101 results on '"Krahn, G."'
Search Results
2. Classical versus quantum dynamics of the atomic Josephson junction
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Krahn, G. J. and O'Dell, D. H. J.
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Condensed Matter - Quantum Gases - Abstract
We compare the classical (mean-field) dynamics with the quantum dynamics of atomic Bose-Einstein condensates in double-well potentials. The quantum dynamics are computed using a simple scheme based upon the Raman-Nath equations. Two different methods for exciting a non-equilbrium state are considered: an asymmetry between the wells which is suddenly removed, and a periodic time oscillating asymmetry. The first method generates wave packets that lead to collapses and revivals of the expectation values of the macroscopic variables, and we calculate the time scale for these revivals. The second method permits the excitation of a single energy eigenstate of the many-particle system, including Schroedinger cat states. We also discuss a band theory interpretation of the energy level structure of an asymmetric double-well, thereby identifying analogies to Bloch oscillations and Bragg resonances. Both the Bloch and Bragg dynamics are purely quantum and are not contained in the mean-field treatment., Comment: 31 pages, 14 figures
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- 2009
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3. Compensatory gain based on lysine level in finishing pigs after being fed lysine deficient 97% corn diets for three or six weeks
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Hagen, C S, primary, Spencer, J D, additional, Krahn, G T, additional, and Greiner, L L, additional
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- 2023
- Full Text
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4. Challenges and progress in health surveillance of people with intellectual disabilities: A tale of two countries
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Krahn, G. L. and Oullette-Kuntz, H.
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- 2012
5. Advances in health surveillance among persons with intellectual disabilities
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Krahn, G. L., Ouellette-Kuntz, H., Emerson, E., Glover, G., Cocks, E., and Rosenwax, L.
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- 2012
6. Health disparities and intellectual disabilities: What do we know? What must we do?
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Krahn, G.
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- 2012
7. New or Progressive Multiple Organ Dysfunction Syndrome in Pediatric Severe Sepsis: A Sepsis Phenotype With Higher Morbidity and Mortality
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Lin, John C, Spinella, Philip C., Fitzgerald, Julie C., Tucci, Marisa, Bush, Jenny L., Nadkarni, Vinay M., Thomas, Neal J., Weiss, Scott L., Fontela, P., Tucci, M., Dumistrascu, M., Skippen, P., Krahn, G., Bezares, E., Puig, G., Puig Ramos, A., Garcia, R., Villar, M., Bigham, M., Polanski, T., Latifi, S., Giebner, D., Anthony, H., Hume, J., Galster, A., Linnerud, L., Sanders, R., Hefley, G., Madden, K., Thompson, A., Shein, S., Gertz, S., Han, Y., Williams, T., Hughes Schalk, A., Chandler, H., Orioles, A., Zielinski, E., Doucette, A., Zebuhr, C., Wilson, T., Dimitriades, C., Ascani, J., Layburn, S., Valley, S., Markowitz, B., Terry, J., Morzov, R., Mcinnes, A., Mcarthur, J., Woods, K., Murkowski, K., Spaeder, M., Sharron, M., Wheeler, D., Beckman, E., Frank, E., Howard, K., Carroll, C., Nett, S., Jarvis, D., Patel, V., Higgerson, R., Christie, L., Typpo, K., Deschenes, J., Kirby, A., Uhl, T., Rehder, K., Cheifetz, I., Wrenn, S., Kypuros, K., Ackerman, K., Maffei, F., Bloomquist, G., Rizkalla, N., Kimura, D., Shah, S., Tigges, C., Su, F., Barlow, C., Michelson, K., Wolfe, K., Goodman, D., Campbell, L., Sorce, L., Bysani, K., Monjure, T., Evans, M., Totapally, B., Chegondi, M., Rodriguez, C., Frazier, J., Steele, L., Viteri, S., Costarino, A., Thomas, N., Spear, D., Hirshberg, E., Lilley, J., Rowan, C., Rider, C., Kane, J., Zimmerman, J., Greeley, C., Lin, J., Jacobs, R., Parker, M., Culver, K., Loftis, L., Jaimon, N., Goldsworthy, M., Diliberto, M., Alen, C., Gessouroun, M., Sapru, A., Lang, T., Alkhouli, M., Kamath, S., Friel, D., Daufeldt, J., Hsing, D., Carlo, C., Pon, S., Scimeme, J., Shaheen, A., Hassinger, A., Qiao, H., Giuliano, J., Tala, J., Vinciguerra, D., Fernandez, A., Carrero, R., Hoyos, P., Jaramillo, J., Posada, A., Izquiierdo, L., Pineres Olave, B. E., Donado, J., Dalmazzo, R., Rendich, S., Palma, L., Lapadula, M., Acuna, C., Cruces, P., De Clety, S. Clement, Dujardin, M., Berghe, C., Renard, S., Zurek, J., Steinherr, H., Mougkou, K., Critselis, E., Di Nardo, M., Picardo, S., Tortora, F., Rossetti, E., Fragasso, T., Cogo, Paola, Netto, R., Dagys, A., Gurskis, V., Kevalas, R., Neeleman, C., Lemson, J., Luijten, C., Wojciech, K., Pagowska Klimek, I., Szczepanska, M., Karpe, J., Nunes, P., Almeida, H., Rios, J., Vieira, M., Garcia Iniguez, J. P., Revilla, P., Urbano, J., Lopez Herce, J., Bustinza, A., Cuesta, A., Hofheinz, S., Rodriguez Nunez, A., Sanagustin, S., Gonzalez, E., Riaza, M., Piaya, R., Soler, P., Esteban, E., Laraudogoitia, J., Monge, C., Herrera, V., Granados, J., Gonzalez, C., Koroglu, T., Ozcelik, E., Baines, P., Plunkett, A., Davis, P., George, S., Tibby, S., Harris, J., Agbeko, R., Lampitt, R., Brierley, J., Peters, M., Jones, A., Dominguez, T., Thiruchelvam, T., Deep, A., Ridley, L., Bowen, W., Levin, R., Macleod, I., Gray, M., Hemat, N., Alexander, J., Ali, S., Pappachan, J., Mccorkell, J., Fortune, P., Macdonald, M., Hudnott, P., Suyun, Q., Singhi, S., Nallasamy, K., Lodha, R., Shime, N., Tabata, Y., Saito, O., Ikeyama, T., Kawasaki, T., Lum, L., Abidin, A., Kee, S., Tang, S., Jalil, R., Guan, Y., Yao, L., Lin, K., Ong, J., Salloo, A., Doedens, L., Mathivha, L., Reubenson, G., Moaisi, S., Pentz, A., Green, R., Schibler, A., Erickson, S., Mceneiry, J., Long, D., Dorofaeff, T., Coulthard, M., Millar, J., Delzoppo, C., Williams, G., Morritt, M., Watts, N., Beca, J., Sherring, C., and Bushell, T.
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Male ,medicine.medical_specialty ,Adolescent ,Cross-sectional study ,Multiple Organ Failure ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Prevalence ,children ,epidemiology ,multiple organ dysfunction syndrome ,severe sepsis ,Pediatrics, Perinatology and Child Health ,Critical Care and Intensive Care Medicine ,030204 cardiovascular system & hematology ,Global Health ,Intensive Care Units, Pediatric ,Pediatrics ,Article ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Epidemiology ,medicine ,Humans ,Hospital Mortality ,Prospective Studies ,030212 general & internal medicine ,Child ,Intensive care medicine ,Prospective cohort study ,Septic shock ,business.industry ,Infant, Newborn ,Infant ,Perinatology and Child Health ,Prognosis ,medicine.disease ,Clinical trial ,Cross-Sectional Studies ,Phenotype ,Child, Preschool ,Disease Progression ,Female ,Multiple organ dysfunction syndrome ,business - Abstract
Copyright © 2016 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.Objectives: To describe the epidemiology, morbidity, and mortality of new or progressive multiple organ dysfunction syndrome in children with severe sepsis. Design: Secondary analysis of a prospective, cross-sectional, point prevalence study. Setting: International, multicenter PICUs. Patients: Pediatric patients with severe sepsis identified on five separate days over a 1-year period. Interventions: None. Measurements and Main Results: Of 567 patients from 128 PICUs in 26 countries enrolled, 384 (68%) developed multiple organ dysfunction syndrome within 7 days of severe sepsis recognition. Three hundred twenty-seven had multiple organ dysfunction syndrome on the day of sepsis recognition. Ninety-one of these patients developed progressive multiple organ dysfunction syndrome, whereas an additional 57 patients subsequently developed new multiple organ dysfunction syndrome, yielding a total proportion with severe sepsis-associated new or progressive multiple organ dysfunction syndrome of 26%. Hospital mortality in patients with progressive multiple organ dysfunction syndrome was 51% compared with patients with new multiple organ dysfunction syndrome (28%) and those with single-organ dysfunction without multiple organ dysfunction syndrome (10%) (p < 0.001). Survivors of new or progressive multiple organ dysfunction syndrome also had a higher frequency of moderate to severe disability defined as a Pediatric Overall Performance Category score of greater than or equal to 3 and an increase of greater than or equal to 1 from baseline: 22% versus 29% versus 11% for progressive, new, and no multiple organ dysfunction syndrome, respectively (p < 0.001). Conclusions: Development of new or progressive multiple organ dysfunction syndrome is common (26%) in severe sepsis and is associated with a higher risk of morbidity and mortality than severe sepsis without new or progressive multiple organ dysfunction syndrome. Our data support the use of new or progressive multiple organ dysfunction syndrome as an important outcome in trials of pediatric severe sepsis although efforts are needed to validate whether reducing new or progressive multiple organ dysfunction syndrome leads to improvements in more definitive morbidity and mortality endpoints.
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- 2017
8. The community engagement initiative
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Drum, C., Krahn, G., and Horner-Johnson, W.
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- 2008
9. US Health care access for people with ID
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Krahn, G.
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- 2008
10. Development of a measure of health status for persons with disabilities
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Krahn, G. L., Horner-Johnson, W., and Hall, T.
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- 2008
11. Testing a health promotion program for people with intellectual disabilities
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Horner-Johnson, W., Lyman, L., Drum, C. E., and Krahn, G.
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- 2008
12. Participatory action toolkit: A resource for researchers and people with disabilities
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Krahn, G. and Weaver, A.
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- 2008
13. Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis
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Thakkar, Rajan K., primary, Weiss, Scott L., additional, Fitzgerald, Julie C., additional, Keele, Luke, additional, Thomas, Neal J., additional, Nadkarni, Vinay M., additional, Muszynski, Jennifer A., additional, Hall, Mark W., additional, Fontela, P., additional, Tucci, M., additional, Dumistrascu, M., additional, Skippen, P., additional, Krahn, G., additional, Bezares, E., additional, Puig, G., additional, Puig-Ramos, A., additional, Garcia, R., additional, Villar, M., additional, Bigham, M., additional, Polanski, T., additional, Latifi, S., additional, Giebner, D., additional, Anthony, H., additional, Hume, J., additional, Galster, A., additional, Linnerud, L., additional, Sanders, R., additional, Hefley, G., additional, Madden, K., additional, Thompson, A., additional, Shein, S., additional, Gertz, S., additional, Han, Y., additional, Williams, T., additional, Hughes-Schalk, A., additional, Chandler, H., additional, Orioles, A., additional, Zielinski, E., additional, Doucette, A., additional, Zebuhr, C., additional, Wilson, T., additional, Dimitriades, C., additional, Ascani, J., additional, Layburn, S., additional, Valley, S., additional, Markowitz, B., additional, Terry, J., additional, Morzov, R., additional, Mcinnes, A., additional, McArthur, J., additional, Woods, K., additional, Murkowski, K., additional, Spaeder, M., additional, Sharron, M., additional, Wheeler, D., additional, Beckman, E., additional, Frank, E., additional, Howard, K., additional, Carroll, C., additional, Nett, S., additional, Jarvis, D., additional, Patel, V., additional, Higgerson, R., additional, Christie, L., additional, Typpo, K., additional, Deschenes, J., additional, Kirby, A., additional, Uhl, T., additional, Rehder, K., additional, Cheifetz, I., additional, Wrenn, S., additional, Kypuros, K., additional, Ackerman, K., additional, Maffei, F., additional, Bloomquist, G., additional, Rizkalla, N., additional, Kimura, D., additional, Shah, S., additional, Tigges, C., additional, Su, F., additional, Barlow, C., additional, Michelson, K., additional, Wolfe, K., additional, Goodman, D., additional, Campbell, L., additional, Sorce, L., additional, Bysani, K., additional, Monjure, T., additional, Evans, M., additional, Totapally, B., additional, Chegondi, M., additional, Rodriguez, C., additional, Frazier, J., additional, Steele, L., additional, Viteri, S., additional, Costarino, A., additional, Thomas, N., additional, Spear, D., additional, Hirshberg, E., additional, Lilley, J., additional, Rowan, C., additional, Rider, C., additional, Kane, J., additional, Zimmerman, J., additional, Greeley, C., additional, Lin, J., additional, Jacobs, R., additional, Parker, M., additional, Culver, K., additional, Loftis, L., additional, Jaimon, N., additional, Goldsworthy, M., additional, Fitzgerald, J., additional, Weiss, S., additional, Nadkarni, V., additional, Bush, J., additional, Diliberto, M., additional, Allen, C., additional, Gessouroun, M., additional, Sapru, A., additional, Lang, T., additional, Alkhouli, M., additional, Kamath, S., additional, Friel, D., additional, Daufeldt, J., additional, Hsing, D., additional, Carlo, C., additional, Pon, S., additional, Scimeme, J., additional, Shaheen, A., additional, Hassinger, A., additional, Qiao, H., additional, Giuliano, J., additional, Tala, J., additional, Vinciguerra, D., additional, Fernandez, A., additional, Carrero, R., additional, Hoyos, P., additional, Jaramillo, J., additional, Posada, A., additional, Izquiierdo, L., additional, Olave, B.E. Piñeres, additional, Donado, J., additional, Dalmazzo, R., additional, Rendich, S., additional, Palma, L., additional, Lapadula, M., additional, Acuna, C., additional, Cruces, P., additional, De Clety, S. Clement, additional, Dujardin, M., additional, Berghe, C., additional, Renard, S., additional, Zurek, J., additional, Steinherr, H., additional, Mougkou, K., additional, Critselis, E., additional, Di Nardo, M., additional, Picardo, S., additional, Tortora, F., additional, Rossetti, E., additional, Fragasso, T., additional, Cogo, P., additional, Netto, R., additional, Dagys, A., additional, Gurskis, V., additional, Kevalas, R., additional, Neeleman, C., additional, Lemson, J., additional, Luijten, C., additional, Wojciech, K., additional, Pagowska-Klimek, I., additional, Szczepanska, M., additional, Karpe, J., additional, Nunes, P., additional, Almeida, H., additional, Rios, J., additional, Vieira, M., additional, Iniguez, J. P. Garcia, additional, Revilla, P., additional, Urbano, J., additional, Lopez-Herce, J., additional, Bustinza, A., additional, Palacios, A., additional, Hofheinz, S., additional, Rodriguez-Nunez, A., additional, Sanagustin, S., additional, Gonzalez, E., additional, Riaza, M., additional, Piaya, R., additional, Soler, P., additional, Esteban, E., additional, Laraudogoitia, J., additional, Monge, C., additional, Herrera, V., additional, Granados, J., additional, Gonzalez, C., additional, Koroglu, T., additional, Ozcelik, E., additional, Baines, P., additional, Plunkett, A., additional, Davis, P., additional, George, S., additional, Tibby, S., additional, Harris, J., additional, Agbeko, R., additional, Lampitt, R., additional, Brierley, J., additional, Peters, M., additional, Jones, A., additional, Dominguez, T., additional, Thiruchelvam, T., additional, Deep, A., additional, Ridley, L., additional, Bowen, W., additional, Levin, R., additional, Macleod, I., additional, Gray, M., additional, Hemat, N., additional, Alexander, J., additional, Ali, S., additional, Pappachan, J., additional, McCorkell, J., additional, Fortune, P., additional, MacDonald, M., additional, Hudnott, P., additional, Suyun, Q., additional, Singhi, S., additional, Nallasamy, K., additional, Lodha, R., additional, Shime, N., additional, Tabata, Y., additional, Saito, O., additional, Ikeyama, T., additional, Kawasaki, T., additional, Lum, L., additional, Abidin, A., additional, Kee, S., additional, Tang, S., additional, Jalil, R., additional, Guan, Y., additional, Yao, L., additional, Lin, K., additional, Ong, J., additional, Salloo, A., additional, Doedens, L., additional, Mathivha, L., additional, Reubenson, G., additional, Moaisi, S., additional, Pentz, A., additional, Green, R., additional, Schibler, A., additional, Erickson, S., additional, McEneiry, J., additional, Long, D., additional, Dorofaeff, T., additional, Coulthard, M., additional, Millar, J., additional, Delzoppo, C., additional, Williams, G., additional, Morritt, M., additional, Watts, N., additional, Beca, J., additional, Sherring, C., additional, and Bushell, T., additional
- Published
- 2019
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14. Comparison of Pediatric Severe Sepsis Managed in U.S. and European ICUs
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Giuliano, John S, Markovitz, Barry P., Brierley, Joe, Levin, Richard, Williams, Gary, Lum, Lucy Chai See, Dorofaeff, Tavey, Cruces, Pablo, Bush, Jenny L., Keele, Luke, Nadkarni, Vinay M., Thomas, Neal J., Fitzgerald, Julie C., Weiss, Scott L., Fontela, P., Tucci, M., Dumistrascu, M., Skippen, P., Krahn, G., Bezares, E., Puig, G., Puig Ramos, A., Garcia, R., Villar, M., Bigham, M., Polanski, T., Latifi, S., Giebner, D., Anthony, H., Hume, J., Galster, A., Linnerud, L., Sanders, R., Hefley, G., Madden, K., Thompson, A., Shein, S., Gertz, S., Han, Y., Williams, T., Hughes Schalk, A., Chandler, H., Orioles, A., Zielinski, E., Doucette, A., Zebuhr, C., Wilson, T., Dimitriades, C., Ascani, J., Layburn, S., Valley, S., Markowitz, B., Terry, J., Morzov, R., Mcinnes, A., Mcarthur, J., Woods, K., Murkowski, K., Spaeder, M., Sharron, M., Wheeler, D., Beckman, E., Frank, E., Howard, K., Carroll, C., Nett, S., Jarvis, D., Patel, V., Higgerson, R., Christie, L., Typpo, K., Deschenes, J., Kirby, A., Uhl, T., Rehder, K., Cheifetz, I., Wrenn, S., Kypuros, K., Ackerman, K., Maffei, F., Bloomquist, G., Rizkalla, N., Kimura, D., Shah, S., Tigges, C., Su, F., Barlow, C., Michelson, K., Wolfe, K., Goodman, D., Campbell, L., Sorce, L., Bysani, K., Monjure, T., Evans, M., Totapally, B., Chegondi, M., Rodriguez, C., Frazier, J., Steele, L., Viteri, S., Costarino, A., Thomas, N., Spear, D., Hirshberg, E., Lilley, J., Rowan, C., Rider, C., Kane, J., Zimmerman, J., Greeley, C., Lin, J., Jacobs, R., Parker, M., Culver, K., Loftis, L., Jaimon, N., Goldsworthy, M., Fitzgerald, J., Weiss, S., Nadkarni, V., Bush, J., Diliberto, M., Alen, C., Gessouroun, M., Sapru, A., Lang, T., Alkhouli, M., Kamath, S., Friel, D., Daufeldt, J., Hsing, D., Carlo, C., Pon, S., Scimeme, J., Shaheen, A., Hassinger, A., Qiao, H., Giuliano, J., Tala, J., Vinciguerra, D., Fernandez, A., Carrero, R., Hoyos, P., Jaramillo, J., Posada, A., Izquiierdo, L., Piñeres Olave, B. E., Donado, J., Dalmazzo, R., Rendich, S., Palma, L., Lapadula, M., Acuna, C., Cruces, P., Clement De Clety, S., Dujardin, M., Berghe, C., Renard, S., Zurek, J., Steinherr, H., Mougkou, K., Critselis, E., Di Nardo, M., Picardo, S., Tortora, F., Rossetti, E., Fragasso, T., Cogo, Paola, Netto, R., Dagys, A., Gurskis, V., Kevalas, R., Neeleman, C., Lemson, J., Luijten, C., Wojciech, K., Pagowska Klimek, I., Szczepanska, M., Karpe, J., Nunes, P., Almeida, H., Rios, J., Vieira, M., Revilla, P., Urbano, J., Lopez Herce, J., Bustinza, A., Cuesta, A., Hofheinz, S., Rodriguez Nunez, A., Sanagustin, S., Gonzalez, E., Riaza, M., Piaya, R., Soler, P., Esteban, E., Laraudogoitia, J., Monge, C., Herrera, V., Granados, J., Gonzalez, C., Koroglu, T., Ozcelik, E., Baines, P., Plunkett, A., Davis, P., George, S., Tibby, S., Harris, J., Agbeko, R., Lampitt, R., Brierley, J., Peters, M., Jones, A., Dominguez, T., Thiruchelvam, T., Deep, A., Ridley, L., Bowen, W., Levin, R., Macleod, I., Gray, M., Hemat, N., Alexander, J., Ali, S., Pappachan, J., Mccorkell, J., Fortune, P., Macdonald, M., Hudnott, P., Suyun, Q., Singhi, S., Nallasamy, K., Lodha, R., Shime, N., Tabata, Y., Saito, O., Ikeyama, T., Kawasaki, T., Lum, L., Abidin, A., Kee, S., Tang, S., Jalil, R., Guan, Y., Yao, L., Lin, K., Ong, J., Salloo, A., Doedens, L., Mathivha, L., Reubenson, G., Moaisi, S., Pentz, A., Green, R., Schibler, A., Erickson, S., Mceneiry, J., Long, D., Dorofaeff, T., Coulthard, M., Millar, J., Delzoppo, C., Williams, G., Morritt, M., Watts, N., Beca, J., Sherring, C., and Bushell, T.
- Subjects
Male ,Pediatrics ,Cross-sectional study ,shock ,Critical Care and Intensive Care Medicine ,Severity of Illness Index ,0302 clinical medicine ,Prevalence ,Hospital Mortality ,Prospective Studies ,030212 general & internal medicine ,Practice Patterns, Physicians' ,Child ,Prospective cohort study ,Pediatric intensive care unit ,Perinatology and Child Health ,Europe ,Treatment Outcome ,Child, Preschool ,outcome ,children ,management ,pediatric intensive care unit ,Pediatrics, Perinatology and Child Health ,Female ,medicine.symptom ,medicine.medical_specialty ,Adolescent ,Critical Care ,Intensive Care Units, Pediatric ,Sepsis ,03 medical and health sciences ,Intensive care ,Severity of illness ,medicine ,Humans ,Healthcare Disparities ,business.industry ,Organ dysfunction ,Infant, Newborn ,Infant ,030208 emergency & critical care medicine ,Health Status Disparities ,medicine.disease ,United States ,Clinical trial ,Cross-Sectional Studies ,Multivariate Analysis ,Emergency medicine ,business - Abstract
Copyright © 2016 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.Objectives: Pediatric severe sepsis remains a significant global health problem without new therapies despite many multicenter clinical trials. We compared children managed with severe sepsis in European and U.S. PICUs to identify geographic variation, which may improve the design of future international studies. Design: We conducted a secondary analysis of the Sepsis PRevalence, OUtcomes, and Therapies study. Data about PICU characteristics, patient demographics, therapies, and outcomes were compared. Multivariable regression models were used to determine adjusted differences in morbidity and mortality. Setting: European and U.S. PICUs. Patients: Children with severe sepsis managed in European and U.S. PICUs enrolled in the Sepsis PRevalence, OUtcomes, and Therapies study. Interventions: None. Measurements and Main Results: European PICUs had fewer beds (median, 11 vs 24; p < 0.001). European patients were younger (median, 1 vs 6 yr; p < 0.001), had higher severity of illness (median Pediatric Index of Mortality-3, 5.0 vs 3.8; p = 0.02), and were more often admitted from the ward (37% vs 24%). Invasive mechanical ventilation, central venous access, and vasoactive infusions were used more frequently in European patients (85% vs 68%, p = 0.002; 91% vs 82%, p = 0.05; and 71% vs 50%; p < 0.001, respectively). Raw morbidity and mortality outcomes were worse for European compared with U.S. patients, but after adjusting for patient characteristics, there were no significant differences in mortality, multiple organ dysfunction, disability at discharge, length of stay, or ventilator/vasoactive-free days. Conclusions: Children with severe sepsis admitted to European PICUs have higher severity of illness, are more likely to be admitted from hospital wards, and receive more intensive care therapies than in the United States. The lack of significant differences in morbidity and mortality after adjusting for patient characteristics suggests that the approach to care between regions, perhaps related to PICU bed availability, needs to be considered in the design of future international clinical trials in pediatric severe sepsis.
- Published
- 2016
15. Comparison of Pediatric Severe Sepsis Managed in US and European ICUs
- Author
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Giuliano, J.S., Markovitz, B.P., Brierley, J., Levin, R., Williams, G., Lum, L.C.S., Dorofaeff, T., Cruces, P., Bush, J.L., Keele, L., Nadkarni, V.M., Thomas, N.J., Fitzgerald, J.C., Weiss, S.L., Fontela, P., Tucci, M., Dumistrascu, M., Skippen, P., Krahn, G., Bezares, E., Puig, G., Puig-Ramos, A., Garcia, R., Villar, M., Bigham, M., Polanski, T., Latifi, S., Giebner, D., Anthony, H., Hume, J., Galster, A., Linnerud, L., Sanders, R., Hefley, G., Madden, K., Thompson, A., Shein, S., Gertz, S., Han, Y., Williams, T., Hughes-Schalk, A., Chandler, H., Orioles, A., Zielinski, E., Doucette, A., Zebuhr, C., Wilson, T., Dimitriades, C., Ascani, J., Layburn, S., Valley, S., Markowitz, B., Terry, J., Morzov, R., McInnes, A., McArthur, J., Woods, K., Murkowski, K., Spaeder, M., Sharron, M., Wheeler, D., Beckman, E., Frank, E., Howard, K., Carroll, C., Nett, S., Jarvis, D., Patel, V., Higgerson, R., Christie, L., Typpo, K., Deschenes, J., Kirby, A., Uhl, T., Rehder, K., Cheifetz, I., Wrenn, S., Kypuros, K., Ackerman, K., Maffei, F., Bloomquist, G., Rizkalla, N., Kimura, D., Shah, S., Tigges, C., Su, F., Barlow, C., Michelson, K., Wolfe, K., Goodman, D., Campbell, L., Sorce, L., Bysani, K., Monjure, T., Evans, M., Totapally, B., Chegondi, M., Rodriguez, C., Frazier, J., Steele, L., Viteri, S., Costarino, A., Spear, D., Hirshberg, E., Lilley, J., Rowan, C., Rider, C., Kane, J., Zimmerman, J., Greeley, C., Lin, J., Jacobs, R., Parker, M., Culver, K., Loftis, L., Jaimon, N., Goldsworthy, M., Fitzgerald, J., Nadkarni, V., Bush, J., Diliberto, M., Alen, C., Gessouroun, M., Sapru, A., Lang, T., Alkhouli, M., Kamath, S., Friel, D., Daufeldt, J., Hsing, D., Carlo, C., Pon, S., Scimeme, J., Shaheen, A., Hassinger, A., Qiao, H., Giuliano, J., Tala, J., Vinciguerra, D., Fernandez, A., Carrero, R., Hoyos, P., Jaramillo, J., Posada, A., Izquiierdo, L., Piñeres Olave, B.E., Donado, J., Dalmazzo, R., Rendich, S., Palma, L., Lapadula, M., Acuna, C., Clement De Clety, S., Dujardin, M., Berghe, C., Renard, S., Zurek, J., Steinherr, H., Mougkou, K., Critselis, E., Di Nardo, M., Picardo, S., Tortora, F., Rossetti, E., Fragasso, T., Cogo, P., Netto, R., Dagys, A., Gurskis, V., Kevalas, R., Neeleman, C., Lemson, J., Luijten, C., Wojciech, K., Pagowska-Klimek, I., Szczepanska, M., Karpe, J., Nunes, P., Almeida, H., Rios, J., Vieira, M., Revilla, P., Urbano, J., Lopez-Herce, J., Bustinza, A., Cuesta, A., Hofheinz, S., Rodriguez-Nunez, A., Sanagustin, S., Gonzalez, E., Riaza, M., Piaya, R., Soler, P., Esteban-Torne E, Laraudogoitia, J., Monge, C., Herrera, V., Granados, J., Gonzalez, C., Koroglu, T., Ozcelik, E., Baines, P., Plunkett, A., Davis, P., George, S., Tibby, S., Harris, J., Agbeko, R., Lampitt, R., Peters, M., Jones, A., Dominguez, T., Thiruchelvam, T., Deep, A., Ridley, L., Bowen, W., Macleod, I., Gray, M., Hemat, N., Alexander, J., Ali, S., Pappachan, J., McCorkell, J., Fortune, P., MacDonald, M., Hudnott, P., Suyun, Q., Singhi, S., Nallasamy, K., Lodha, R., Shime, N., Tabata, Y., Saito, O., Ikeyama, T., Kawasaki, T., Lum, L., Abidin, A., Kee, S., Tang, S., Jalil, R., Guan, Y., Yao, L., Lin, K., Ong, J., Salloo, A., Doedens, L., Mathivha, L., Reubenson, G., Moaisi, S., Pentz, A., Green, R., Schibler, A., Erickson, S., McEneiry, J., Long, D., Coulthard, M., Millar, J., Delzoppo, C., Morritt, M., Watts, N., Beca, J., Sherring, C., and Bushell, T.
- Published
- 2016
16. Acute kidney injury in pediatric severe sepsis : An independent risk factor for death and new disability
- Author
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Fitzgerald, Julie C., Basu, Rajit K., Akcan-Arikan, Ayse, Izquierdo, Ledys M., Piñeres Olave, Byron E., Hassinger, Amanda B., Szczepanska, Maria, Deep, Akash, Williams, Duane, Sapru, Anil, Roy, Jason A., Nadkarni, Vinay M., Thomas, Neal J., Weiss, Scott L., Furth, Susan, Fontela, P., Tucci, M., Dumistrascu, M., Skippen, P., Krahn, G., Bezares, E., Puig, G., Puig-Ramos, A., Garcia, R., Villar, M., Bigham, M., Polanski, T., Latifi, S., Giebne, D., Anthony, H., Hume, J., Galster, A., Linnerud, L., Sanders, R., Hefley, G., Madden, K., Thompson, A., Shein, S., Gertz, S., Han, Y., Hughes-Schalk, A., Chandler, H., Orioles, A., Zielinski, E., Doucette, A., Zebuhr, C., Wilson, T., Dimitriades, C., Ascani, J., Layburn, S., Valley, S., Markowitz, B., Terry, J., Morzov, R., Mcinnes, A., McArthur, J., Woods, K., Murkowski, K., Spaeder, M., Sharron, M., Wheeler, D., Beckman, E., Frank, E., Howard, K., Carroll, C., Nett, S., Jarvis, D., Patel, V., Higgerson, R., Christie, L., Typpo, K., Deschenes, J., Kirby, A., Uhl, T., Rehder, K., Cheifetz, I., Wrenn, S., Kypuros, K., Ackerman, K., Maffei, F., Bloomquist, G., Rizkalla, N., Kimura, D., Shah, S., Tigges, C., Su, F., Barlow, C., Michelson, K., Wolfe, K., Goodman, D., Campbell, L., Sorce, L., Bysani, K., Monjure, T., Evans, M., Totapally, B., Chegondi, M., Rodriguez, C., Frazier, J., Steele, L., Viteri, S., Costarino, A., Spear, D., Hirshberg, E., Lilley, J., Rowan, C., Rider, C., Kane, J., Zimmerman, J., Greeley, C., Lin, J., Jacobs, R., Parker, M., Culver, K., Loftis, L., Jaimon, N., Goldsworthy, M., Bush, J., Diliberto, M., Allen, C., Gessouroun, M., Lang, T., Alkhouli, M., Kamath, S., Friel, D., Daufeldt, J., Hsing, D., Carlo, C., Pon, S., Scimeme, J., Shaheen, A., Qiao, H., Giuliano, J., Tala, J., Vinciguerra, D., Fernandez, A., Carrero, R., Hoyos, P., Jaramillo, J., Posada, A., Izquiierdo, L., Donado, J., Dalmazzo, R., Rendich, S., Palma, L., Lapadula, M., Acuna, C., Cruces, P., Clement De Clety, S., Dujardin, M., Berghe, C., Renard, S., Zurek, J., Steinherr, H., Mougkou, K., Critselis, E., Di Nardo, M., Picardo, S., Tortora, F., Rossetti, E., Fragasso, T., Cogo, P., Netto, R., Dagys, A., Gurskis, V., Kevalas, R., Neeleman, C., Lemson, J., Luijten, C., Wojciech, K., Pagowska-Klimek, I., Karpe, J., Nunes, P., Almeida, H., Rios, J., Vieira, M., Garcia Iniguez, JP, Revilla, P., Urbano, J., Lopez-Herce, J., Bustinza, A., Palacios, A., Hofheinz, S., Rodriguez-Nunez, A., Sanagustin, S., Gonzalez, E., Riaza, M., Piaya, R., Soler, P., Esteban, E., Laraudogoitia, J., Monge, C., Herrera, V., Granados, J., Gonzalez, C., Koroglu, T., Ozcelik, E., Baines, P., Plunkett, A., Davis, P., George, S., Tibby, S., Harris, J., Agbeko, R., Lampitt, R., Brierley, J., Peters, M., Jones, A., Dominguez, T., Thiruchelvam, T., Ridley, L., Bowen, W., Levin, R., Macleod, I., Gray, M., Hemat, N., Alexander, J., Ali, S., Pappachan, J., McCorkell, J., Fortune, P., MacDonald, M., Hudnott, P., Suyun, Q., Singhi, S., Nallasamy, K., Lodha, R., Shime, N., Tabata, Y., Saito, O., Ikeyama, T., Kawasaki, T., Lum, L., Abidin, A., Kee, S., Tang, S., Jalil, R., Guan, Y., Yao, L., Lin, K., Ong, J., Salloo, A., Doedens, L., Mathivha, L., Reubenson, G., Moaisi, S., Pentz, A., Green, R., Schibler, A., Long, D., Fitzgerald, Julie C., Basu, Rajit K., Akcan-Arikan, Ayse, Izquierdo, Ledys M., Piñeres Olave, Byron E., Hassinger, Amanda B., Szczepanska, Maria, Deep, Akash, Williams, Duane, Sapru, Anil, Roy, Jason A., Nadkarni, Vinay M., Thomas, Neal J., Weiss, Scott L., Furth, Susan, Fontela, P., Tucci, M., Dumistrascu, M., Skippen, P., Krahn, G., Bezares, E., Puig, G., Puig-Ramos, A., Garcia, R., Villar, M., Bigham, M., Polanski, T., Latifi, S., Giebne, D., Anthony, H., Hume, J., Galster, A., Linnerud, L., Sanders, R., Hefley, G., Madden, K., Thompson, A., Shein, S., Gertz, S., Han, Y., Hughes-Schalk, A., Chandler, H., Orioles, A., Zielinski, E., Doucette, A., Zebuhr, C., Wilson, T., Dimitriades, C., Ascani, J., Layburn, S., Valley, S., Markowitz, B., Terry, J., Morzov, R., Mcinnes, A., McArthur, J., Woods, K., Murkowski, K., Spaeder, M., Sharron, M., Wheeler, D., Beckman, E., Frank, E., Howard, K., Carroll, C., Nett, S., Jarvis, D., Patel, V., Higgerson, R., Christie, L., Typpo, K., Deschenes, J., Kirby, A., Uhl, T., Rehder, K., Cheifetz, I., Wrenn, S., Kypuros, K., Ackerman, K., Maffei, F., Bloomquist, G., Rizkalla, N., Kimura, D., Shah, S., Tigges, C., Su, F., Barlow, C., Michelson, K., Wolfe, K., Goodman, D., Campbell, L., Sorce, L., Bysani, K., Monjure, T., Evans, M., Totapally, B., Chegondi, M., Rodriguez, C., Frazier, J., Steele, L., Viteri, S., Costarino, A., Spear, D., Hirshberg, E., Lilley, J., Rowan, C., Rider, C., Kane, J., Zimmerman, J., Greeley, C., Lin, J., Jacobs, R., Parker, M., Culver, K., Loftis, L., Jaimon, N., Goldsworthy, M., Bush, J., Diliberto, M., Allen, C., Gessouroun, M., Lang, T., Alkhouli, M., Kamath, S., Friel, D., Daufeldt, J., Hsing, D., Carlo, C., Pon, S., Scimeme, J., Shaheen, A., Qiao, H., Giuliano, J., Tala, J., Vinciguerra, D., Fernandez, A., Carrero, R., Hoyos, P., Jaramillo, J., Posada, A., Izquiierdo, L., Donado, J., Dalmazzo, R., Rendich, S., Palma, L., Lapadula, M., Acuna, C., Cruces, P., Clement De Clety, S., Dujardin, M., Berghe, C., Renard, S., Zurek, J., Steinherr, H., Mougkou, K., Critselis, E., Di Nardo, M., Picardo, S., Tortora, F., Rossetti, E., Fragasso, T., Cogo, P., Netto, R., Dagys, A., Gurskis, V., Kevalas, R., Neeleman, C., Lemson, J., Luijten, C., Wojciech, K., Pagowska-Klimek, I., Karpe, J., Nunes, P., Almeida, H., Rios, J., Vieira, M., Garcia Iniguez, JP, Revilla, P., Urbano, J., Lopez-Herce, J., Bustinza, A., Palacios, A., Hofheinz, S., Rodriguez-Nunez, A., Sanagustin, S., Gonzalez, E., Riaza, M., Piaya, R., Soler, P., Esteban, E., Laraudogoitia, J., Monge, C., Herrera, V., Granados, J., Gonzalez, C., Koroglu, T., Ozcelik, E., Baines, P., Plunkett, A., Davis, P., George, S., Tibby, S., Harris, J., Agbeko, R., Lampitt, R., Brierley, J., Peters, M., Jones, A., Dominguez, T., Thiruchelvam, T., Ridley, L., Bowen, W., Levin, R., Macleod, I., Gray, M., Hemat, N., Alexander, J., Ali, S., Pappachan, J., McCorkell, J., Fortune, P., MacDonald, M., Hudnott, P., Suyun, Q., Singhi, S., Nallasamy, K., Lodha, R., Shime, N., Tabata, Y., Saito, O., Ikeyama, T., Kawasaki, T., Lum, L., Abidin, A., Kee, S., Tang, S., Jalil, R., Guan, Y., Yao, L., Lin, K., Ong, J., Salloo, A., Doedens, L., Mathivha, L., Reubenson, G., Moaisi, S., Pentz, A., Green, R., Schibler, A., and Long, D.
- Abstract
Objectives: The prevalence of septic acute kidney injury and impact on functional status of PICU survivors are unknown. We used data from an international prospective severe sepsis study to elucidate functional outcomes of children suffering septic acute kidney injury. Design: Secondary analysis of patients in the Sepsis PRevalence, OUtcomes, and Therapies point prevalence study: acute kidney injury was defined on the study day using Kidney Disease Improving Global Outcomes definitions. Patients with no acute kidney injury or stage 1 acute kidney injury ("no/mild acute kidney injury") were compared with those with stage 2 or 3 acute kidney injury ("severe acute kidney injury"). The primary outcome was a composite of death or new moderate disability at discharge defined as a Pediatric Overall Performance Category score of 3 or higher and increased by 1 from baseline. Setting: One hundred twenty-eight PICUs in 26 countries. Patients: Children with severe sepsis in the Sepsis PRevalence, OUtcomes, and Therapies study. Interventions: None. Measurements and Main Results: One hundred two (21%) of 493 patients had severe acute kidney injury. More than twice as many patients with severe acute kidney injury died or developed new moderate disability compared with those with no/mild acute kidney injury (64% vs 30%; p < 0.001). Severe acute kidney injury was independently associated with death or new moderate disability (adjusted odds ratio, 2.5; 95% CI, 1.5-4.2; p = 0.001) after adjustment for age, region, baseline disability, malignancy, invasive mechanical ventilation, albumin administration, and the pediatric logistic organ dysfunction score. Conclusions: In a multinational cohort of critically ill children with severe sepsis and high mortality rates, septic acute kidney injury is independently associated with further increased death or new disability.
- Published
- 2016
17. Comparison of pediatric severe sepsis managed in U.S. and European ICUs
- Author
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Giuliano, John S., Markovitz, Barry P., Brierley, Joe, Levin, Richard, Williams, Gary, Lum, Lucy Chai See, Dorofaeff, Tavey, Cruces, Pablo, Bush, Jenny L., Keele, Luke, Nadkarni, V., Thomas, Neal J., Fitzgerald, Julie C., Weiss, Scott L., Fontela, P., Tucci, M., Dumistrascu, M., Skippen, P., Krahn, G., Bezares, E., Puig, G., Puig-Ramos, A., Garcia, R., Villar, M., Bigham, M., Polanski, T., Latifi, S., Giebner, D., Anthony, H., Hume, J., Galster, A., Linnerud, L., Sanders, R., Hefley, G., Madden, K., Thompson, A., Shein, S., Gertz, S., Han, Y., Williams, T., Hughes-Schalk, A., Chandler, H., Orioles, A., Zielinski, E., Doucette, A., Zebuhr, C., Wilson, T., Dimitriades, C., Ascani, J., Layburn, S., Valley, S., Terry, J., Morzov, R., McInnes, A., McArthur, J., Woods, K., Murkowski, K., Spaeder, M., Sharron, M., Wheeler, D., Beckman, E., Frank, E., Howard, K., Carroll, C., Nett, S., Jarvis, D., Patel, V., Higgerson, R., Christie, L., Typpo, K., Deschenes, J., Kirby, A., Uhl, T., Rehder, K., Cheifetz, I., Wrenn, S., Kypuros, K., Ackerman, K., Maffei, F., Bloomquist, G., Rizkalla, N., Kimura, D., Shah, S., Tigges, C., Su, F., Barlow, C., Michelson, K., Wolfe, K., Goodman, D., Campbell, L., Sorce, L., Bysani, K., Monjure, T., Evans, M., Totapally, B., Chegondi, M., Rodriguez, C., Frazier, J., Steele, L., Viteri, S., Costarino, A., Spear, D., Hirshberg, E., Lilley, J., Rowan, C., Rider, C., Kane, J., Zimmerman, J., Greeley, C., Lin, J., Jacobs, R., Parker, M., Culver, K., Loftis, L., Jaimon, N., Goldsworthy, M., Diliberto, M., Alen, C., Gessouroun, M., Sapru, A., Lang, T., Alkhouli, M., Kamath, S., Friel, D., Daufeldt, J., Hsing, D., Carlo, C., Pon, S., Scimeme, J., Shaheen, A., Hassinger, A., Qiao, H., Tala, J., Vinciguerra, D., Fernandez, A., Carrero, R., Hoyos, P., Jaramillo, J., Posada, A., Izquiierdo, L., Piñeres Olave, B. E., Donado, J., Dalmazzo, R., Rendich, S., Palma, L., Lapadula, M., Acuna, C., Clement De Clety, S., Dujardin, M., Berghe, C., Renard, S., Zurek, J., Steinherr, H., Mougkou, K., Critselis, E., Di Nardo, M., Picardo, S., Tortora, F., Rossetti, E., Fragasso, T., Cogo, P., Netto, R., Dagys, A., Gurskis, V., Kevalas, R., Neeleman, C., Lemson, J., Luijten, C., Wojciech, K., Pagowska-Klimek, I., Szczepanska, M., Karpe, J., Nunes, P., Almeida, H., Rios, J., Vieira, M., Revilla, P., Urbano, J., Lopez-Herce, J., Bustinza, A., Cuesta, A., Hofheinz, S., Rodriguez-Nunez, A., Sanagustin, S., Gonzalez, E., Riaza, M., Piaya, R., Soler, P., Esteban, E., Laraudogoitia, J., Monge, C., Herrera, V., Granados, J., Gonzalez, C., Koroglu, T., Ozcelik, E., Baines, P., Plunkett, A., Davis, P., George, S., Tibby, S., Harris, J., Agbeko, R., Lampitt, R., Peters, M., Jones, A., Dominguez, T., Thiruchelvam, T., Deep, A., Ridley, L., Bowen, W., Macleod, I., Gray, M., Hemat, N., Alexander, J., Ali, S., Pappachan, J., McCorkell, J., Fortune, P., MacDonald, M., Hudnott, P., Suyun, Q., Singhi, S., Nallasamy, K., Lodha, R., Shime, N., Tabata, Y., Saito, O., Ikeyama, T., Kawasaki, T., Abidin, A., Kee, S., Tang, S., Jalil, R., Guan, Y., Yao, L., Lin, K., Ong, J., Salloo, A., Doedens, L., Mathivha, L., Reubenson, G., Moaisi, S., Pentz, A., Green, R., Giuliano, John S., Markovitz, Barry P., Brierley, Joe, Levin, Richard, Williams, Gary, Lum, Lucy Chai See, Dorofaeff, Tavey, Cruces, Pablo, Bush, Jenny L., Keele, Luke, Nadkarni, V., Thomas, Neal J., Fitzgerald, Julie C., Weiss, Scott L., Fontela, P., Tucci, M., Dumistrascu, M., Skippen, P., Krahn, G., Bezares, E., Puig, G., Puig-Ramos, A., Garcia, R., Villar, M., Bigham, M., Polanski, T., Latifi, S., Giebner, D., Anthony, H., Hume, J., Galster, A., Linnerud, L., Sanders, R., Hefley, G., Madden, K., Thompson, A., Shein, S., Gertz, S., Han, Y., Williams, T., Hughes-Schalk, A., Chandler, H., Orioles, A., Zielinski, E., Doucette, A., Zebuhr, C., Wilson, T., Dimitriades, C., Ascani, J., Layburn, S., Valley, S., Terry, J., Morzov, R., McInnes, A., McArthur, J., Woods, K., Murkowski, K., Spaeder, M., Sharron, M., Wheeler, D., Beckman, E., Frank, E., Howard, K., Carroll, C., Nett, S., Jarvis, D., Patel, V., Higgerson, R., Christie, L., Typpo, K., Deschenes, J., Kirby, A., Uhl, T., Rehder, K., Cheifetz, I., Wrenn, S., Kypuros, K., Ackerman, K., Maffei, F., Bloomquist, G., Rizkalla, N., Kimura, D., Shah, S., Tigges, C., Su, F., Barlow, C., Michelson, K., Wolfe, K., Goodman, D., Campbell, L., Sorce, L., Bysani, K., Monjure, T., Evans, M., Totapally, B., Chegondi, M., Rodriguez, C., Frazier, J., Steele, L., Viteri, S., Costarino, A., Spear, D., Hirshberg, E., Lilley, J., Rowan, C., Rider, C., Kane, J., Zimmerman, J., Greeley, C., Lin, J., Jacobs, R., Parker, M., Culver, K., Loftis, L., Jaimon, N., Goldsworthy, M., Diliberto, M., Alen, C., Gessouroun, M., Sapru, A., Lang, T., Alkhouli, M., Kamath, S., Friel, D., Daufeldt, J., Hsing, D., Carlo, C., Pon, S., Scimeme, J., Shaheen, A., Hassinger, A., Qiao, H., Tala, J., Vinciguerra, D., Fernandez, A., Carrero, R., Hoyos, P., Jaramillo, J., Posada, A., Izquiierdo, L., Piñeres Olave, B. E., Donado, J., Dalmazzo, R., Rendich, S., Palma, L., Lapadula, M., Acuna, C., Clement De Clety, S., Dujardin, M., Berghe, C., Renard, S., Zurek, J., Steinherr, H., Mougkou, K., Critselis, E., Di Nardo, M., Picardo, S., Tortora, F., Rossetti, E., Fragasso, T., Cogo, P., Netto, R., Dagys, A., Gurskis, V., Kevalas, R., Neeleman, C., Lemson, J., Luijten, C., Wojciech, K., Pagowska-Klimek, I., Szczepanska, M., Karpe, J., Nunes, P., Almeida, H., Rios, J., Vieira, M., Revilla, P., Urbano, J., Lopez-Herce, J., Bustinza, A., Cuesta, A., Hofheinz, S., Rodriguez-Nunez, A., Sanagustin, S., Gonzalez, E., Riaza, M., Piaya, R., Soler, P., Esteban, E., Laraudogoitia, J., Monge, C., Herrera, V., Granados, J., Gonzalez, C., Koroglu, T., Ozcelik, E., Baines, P., Plunkett, A., Davis, P., George, S., Tibby, S., Harris, J., Agbeko, R., Lampitt, R., Peters, M., Jones, A., Dominguez, T., Thiruchelvam, T., Deep, A., Ridley, L., Bowen, W., Macleod, I., Gray, M., Hemat, N., Alexander, J., Ali, S., Pappachan, J., McCorkell, J., Fortune, P., MacDonald, M., Hudnott, P., Suyun, Q., Singhi, S., Nallasamy, K., Lodha, R., Shime, N., Tabata, Y., Saito, O., Ikeyama, T., Kawasaki, T., Abidin, A., Kee, S., Tang, S., Jalil, R., Guan, Y., Yao, L., Lin, K., Ong, J., Salloo, A., Doedens, L., Mathivha, L., Reubenson, G., Moaisi, S., Pentz, A., and Green, R.
- Abstract
Objectives: Pediatric severe sepsis remains a significant global health problem without new therapies despite many multicenter clinical trials. We compared children managed with severe sepsis in European and U.S. PICUs to identify geographic variation, which may improve the design of future international studies. Design: We conducted a secondary analysis of the Sepsis PRevalence, OUtcomes, and Therapies study. Data about PICU characteristics, patient demographics, therapies, and outcomes were compared. Multivariable regression models were used to determine adjusted differences in morbidity and mortality. Setting: European and U.S. PICUs. Patients: Children with severe sepsis managed in European and U.S. PICUs enrolled in the Sepsis PRevalence, OUtcomes, and Therapies study. Interventions: None. Measurements and Main Results: European PICUs had fewer beds (median, 11 vs 24; p < 0.001). European patients were younger (median, 1 vs 6 yr; p < 0.001), had higher severity of illness (median Pediatric Index of Mortality-3, 5.0 vs 3.8; p = 0.02), and were more often admitted from the ward (37% vs 24%). Invasive mechanical ventilation, central venous access, and vasoactive infusions were used more frequently in European patients (85% vs 68%, p = 0.002; 91% vs 82%, p = 0.05; and 71% vs 50%; p < 0.001, respectively). Raw morbidity and mortality outcomes were worse for European compared with U.S. patients, but after adjusting for patient characteristics, there were no significant differences in mortality, multiple organ dysfunction, disability at discharge, length of stay, or ventilator/vasoactive-free days. Conclusions: Children with severe sepsis admitted to European PICUs have higher severity of illness, are more likely to be admitted from hospital wards, and receive more intensive care therapies than in the United States. The lack of significant differences in morbidity and mortality after
- Published
- 2016
18. Comparison of Pediatric Severe Sepsis Managed in U.S. and European ICUs
- Author
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Giuliano, J., Markovitz, B., Brierley, J., Levin, R., Williams, G., Lum, L., Dorofaeff, T., Cruces, P., Bush, J., Keele, L., Nadkarni, V., Thomas, N., Fitzgerald, J., Weiss, S., Fontela, P., Tucci, M., Dumistrascu, M., Skippen, P., Krahn, G., Bezares, E., Puig, G., Puig-Ramos, A., Garcia, R., Villar, M., Bigham, M., Polanski, T., Latifi, S., Giebner, D., Anthony, H., Hume, J., Galster, A., Linnerud, L., Sanders, R., Hefley, G., Madden, K., Thompson, A., Shein, S., Gertz, S., Han, Y., Williams, Teresa, Hughes-Schalk, A., Chandler, H., Orioles, A., Zielinski, E., Doucette, A., Zebuhr, C., Wilson, T., Dimitriades, C., Ascani, J., Layburn, S., Valley, S., Markowitz, B., Terry, J., Morzov, R., McInnes, A., McArthur, J., Woods, K., Murkowski, K., Spaeder, M., Sharron, M., Wheeler, D., Beckman, E., Frank, E., Howard, K., Carroll, C., Nett, S., Jarvis, D., Patel, V., Higgerson, R., Christie, L., Typpo, K., Deschenes, J., Kirby, A., Uhl, T., Rehder, K., Cheifetz, I., Wrenn, S., Kypuros, K., Ackerman, K., Maffei, F., Bloomquist, G., Rizkalla, N., Kimura, D., Shah, S., Tigges, C., Su, F., Barlow, C., Michelson, K., Wolfe, K., Goodman, D., Campbell, L., Sorce, L., Bysani, K., Monjure, T., Evans, M., Totapally, B., Chegondi, M., Giuliano, J., Markovitz, B., Brierley, J., Levin, R., Williams, G., Lum, L., Dorofaeff, T., Cruces, P., Bush, J., Keele, L., Nadkarni, V., Thomas, N., Fitzgerald, J., Weiss, S., Fontela, P., Tucci, M., Dumistrascu, M., Skippen, P., Krahn, G., Bezares, E., Puig, G., Puig-Ramos, A., Garcia, R., Villar, M., Bigham, M., Polanski, T., Latifi, S., Giebner, D., Anthony, H., Hume, J., Galster, A., Linnerud, L., Sanders, R., Hefley, G., Madden, K., Thompson, A., Shein, S., Gertz, S., Han, Y., Williams, Teresa, Hughes-Schalk, A., Chandler, H., Orioles, A., Zielinski, E., Doucette, A., Zebuhr, C., Wilson, T., Dimitriades, C., Ascani, J., Layburn, S., Valley, S., Markowitz, B., Terry, J., Morzov, R., McInnes, A., McArthur, J., Woods, K., Murkowski, K., Spaeder, M., Sharron, M., Wheeler, D., Beckman, E., Frank, E., Howard, K., Carroll, C., Nett, S., Jarvis, D., Patel, V., Higgerson, R., Christie, L., Typpo, K., Deschenes, J., Kirby, A., Uhl, T., Rehder, K., Cheifetz, I., Wrenn, S., Kypuros, K., Ackerman, K., Maffei, F., Bloomquist, G., Rizkalla, N., Kimura, D., Shah, S., Tigges, C., Su, F., Barlow, C., Michelson, K., Wolfe, K., Goodman, D., Campbell, L., Sorce, L., Bysani, K., Monjure, T., Evans, M., Totapally, B., and Chegondi, M.
- Abstract
Copyright © 2016 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.Objectives: Pediatric severe sepsis remains a significant global health problem without new therapies despite many multicenter clinical trials. We compared children managed with severe sepsis in European and U.S. PICUs to identify geographic variation, which may improve the design of future international studies. Design: We conducted a secondary analysis of the Sepsis PRevalence, OUtcomes, and Therapies study. Data about PICU characteristics, patient demographics, therapies, and outcomes were compared. Multivariable regression models were used to determine adjusted differences in morbidity and mortality. Setting: European and U.S. PICUs. Patients: Children with severe sepsis managed in European and U.S. PICUs enrolled in the Sepsis PRevalence, OUtcomes, and Therapies study. Interventions: None. Measurements and Main Results: European PICUs had fewer beds (median, 11 vs 24; p < 0.001). European patients were younger (median, 1 vs 6 yr; p < 0.001), had higher severity of illness (median Pediatric Index of Mortality-3, 5.0 vs 3.8; p = 0.02), and were more often admitted from the ward (37% vs 24%). Invasive mechanical ventilation, central venous access, and vasoactive infusions were used more frequently in European patients (85% vs 68%, p = 0.002; 91% vs 82%, p = 0.05; and 71% vs 50%; p < 0.001, respectively). Raw morbidity and mortality outcomes were worse for European compared with U.S. patients, but after adjusting for patient characteristics, there were no significant differences in mortality, multiple organ dysfunction, disability at discharge, length of stay, or ventilator/vasoactive-free days. Conclusions: Children with severe sepsis admitted to European PICUs have higher severity of illness, are more likely to be admitted from hospital wards, and receive more intensive care therapies than in the United States. The lack of
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- 2016
19. Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study
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Weiss, S., Fitzgerald, J., Maffei, F., Kane, J., Rodriguez-Nunez, A., Hsing, D., Franzon, D., Kee, S., Bush, J., Roy, J., Thomas, N., Nadkarni, V., Fontela, P., Tucci, M., Dumistrascu, M., Skippen, P., Krahn, G., Bezares, E., Puig, G., Puig-Ramos, A., Garcia, R., Villar, M., Bigham, M., Polanski, T., Latifi, S., Giebner, D., Anthony, H., Hume, J., Galster, A., Linnerud, L., Sanders, R., Hefley, G., Madden, K., Thompson, A., Shein, S., Gertz, S., Han, Y., Williams, Teresa, Hughes-Schalk, A., Chandler, H., Orioles, A., Zielinski, E., Doucette, A., Zebuhr, C., Wilson, T., Dimitriades, C., Ascani, J., Layburn, S., Valley, S., Markowitz, B., Terry, J., Morzov, R., McInnes, A., McArthur, J., Woods, K., Murkowski, K., Spaeder, M., Sharron, M., Wheeler, D., Beckman, E., Frank, E., Howard, K., Carroll, C., Nett, S., Jarvis, D., Patel, V., Higgerson, R., Christie, L., Typpo, K., Deschenes, J., Kirby, A., Uhl, T., Rehder, K., Cheifetz, I., Wrenn, S., Kypuros, K., Ackerman, K., Bloomquist, G., Rizkalla, N., Kimura, D., Shah, S., Tigges, C., Su, F., Barlow, C., Michelson, K., Wolfe, K., Goodman, D., Campbel, L., Sorce, L., Bysani, K., Monjure, T., Evans, M., Totapally, B., Chegondi, M., Rodriguez, C., Frazier, J., Weiss, S., Fitzgerald, J., Maffei, F., Kane, J., Rodriguez-Nunez, A., Hsing, D., Franzon, D., Kee, S., Bush, J., Roy, J., Thomas, N., Nadkarni, V., Fontela, P., Tucci, M., Dumistrascu, M., Skippen, P., Krahn, G., Bezares, E., Puig, G., Puig-Ramos, A., Garcia, R., Villar, M., Bigham, M., Polanski, T., Latifi, S., Giebner, D., Anthony, H., Hume, J., Galster, A., Linnerud, L., Sanders, R., Hefley, G., Madden, K., Thompson, A., Shein, S., Gertz, S., Han, Y., Williams, Teresa, Hughes-Schalk, A., Chandler, H., Orioles, A., Zielinski, E., Doucette, A., Zebuhr, C., Wilson, T., Dimitriades, C., Ascani, J., Layburn, S., Valley, S., Markowitz, B., Terry, J., Morzov, R., McInnes, A., McArthur, J., Woods, K., Murkowski, K., Spaeder, M., Sharron, M., Wheeler, D., Beckman, E., Frank, E., Howard, K., Carroll, C., Nett, S., Jarvis, D., Patel, V., Higgerson, R., Christie, L., Typpo, K., Deschenes, J., Kirby, A., Uhl, T., Rehder, K., Cheifetz, I., Wrenn, S., Kypuros, K., Ackerman, K., Bloomquist, G., Rizkalla, N., Kimura, D., Shah, S., Tigges, C., Su, F., Barlow, C., Michelson, K., Wolfe, K., Goodman, D., Campbel, L., Sorce, L., Bysani, K., Monjure, T., Evans, M., Totapally, B., Chegondi, M., Rodriguez, C., and Frazier, J.
- Abstract
Introduction: Consensus criteria for pediatric severe sepsis have standardized enrollment for research studies. However, the extent to which critically ill children identified by consensus criteria reflect physician diagnosis of severe sepsis, which underlies external validity for pediatric sepsis research, is not known. We sought to determine the agreement between physician diagnosis and consensus criteria to identify pediatric patients with severe sepsis across a network of international pediatric intensive care units (PICUs). Methods: We conducted a point prevalence study involving 128 PICUs in 26 countries across 6 continents. Over the course of 5 study days, 6925 PICU patients <18 years of age were screened, and 706 with severe sepsis defined either by physician diagnosis or on the basis of 2005 International Pediatric Sepsis Consensus Conference consensus criteria were enrolled. The primary endpoint was agreement of pediatric severe sepsis between physician diagnosis and consensus criteria as measured using Cohen's ?. Secondary endpoints included characteristics and clinical outcomes for patients identified using physician diagnosis versus consensus criteria. Results: Of the 706 patients, 301 (42.6 %) met both definitions. The inter-rater agreement (? ± SE) between physician diagnosis and consensus criteria was 0.57 ± 0.02. Of the 438 patients with a physician's diagnosis of severe sepsis, only 69 % (301 of 438) would have been eligible to participate in a clinical trial of pediatric severe sepsis that enrolled patients based on consensus criteria. Patients with physician-diagnosed severe sepsis who did not meet consensus criteria were younger and had lower severity of illness and lower PICU mortality than those meeting consensus criteria or both definitions. After controlling for age, severity of illness, number of comorbid conditions, and treatment in developed versus resource-limited regions, patients identified with severe sepsis by physician diagnosis
- Published
- 2015
20. Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study
- Author
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Weiss, Scott L, Fitzgerald, Julie C., Maffei, Frank A., Kane, Jason M., Rodriguez Nunez, Antonio, Hsing, Deyin D., Franzon, Deborah, Kee, Sze Ying, Bush, Jenny L., Roy, Jason A., Thomas, Neal J., Nadkarni, Vinay M., Fontela, P., Tucci, M., Dumistrascu, M., Skippen, P., Krahn, G., Bezares, E., Puig, G., Puig Ramos, A., Garcia, R., Villar, M., Bigham, M., Polanski, T., Latifi, S., Giebner, D., Anthony, H., Hume, J., Galster, A., Linnerud, L., Sanders, R., Hefley, G., Madden, K., Thompson, A., Shein, S., Gertz, S., Han, Y., Williams, T., Hughes Schalk, A., Chandler, H., Orioles, A., Zielinski, E., Doucette, A., Zebuhr, C., Wilson, T., Dimitriades, C., Ascani, J., Layburn, S., Valley, S., Markowitz, B., Terry, J., Morzov, R., Mcinnes, A., Mcarthur, J., Woods, K., Murkowski, K., Spaeder, M., Sharron, M., Wheeler, D., Beckman, E., Frank, E., Howard, K., Carroll, C., Nett, S., Jarvis, D., Patel, V., Higgerson, R., Christie, L., Typpo, K., Deschenes, J., Kirby, A., Uhl, T., Rehder, K., Cheifetz, I., Wrenn, S., Kypuros, K., Ackerman, K., Maffei, F., Bloomquist, G., Rizkalla, N., Kimura, D., Shah, S., Tigges, C., Su, F., Barlow, C., Michelson, K., Wolfe, K., Goodman, D., Campbel, L., Sorce, L., Bysani, K., Monjure, T., Evans, M., Totapally, B., Chegondi, M., Rodriguez, C., Frazier, J., Steele, L., Viteri, S., Costarino, A., Thomas, N., Spear, D., Hirshberg, E., Lilley, J., Rowan, C., Rider, C., Kane, J., Zimmerman, J., Greeley, C., Lin, J., Jacobs, R., Parker, M., Culver, K., Loftis, L., Jaimon, N., Goldsworthy, M., Fitzgerald, J., Weiss, S., Nadkarni, V., Bush, J., Diliberto, M., Alen, C., Gessouroun, M., Sapru, A., Lang, T., Alkhouli, M., Kamath, S., Friel, D., Daufeldt, J., Hsing, D., Carlo, C., Pon, S., Scimeme, J., Shaheen, A., Hassinger, A., Qiao, H., Giuliano, J., Tala, J., Vinciguerra, D., Fernandez, A., Carrero, R., Hoyos, P., Jaramillo, J., Posada, A., Izquiierdo, L., Piñeres Olave, B. E., Donado, J., Dalmazzo, R., Rendich, S., Palma, L., Lapadula, M., Acuna, C., Cruces, P., Clement De Clety, S., Dujardin, M., Berghe, C., Renard, S., Zurek, J., Steinherr, H., Mougkou, K., Critselis, E., Di Nardo, M., Picardo, S., Tortora, F., Rossetti, E., Fragasso, T., Cogo, Paola, Netto, R., Dagys, A., Gurskis, V., Kevalas, R., Neeleman, C., Lemson, J., Luijten, C., Wojciech, K., Pagowska Klimek, I., Szczepanska, M., Karpe, J., Nunes, P., Almeida, H., Rios, J., Vieira, M., Revilla, P., Urbano, J., Lopez Herce, J., Bustinza, A., Cuesta, A., Hofheinz, S., Rodriguez Nunez, A., Sanagustin, S., Gonzalez, E., Riaza, M., Piaya, R., Soler, P., Esteban, E., Laraudogoitia, J., Monge, C., Herrera, V., Granados, J., Gonzalez, C., Koroglu, T., Ozcelik, E., Baines, P., Plunkett, A., Davis, P., George, S., Tibby, S., Harris, J., Agbeko, R., Lampitt, R., Bierley, J., Peters, M., Jones, A., Dominguez, T., Thiruchelvam, T., Deep, A., Ridley, L., Bowen, W., Levin, R., Macleod, I., Gray, M., Hemat, N., Alexander, J., Ali, S., Pappachan, J., Mccorkell, J., Schibler, A., Fortune, P., Macdonald, M., Hudnott, P., Erickson, S., Millar, J., Delzoppo, C., Williams, G., Morritt, M., Mceneiry, J., Long, D., Dorofaeff, T., Coulthard, M., Watts, N., Suyun, Q., Singhi, S., Nallasamy, K., Lodha, R., Shime, N., Tabata, Y., Saito, O., Ikeyama, T., Kawasaki, T., Lum, L., Abidin, A., Kee, S., Tang, S., Jalil, R., Beca, J., Sherring, C., Bushell, T., Guan, Y., Yao, L., Lin, K., Ong, J., Salloo, A., Doedens, L., Mathivha, L., Reubenson, G., Moaisi, S., Pentz, A., and Green, R.
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Male ,medicine.medical_specialty ,Biomedical Research ,Adolescent ,lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4] ,Practice Patterns ,macromolecular substances ,Critical Care and Intensive Care Medicine ,Sepsis ,Intensive care ,Epidemiology ,Severity of illness ,Clinical endpoint ,Prevalence ,Medicine ,Humans ,Practice Patterns, Physicians' ,Preschool ,Intensive care medicine ,Child ,Pediatric intensive care unit ,Observer Variation ,Physicians' ,business.industry ,Research ,Organ dysfunction ,Infant, Newborn ,Infant ,Child, Preschool ,Female ,Treatment Outcome ,Newborn ,medicine.disease ,3. Good health ,Clinical trial ,medicine.symptom ,business - Abstract
Introduction Consensus criteria for pediatric severe sepsis have standardized enrollment for research studies. However, the extent to which critically ill children identified by consensus criteria reflect physician diagnosis of severe sepsis, which underlies external validity for pediatric sepsis research, is not known. We sought to determine the agreement between physician diagnosis and consensus criteria to identify pediatric patients with severe sepsis across a network of international pediatric intensive care units (PICUs). Methods We conducted a point prevalence study involving 128 PICUs in 26 countries across 6 continents. Over the course of 5 study days, 6925 PICU patients Results Of the 706 patients, 301 (42.6 %) met both definitions. The inter-rater agreement (κ ± SE) between physician diagnosis and consensus criteria was 0.57 ± 0.02. Of the 438 patients with a physician’s diagnosis of severe sepsis, only 69 % (301 of 438) would have been eligible to participate in a clinical trial of pediatric severe sepsis that enrolled patients based on consensus criteria. Patients with physician-diagnosed severe sepsis who did not meet consensus criteria were younger and had lower severity of illness and lower PICU mortality than those meeting consensus criteria or both definitions. After controlling for age, severity of illness, number of comorbid conditions, and treatment in developed versus resource-limited regions, patients identified with severe sepsis by physician diagnosis alone or by consensus criteria alone did not have PICU mortality significantly different from that of patients identified by both physician diagnosis and consensus criteria. Conclusions Physician diagnosis of pediatric severe sepsis achieved only moderate agreement with consensus criteria, with physicians diagnosing severe sepsis more broadly. Consequently, the results of a research study based on consensus criteria may have limited generalizability to nearly one-third of PICU patients diagnosed with severe sepsis.
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- 2015
21. Advances in health surveillance among persons with intellectual disabilities
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Krahn, G., Oulette-Kuntz, H., Emerson, E., Glover, G., Cocks, E., Rosenwax, Lorna, Krahn, G., Oulette-Kuntz, H., Emerson, E., Glover, G., Cocks, E., and Rosenwax, Lorna
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- 2012
22. Continuous Central Venous Oxygen Saturation Monitoring under Varying Physiological Conditions in an Animal Model
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Kissoon, N., primary, Spenceley, N., additional, Krahn, G., additional, and Milner, R., additional
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- 2010
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23. Classical versus quantum dynamics of the atomic Josephson junction
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Krahn, G J, primary and O'Dell, D H J, additional
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- 2009
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24. Charakterisierung von autokatalytischen Zersetzungsreaktionen anhand von Messungen mit einem dynamischen Differenzkalorimeter
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Fischer, S., primary, Krahn, G., additional, and Reimer, B., additional
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- 2007
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25. Evaluation of microcalorimetric measurements in terms of information content for decomposition reactions
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Fischer, S., primary, Krahn, G., additional, and Reimer, B., additional
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- 2006
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26. Reducing Health Disparity in People with Intellectual Disabilities: A Report from Health Issues Special Interest Research Group of the International Association for the Scientific Study of Intellectual Disabilities1
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Scheepers, M., primary, Kerr, M., additional, O'Hara, D., additional, Bainbridge, D., additional, Cooper, S.‐A., additional, Davis, R., additional, Fujiura, G., additional, Heller, T., additional, Holland, A., additional, Krahn, G., additional, Lennox, N., additional, Meaney, J., additional, and Wehmeyer, M., additional
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- 2005
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27. Risk and protective factors for sporadic basal cell carcinoma: results of a two-centre case-control study in southern Germany. Clinical actinic elastosis may be a protective factor
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Walther, U., primary, Kron, M., additional, Sander, S., additional, Sebastian, G., additional, Sander, R., additional, Peter, R.U., additional, Meurer, M., additional, Krahn, G., additional, and Kaskel, P., additional
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- 2004
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28. Outdoor activities in childhood: a protective factor for cutaneous melanoma? Results of a case-control study in 271 matched pairs
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Kaskel, P., primary, Sander, S., additional, Kron, M., additional, Kind, P., additional, Peter, R.U., additional, and Krahn, G., additional
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- 2001
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29. Non-professional identification of malignant melanoma: are wives more attentive?
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Kaskel, P., primary, Kind, P., additional, Sander, S., additional, Peter, R.U., additional, and Krahn, G., additional
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- 1999
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30. Evaluation of a pediatric central venous oximetry catheter in critically ill children.
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Spenceley N, Krahn G, Skippen PW, and Kissoon N
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- 2010
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31. Developing summary scores of health-related quality of life for a population-based survey.
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Horner-Johnson W, Krahn G, Andresen E, Hall T, and RRTC Expert Panel on Health Status Measurement
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Objective. Health-related quality of life (HRQOL) is an important indicator of public health. The Centers for Disease Control and Prevention's (CDC's) Behavioral Risk Factor Surveillance System (BRFSS) includes nine HRQOL items that can be used to monitor the health status of the nation. The objective of this study was to examine the numerical relationships among these HRQOL items to develop summary scores by combining items. Methods. Using 2001 and 2002 BRFSS data from states that included all nine HRQOL questions, factor analyses were performed to determine whether the items would group together into multi-item scales. Results. Two factors emerged, corresponding conceptually to a physical health construct and a mental health construct. The resulting scales demonstrated acceptable internal consistency and ability to distinguish between population subgroups known to differ on HRQOL. Conclusions. This study provides support for condensing the BRFSS core and optional HRQOL questions into two scales. These scales provide more complete information about physical and mental HRQOL than is available from single items, while limiting the number of individual variables required for a given analysis. However, the four core HRQOL questions focus primarily on physical health. Thus, the five supplemental questions should be included when measuring mental health is of interest. [ABSTRACT FROM AUTHOR]
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- 2009
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32. Reducing catheter-associated blood stream infections in a pediatric intensive care unit: a collaborative effort.
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Sharar ZA, Northway T, Skippen P, Braun L, Krahn G, Kissoon N, and Milner R
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- 2008
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33. Use of complementary and alternative medicine practitioners by people with physical disabilities: estimates from a national US survey.
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Carlson MJ and Krahn G
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PURPOSE: To estimate the prevalence of complementary and alternative medicine (CAM) practitioner use, assess the reasons for use, and determine the symptoms for which CAM practitioners were consulted in a national US sample of insured adults with physical disabilities. METHODS: Data for this study come from a longitudinal survey conducted in 2000 and 2001 on a national sample of 830 adults with health insurance who had one of four disabling conditions: multiple sclerosis, cerebral palsy, spinal cord injury, and arthritis. Estimates of annual prevalence and reasons and symptoms for which CAM practitioners were consulted are derived from cross-sectional analysis of the 2001 survey data. Prior use of CAM was assessed using the 2000 survey. RESULTS: CAM practitioners were consulted by 19% of the sample, a rate similar to, or higher than the general population. CAM use was more prevalent among women than men (24 vs. 10%), in the Western US (30%) compared to the Midwest (20%) Northeast (14%), and South (10%) and among prior users (62%) compared to non-users (8%). There were no significant differences in CAM use by condition, although individuals with spinal cord injury reported the lowest use (14%). Common symptoms treated were pain (80%), decreased functioning (43%), and lack of energy (24%). Common reasons for using CAM practitioners included lifestyle choice (67%) and because they are perceived to be more effective than conventional medicine (44%). CONCLUSIONS: Evidence from the current survey suggests that a significant proportion of people with physical disabilities consult CAM practitioners. Many of those who use CAM do so because it fits their lifestyle and because they perceive it to be more effective than conventional medicine for treating common symptoms including pain and decreased functioning. [ABSTRACT FROM AUTHOR]
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- 2006
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34. Recognizing and responding to the health disparities of people with disabilities.
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Drum CE, Krahn G, Culley C, and Hammond L
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- 2005
35. UVB-induced Decrease of p16/CDKN2A Expression in Skin Cancer Patients.
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Krahn, G., Leiter, U., Udart, M., Kaskel, P., and Peter, R. U.
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GENE expression , *DNA polymerases , *SKIN cancer , *ERYTHEMA , *STRUCTURE-activity relationships ,GENETIC aspects - Abstract
Focuses on a study which determined the p16/CDKN2A gene expression by reverse transcription polymerase chain reaction in patients with skin cancer. Descriptive statistical analysis on6 p16/CDKN2A expression ratio; Comparison of expression levels in skin cancer patients and in healthy individuals; Regulation of p16 after ultraviolet beta exposure at minimal erythema dose.
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- 2001
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36. Coexpression patterns of EGFR, HER2, HER3 and HER4 in non-melanoma skin cancer
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Krahn, G., Leiter, U., Kaskel, P., Udart, M., Utikal, J., Bezold, G., and Peter, R. U.
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- 2001
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37. Mycophenolate mofetil: A new therapeutic option in the treatment of blistering autoimmune diseases
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Grundmann-Kollmann, M., Korting, H.C., Behrens, S., Kaskel, P., Leiter, U., Krahn, G., Kerscher, M., and Peter, R.U.
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Background: Mycophenolate mofetil (MMF), an ester of mycophenolic acid (MPA), was approved by the Food and Drug Administration in 1995 and is currently primarily indicated for the prophylaxis of rejection in renal transplant patients. The drug seems also to be of value in the treatment of psoriasis and rheumatic arthritis. Recently there have been 6 reported cases of successful treatment of blistering autoimmune diseases with MMF in combination with high dose prednisone therapy. Objective: On the basis of these reports we administered this new treatment regimen to several patients with blistering autoimmune diseases. Besides using a combination of MMF and high-dose prednisone we wanted to evaluate whether MMF monotherapy is also effective in the treatment of blistering autoimmune diseases. Methods: We administered MMF to 5 patients who had severe pemphigus vulgaris or bullous pemphigoid. Two patients received MMF in combination with high-dose prednisone therapy and 3 patients received MMF monotherapy. To our knowledge, this is the first report of successful treatment of pemphigus vulgaris and bullous pemphigoid with MMF monotherapy. Results: All patients were completely free of symptoms within 8 to 11 weeks of therapy. Patients who had received MMF monotherapy responded as well to treatment as those who received a combination of MMF and high-dose prednisone. Conclusion: Our experiences strongly suggest that MMF monotherapy may be effective for patients even with severe pemphigus vulgaris and bullous pemphigoid. In addition, MMF monotherapy, at least over the short term, offers the advantage of fewer side effects in comparison to immunosuppressive combination therapy and was well tolerated by our patients. (J Am Acad Dermatol 1999;40:957-60.)
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- 1999
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38. S-100 protein in peripheral blood: A marker for melanoma metastases
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Kaskel, P., Berking, C., Sander^b, S., Volkenandt, M., Peter, R.U., and Krahn, G.
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Background: S-100 protein, commonly used in the immunohistochemical diagnosis of malignant melanoma and melanoma metastases, has recently been introduced as a tumor marker in peripheral blood. Objective: This prospective, observational, 2-center study evaluates S-100 in peripheral blood of patients with melanoma as a marker for metastasis. Methods: With application of an immunoluminometric assay, S-100 levels in 1396 samples of 570 patients with melanoma and 53 control subjects were measured in a blinded manner. Results: The cut-off level for patients with melanoma without medical history of metastases versus patients with newly occurring lymph node, visceral, and/or brain metastases was 0.114 @mg/L, with a sensitivity of 94% (95% confidence interval, 86.4%-98.5%) and a specificity of 91% (95% confidence interval, 87.7%-93.6%). False-negative results included patients with unknown primary melanoma and those with amelanotic melanoma metastases. Conclusion: The data suggest that S-100 in the peripheral blood of patients with melanoma could serve as a marker indicating new melanoma metastases and could help to monitor the course of the disease. (J Am Acad Dermatol 1999;41:962-9.)
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- 1999
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39. Interferon gamma in survivors of the Chernobyl power plant accident: new therapeutic option for radiation-induced fibrosis
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Peter, R.U., Gottlober, P., Nadeshina, N., Krahn, G., Braun-Falco, O., and Plewig, G.
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- 1999
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40. Ein Beitrag zur Thermodynamik von Polymerlösungen
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Rätzsch, M. T., Krahn, G., and Peinze, K.
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- 1974
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41. Zur modifizierten Theorie der regulären Lösung
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Rätzsch, M. T., Krahn, G., Illig, G., and Reisdorf, H.-J.
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- 1974
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42. Erratum: Expression of c-myc and bcl-2 in primary and advanced cutaneous melanoma (Cancer Investigation (2002) 20: 7-8 (914-921))
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Utikal, J., Ulrike Leiter, Udart, M., Kaskel, P., Peter, R. U., and Krahn, G. M.
43. DFM Pak®, a novel combination of Bacillus strains reduces environmental E coli bioburden, manure buildup, and odor compounds in the swine housing environment
- Author
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Lee, J., primary, Galbraith, E., additional, Krahn, G., additional, Spencer, J., additional, Son, S., additional, and King, M., additional
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44. From product development to field implementation
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Spencer, J., primary and Krahn, G., additional
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45. Two dimensional transformations and its application to vehicle motion control and analysis.
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Kanayama, Y., MacPherson, D., and Krahn, G.
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- 1993
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46. Performance of the pediatric logistic organ dysfunction-2 score in critically ill children requiring plasma transfusions
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Alvin Yiu, Suzan Cochius-den Otter, David Inwald, Rica Morzov, Stephen McKeever, Laura Campbell, Marie E. Steiner, Tracey Bushell, Aurélie Portefaix, Manuel Nieto Faza, Dan Nerheim, Marisa Tucci, Simon Erickson, Maria Teresa Alonso, Melissa Thomas, Amanda Johnson, Marc Andre Dugas, Miriam Rea, Petr Jirasek, David McKinley, Melania M. Bembea, Jennifer Sankey, Isobel MacLeod, Pierre Louis Leger, Elizabeth Scarlett, Marisa Vieira, Joan Balcells, Anna Deho, Erin Felkel, Amina Abdulla, Shancy Rooze, Maria José Solana, Davinia E. Withington, Scot T. Bateman, Arash Afshari, Olivier Brissaud, Peter Davis, Etienne Javouhey, Marcy Singleton, Pierre Tissieres, Stéphan Clénent de Cléty, Barry P. Markovitz, Lee Ann M. Christie, Carmel Delzoppo, Kelly Michelson, Lois Sanders, Anne Mette Baek Jensen, Tavey Dorofaeff, Nicola Kelly, Fleur Cour-Andlauer, John Beca, Maria Pisarcikova, Matthieu Maria, Miriam Santschi, Claire Sherring, Pierre Demaret, Simon J. Stanworth, Lasse Hoegh Andersen, Michael C. McCrory, Antonio Morales Martinez, Ariane Willems, Debbie Spear, Debbie Long, Douglas F. Willson, Sophie Raghunanan, Marc Trippaerts, Marianne E. Nellis, Caroline P. Ozment, Bettina Von Dessauer, Jennifer A. Muszynski, Nicolas Roullet-Renoleau, Saleh Alshehri, Bob Taylor, Annick De Jaeger, Sheila J. Hanson, Julie Guichoux, Nathan Smalley, Jesús López-Herce, Aimée Dorkenoo, Barney Scholefield, Sholeen Nett, Gavin Morrison, Marie-Hélène Perez, Christopher Babbitt, Dean Jarvis, Alice Bordessoule, Gunnar Bentsen, Kevin O’Brien, Katherine Woods, Marta Vazquez Moyano, Carsten Doell, Jens Christian Nilsson, Santiago Campos Mino, Vivianne Amiet, Samuel J. Ajizian, Karen Choong, Audrey Breining, Oliver Karam, Anna Camporesi, Kym Bain, Guillaume Mortamet, Richard Levin, Antonio Perez-Ferrer, Alain Duhamel, Janice Tijssen, Caroline Berghe, Marie Horan, Kathy Murkowski, Margaret M. Parker, Michelle Hoot, Tatsuya Kawasaki, Liz Rourke, Hannah Sparkes, Gordon Krahn, Lisa Steele, Andrew Michael, David Triscari, Jay Rilinger, David Wensley, Iolanda Jordan, Minal Parikh, Stéphane Leteurtre, Manal Alasnag, Jozef De Dooy, Alison Shefler, Nadia Ordenes, Nicolas Joram, Katie McCall, Daniel Martin, Jill M. Cholette, Renee A. Higgerson, Shira Gertz, Asumthia Jeyapalan, Marta Moniz, S. Faustino, Jose Carlos Flores González, Machelle Zink, Valerie Payen, Satnam Virdee, Edward J. Truemper, Julia Hickey, Elaine Gilfoyle, Federica Mario, Mariana Dumitrascu, Vanessa Rea, Joe Brierley, Gabriela Pereira, Lynette Wohlgemuth, Victoria Brown, Berber Kapitein, E. Vincent, Vicki L. Montgomery, Harry Steinherr, Kay C. Hawkins, Greg Wiseman, Mathias Johansen, Glenn Levine, Louise Gosselin, Warwick Butt, Jesús de Vicente Sánchez, Susan George, Amanda Galster, Alexandra Dinis, Filippia Nikolaou, Jeff Terry, Michelle Grunauer, Philip C. Spinella, Martin C. J. Kneyber, Shinya Miura, Mickael Afanetti, Andrea Kelleher, Neal J. Thomas, Kim Sykes, Anke Top, CHU Lille, Université de Lille, Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS], METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694, University of Oxford, University of Washington [Seattle], John Radcliffe Hospital [Oxford University Hospital], CHU Sainte Justine [Montréal], Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), University of Oxford [Oxford], PlasmaTV investigators, Butt, W., Delzoppo, C., Bain, K., Erickson, S., Smalley, N., Dorofaeff, T., Long, D., Wiseman, G., Clénent de Cléty, S., Berghe, C., de Jaeger, A., Demaret, P., Trippaerts, M., Willems, A., Rooze, S., De Dooy, J., Gilfoyle, E., Wohlgemuth, L., Tucci, M., Dumitrascu, M., Withington, D., Hickey, J., Choong, K., Sanders, L., Morrison, G., Tijssen, J., Wensley, D., Krahn, G., Dugas, M.A., Gosselin, L., Santschi, M., Von Dessauer, B., Ordenes, N., Afshari, A., Andersen, L.H., Nilsson, J.C., Johansen, M., Baek Jensen, A.M., Campos Mino, S., Grunauer, M., Joram, N., Roullet-Renoleau, N., Javouhey, E., Cour-Andlauer, F., Portefaix, A., Brissaud, O., Guichoux, J., Payen, V., Léger, P.L., Afanetti, M., Mortamet, G., Maria, M., Breining, A., Tissieres, P., Dorkenoo, A., Deho, A., Steinherr, H., Nikolaou, F., Camporesi, A., Mario, F., Kawasaki, T., Miura, S., Beca, J., Rea, M., Sherring, C., Bushell, T., Bentsen, G., Dinis, A., Pereira, G., Vieira, M., Moniz, M., Alshehri, S., Alasnag, M., Pisarcikova, M., Jordan, I., Balcells, J., Perez-Ferrer, A., de Vicente Sánchez, J., Vazquez Moyano, M., Morales Martinez, A., Lopez-Herce, J., Solana, M.J., Flores González, J.C., Alonso, M.T., Nieto Faza, M., Perez, M.H., Amiet, V., Doell, C., Bordessoule, A., Cochius-den Otter, S., Kapitein, B., Kneyber, M., Brierley, J., Rea, V., McKeever, S., Kelleher, A., Scholefield, B., Top, A., Kelly, N., Virdee, S., Davis, P., George, S., Hawkins, K.C., McCall, K., Brown, V., Sykes, K., Levin, R., MacLeod, I., Horan, M., Jirasek, P., Inwald, D., Abdulla, A., Raghunanan, S., Taylor, B., Shefler, A., Sparkes, H., Hanson, S., Woods, K., Triscari, D., Murkowski, K., Ozment, C., Steiner, M., Nerheim, D., Galster, A., Higgerson, R., Christie, L., Spinella, P.C., Martin, D., Rourke, L., Muszynski, J., Steele, L., Ajizian, S., McCrory, M.C., O'Brien, K., Babbitt, C., Felkel, E., Levine, G., Truemper, E.J., Zink, M., Nellis, M., Thomas, N.J., Spear, D., Markovitz, B., Terry, J., Morzov, R., Montgomery, V., Michael, A., Thomas, M., Singleton, M., Jarvis, D., Nett, S., Willson, D., Hoot, M., Bembea, M., Yiu, A., McKinley, D., Scarlett, E., Sankey, J., Parikh, M., Faustino, EVS, Michelson, K., Rilinger, J., Campbell, L., Gertz, S., Cholette, J.M., Jeyapalan, A., Parker, M., Bateman, S., Johnson, A., UCL - (SLuc) Service de soins intensifs, UCL - SSS/IREC/PEDI - Pôle de Pédiatrie, and Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)
- Subjects
medicine.medical_specialty ,Population ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology ,Organ Dysfunction Scores ,Internal medicine ,medicine ,030212 general & internal medicine ,10. No inequality ,Intensive care medicine ,education ,Children ,Outcome ,Pediatric intensive care unit ,education.field_of_study ,[SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics ,ddc:618 ,business.industry ,Mortality rate ,Research ,Organ dysfunction ,Score ,Critical care ,Multiple organ failure ,Plasma transfusion ,030208 emergency & critical care medicine ,Clinical trial ,PlasmaTV investigators ,Observational study ,medicine.symptom ,business - Abstract
BACKGROUND: Organ dysfunction scores, based on physiological parameters, have been created to describe organ failure. In a general pediatric intensive care unit (PICU) population, the PEdiatric Logistic Organ Dysfunction-2 score (PELOD-2) score had both a good discrimination and calibration, allowing to describe the clinical outcome of critically ill children throughout their stay. This score is increasingly used in clinical trials in specific subpopulation. Our objective was to assess the performance of the PELOD-2 score in a subpopulation of critically ill children requiring plasma transfusions.METHODS: This was an ancillary study of a prospective observational study on plasma transfusions over a 6-week period, in 101 PICUs in 21 countries. All critically ill children who received at least one plasma transfusion during the observation period were included. PELOD-2 scores were measured on days 1, 2, 5, 8, and 12 after plasma transfusion. Performance of the score was assessed by the determination of the discrimination (area under the ROC curve: AUC) and the calibration (Hosmer-Lemeshow test).RESULTS: Four hundred and forty-three patients were enrolled in the study (median age and weight: 1 year and 9.1 kg, respectively). Observed mortality rate was 26.9 % (119/443). For PELOD-2 on day 1, the AUC was 0.76 (95 % CI 0.71-0.81) and the Hosmer-Lemeshow test was p = 0.76. The serial evaluation of the changes in the daily PELOD-2 scores from day 1 demonstrated a significant association with death, adjusted for the PELOD-2 score on day 1.CONCLUSIONS: In a subpopulation of critically ill children requiring plasma transfusion, the PELOD-2 score has a lower but acceptable discrimination than in an entire population. This score should therefore be used cautiously in this specific subpopulation.
- Published
- 2016
47. Pediatric Delirium Educational Tool Development With Intensive Care Unit Clinicians and Caregivers in Canada: Focus Group Study.
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Wood M, Gandhi K, Chapman A, Skippen P, Krahn G, Görges M, and Stewart SE
- Abstract
Background: Pediatric intensive care unit (PICU)-associated delirium contributes to a decline in postdischarge quality of life, with worse outcomes for individuals with delayed identification. As delirium screening rates remain low within PICUs, caregivers may be able to assist with early detection, for which they need more education, as awareness of pediatric delirium among caregivers remains limited., Objective: This study aimed to develop an educational tool for caregivers to identify potential delirium symptoms during their child's PICU stay, educate them on how to best support their child if they experience delirium, and guide them to relevant family resources., Methods: Web-based focus groups were conducted at a tertiary pediatric hospital with expected end users of the tool (ie, PICU health care professionals and caregivers of children with an expected PICU length of stay of over 48 h) to identify potential educational information for inclusion in a family resource guide and to identify strategies for effective implementation. Data were analyzed thematically to generate requirements to inform prototype development. Participants then provided critical feedback on the initial prototype, which guided the final design., Results: In all, 24 participants (18 health care professionals and 6 caregivers) attended 7 focus groups. Participants identified five informational sections for inclusion: (1) delirium definition, (2) key features of delirium (signs and symptoms), (3) postdischarge outcomes associated with delirium, (4) tips to inform family-centered care, and (5) education or supportive resources. Participants identified seven design requirements: information should (1) be presented in an order that resembles the structure of the clinical discussion around delirium; (2) increase accessibility, recall, and preparedness by providing multiple formats; (3) aim to reduce stress by implementing positive framing; (4) minimize cognitive load to ensure adequate information processing; (5) provide supplemental electronic resources via QR codes; (6) emphasize collaboration between caregivers and the health care team; and (7) use prompting questions to act as a call to action for caregivers., Conclusions: Key design requirements derived from end-user feedback were established and guided the development of a novel pediatric delirium education tool. Implementing this tool into regular practice has the potential to reduce distress and assist in the early recognition and treatment of delirium in the PICU domain. Future evaluation of its clinical utility is necessary., (© Michael Wood, Kavi Gandhi, Andrea Chapman, Peter Skippen, Gordon Krahn, Matthias Görges, S Evelyn Stewart. Originally published in JMIR Pediatrics and Parenting (https://pediatrics.jmir.org).)
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- 2023
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48. Recruiting the Voices of Persons With Intellectual and Developmental Disabilities in Policy Development: Priorities for Health Equity Data.
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Krahn G, Cargill-Willis K, Bersani L, Moore T, and Johnson J
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- Adult, Child, Humans, Quality of Life, Developmental Disabilities, Policy, Health Equity, Intellectual Disability, Disabled Persons
- Abstract
Through focus groups, adults with intellectual and developmental disabilities (IDD) provided their priorities for health equity data, surveys, and information dissemination by U.S. federal agencies. Participants reported privacy concerns about sharing information, need for better data to promote access to quality health care and services, and need for information on social contexts that influence quality of life. Data should include functional limitations, health risks, and priorities for health care, and should support choice and self-determination. Adults with IDD believe parents or support persons do not always share their views, raising concerns about proxy reporting. Surveys and information need to use clear language, visual aids, and provide neutral supports. Information should be shared broadly, including to persons with IDD and families, health care professionals, and policy makers., (©AAIDD.)
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- 2023
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49. Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children.
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Napolitano N, Polikoff L, Edwards L, Tarquinio KM, Nett S, Krawiec C, Kirby A, Salfity N, Tellez D, Krahn G, Breuer R, Parsons SJ, Page-Goertz C, Shults J, Nadkarni V, and Nishisaki A
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- Child, Child, Preschool, Humans, Infant, Hypoxia etiology, Oxygen, Respiration, Artificial methods, Critical Illness epidemiology, Critical Illness therapy, Intubation, Intratracheal adverse effects, Intubation, Intratracheal methods
- Abstract
Background: Determine if apneic oxygenation (AO) delivered via nasal cannula during the apneic phase of tracheal intubation (TI), reduces adverse TI-associated events (TIAEs) in children., Methods: AO was implemented across 14 pediatric intensive care units as a quality improvement intervention during 2016-2020. Implementation consisted of an intubation safety checklist, leadership endorsement, local champion, and data feedback to frontline clinicians. Standardized oxygen flow via nasal cannula for AO was as follows: 5 L/min for infants (< 1 year), 10 L/min for young children (1-7 years), and 15 L/min for older children (≥ 8 years). Outcomes were the occurrence of adverse TIAEs (primary) and hypoxemia (SpO
2 < 80%, secondary)., Results: Of 6549 TIs during the study period, 2554 (39.0%) occurred during the pre-implementation phase and 3995 (61.0%) during post-implementation phase. AO utilization increased from 23 to 68%, p < 0.001. AO was utilized less often when intubating infants, those with a primary cardiac diagnosis or difficult airway features, and patient intubated due to respiratory or neurological failure or shock. Conversely, AO was used more often in TIs done for procedures and those assisted by video laryngoscopy. AO utilization was associated with a lower incidence of adverse TIAEs (AO 10.5% vs. without AO 13.5%, p < 0.001), aOR 0.75 (95% CI 0.58-0.98, p = 0.03) after adjusting for site clustering (primary analysis). However, after further adjusting for patient and provider characteristics (secondary analysis), AO utilization was not independently associated with the occurrence of adverse TIAEs: aOR 0.90, 95% CI 0.72-1.12, p = 0.33 and the occurrence of hypoxemia was not different: AO 14.2% versus without AO 15.2%, p = 0.43., Conclusion: While AO use was associated with a lower occurrence of adverse TIAEs in children who required TI in the pediatric ICU after accounting for site-level clustering, this result may be explained by differences in patient, provider, and practice factors. Trial Registration Trial not registered., (© 2023. The Author(s).)- Published
- 2023
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50. Unlocking the Potential of State Level Data: Opportunities to Monitor Health and Related Outcomes in People With Intellectual and Developmental Disabilities.
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Bonardi A, Lauer E, Lulinski A, Fay ML, Morris A, Nygren MA, and Krahn G
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- Data Collection, Humans, Population Surveillance, United States, Developmental Disabilities, Health Status, Intellectual Disability
- Abstract
No single U.S. health surveillance system adequately describes the health of people with intellectual and developmental disabilities (IDD). Researchers and policy makers have sought to understand the potential of state and local administrative and survey data to produce a local as well as a national picture of the health of the population with IDD. Analyses of these secondary data sources have significant appeal because of the potential to derive new information without the burden and expense of new data collection. The authors examined the potential for data collected by states and territories to inform health surveillance in the population with IDD, including data from the administration of eligibility-based supports, health insurance claims, and surveys administered for monitoring and quality improvement. Although there are opportunities to align and harmonize datasets to enhance the available information, there is no simple path to use state and local data to assess and report on the health of the population with IDD. Recommendations for policy, practice, and research include the development and use of consistent operational definitions in data collection, and research to fill knowledge gaps.
- Published
- 2019
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