs per day during subsequent time periods post-HCT were also significantly greater in the AYA group. In multivariable analysis, increasing age at HCT, LOS, use of cord blood or an unrelated donor, occurrence of any graft-versus-host disease, infection, and use of dialysis or mechanical ventilation were significant drivers of increased cost at initial admission. In conclusion, allogeneic HCT for acute leukemia and MDS is associated with higher costs in AYA recipients than in children. Therefore, directing efforts and resources aimed at reducing HCT-related costs may be advantageous in this high-risk group. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
250. Hematologic Considerations and Management of Adolescent Girls with Heavy Menstrual Bleeding and Anemia in US Children's Hospitals.
- Author
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Powers, Jacquelyn M., Stanek, Joseph R., Srivaths, Lakshmi, Haamid, Fareeda W., and O'brien, Sarah H.
- Subjects
- *
MENSTRUAL cycle , *TEENAGE girls , *ANEMIA treatment , *CHILDREN'S hospitals , *IDIOPATHIC thrombocytopenic purpura , *DISEASES - Abstract
Study Objective To assess the frequency, severity, and inpatient management of girls admitted with heavy menstrual bleeding and iron deficiency anemia at US children's hospitals, with a focus on hematologic considerations. Design Retrospective multicenter cohort study from October 2012 through September 2015. Setting Children's hospitals submitting data to the Pediatric Health Information System. Participants Female patients, age 8-18 years, admitted with heavy menstrual bleeding and anemia as either a primary or secondary diagnosis. Patients with cancer, immune thrombocytopenic purpura, aplastic anemia, and pregnancy were excluded. Interventions and Main Outcome Measures Hemostatic evaluation; provision of iron therapy. Results We identified 1183 admissions (1134 unique patients). Patients’ median (interquartile range) age was 14 (11-17) years. Forty-one percent were Caucasian (n = 480), 31% African American (n = 371), and 26% Hispanic ethnicity (n = 310). Intensive care use occurred in 5% of admissions (n = 56). Hemostatic assessment was inconsistent; 15% (n = 182) had no such evaluation. Two-thirds (n = 797; 67%) involved transfusions, 37% (n = 433) received no inpatient iron therapy, and 17% (n = 197) received no hormonal or antifibrinolytic therapy. Hemostatic evaluation was associated with intensive care use: odds ratio (OR), 4.80 (95% confidence interval [CI], 1.16-19.86; P = .03); emergency department visit: OR, 2.60 (95% CI, 1.86-3.65; P < .01); private insurance: OR, 1.62 (95% CI, 1.12-2.35; P = .01); and younger age: OR, 0.84 (95% CI, 0.77-0.92; P < .01). Conclusion Hundreds of girls with heavy menstrual bleeding and anemia are hospitalized at US children's hospitals each year with variable inpatient hematologic evaluation and management. Future guidelines should emphasize early identification of at-risk patients and promote effective implementation strategies to reduce the burden of this preventable complication. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
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