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1. Impact on postoperative bleeding and cost of recombinant activated factor VII in patients undergoing heart transplantation

Author

Allison L Hollis, Ashleigh V Lowery, Mehrnaz Pajoumand, Si M Pham, Julia F Slejko, Kenichi A Tanaka, and Michael Mazzeffi

Subjects
Bleeding, Heart transplantation, Recombinant activated factor VII, Transfusion, Anesthesiology, RD78.3-87.3, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: Cardiac transplantation can be complicated by refractory hemorrhage particularly in cases where explantation of a ventricular assist device is necessary. Recombinant activated factor VII (rFVIIa) has been used to treat refractory bleeding in cardiac surgery patients, but little information is available on its efficacy or cost in heart transplant patients. Methods: Patients who had orthotopic heart transplantation between January 2009 and December 2014 at a single center were reviewed. Postoperative bleeding and the total costs of hemostatic therapies were compared between patients who received rFVIIa and those who did not. Propensity scores were created and used to control for the likelihood of receiving rFVIIa in order to reduce bias in our risk estimates. Results: Seventy-six patients underwent heart transplantation during the study period. Twenty-one patients (27.6%) received rFVIIa for refractory intraoperative bleeding. There was no difference in postoperative red blood cell transfusion, chest tube output, or surgical re-exploration between patients who received rFVIIa and those who did not, even after adjusting with the propensity score (P = 0.94, P = 0.60, and P = 0.10, respectively). The total cost for hemostatic therapies was significantly higher in the rFVIIa group (median $10,819 vs. $1,985; P < 0.0001). Subgroup analysis of patients who underwent redo-sternotomy with left ventricular assist device explantation did not show any benefit for rFVIIa either. Conclusions: In this relatively small cohort, rFVIIa use was not associated with decreased postoperative bleeding in patients undergoing heart transplantation; however, it led to significantly higher cost.

Published
2016
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2. Stannsoporfin with phototherapy to treat hyperbilirubinemia in newborn hemolytic disease

Author

Rana Alissa, N. Shafi, A. Jewell, Shiva Gautam, W. Wong, Anna L. Brown, N. Katof, L. Bettica, W. Rosenfeld, A. Barringham, J. Nason, M. Hudak, Mark L. Hudak, O. Fofah, S. Kicklighter, Karen E. Shattuck, K. Pollock, Dan L. Stewart, F. Banfro, Nancy Ruiz, Ramasubbareddy Dhanireddy, A. Eldemerdash, L. G. Camp, R. Bimbi, Jaeyeoul Kim, L. Meloy, F. D. Kehinde, Warren Rosenfeld, D. Reyes, P. Smith, Carol L. Wagner, A. Maddox, G. Rhodes Ryan, E. Maduekwe, Nazeeh Hanna, Susan E. Richter, L. Clark, V. Lowery, B. Chakraborty, M.R. Thomas, and S. Crawford

Subjects
medicine.medical_specialty, business.industry, Internal medicine, Pediatrics, Perinatology and Child Health, medicine, Tin-mesoporphyrin, Obstetrics and Gynecology, Stannsoporfin, Placebo, medicine.disease, business, Gastroenterology, Hemolysis
Abstract

OBJECTIVE To evaluate the efficacy and safety of tin mesoporphyrin (SnMP) in neonates with hyperbilirubinemia (HB) due to hemolysis. STUDY DESIGN This multicenter, placebo-controlled phase 2b study (NCT01887327) randomized newborns (35-42 weeks) with hemolysis started on phototherapy (PT) to placebo (Ctrl), SnMP 3.0 mg/kg, or SnMP 4.5 mg/kg given once IM within 30 min of initiation of PT. RESULTS In all, 91 patients were randomized (Ctrl: n = 30; 3 mg/kg SnMP: n = 30; 4.5 mg/kg SnMP: n = 31). At 48 h TSB significantly increased in Ctrl by 17.5% (95% CI 5.6-30.7; p = 0.004) and significantly decreased by -13% (95% CI -21.7 to -3.2; p = 0.013) in the 3.0 mg/kg and by -10.5% (95% CI -19.4 to -0.6; p = 0.041) in the 4.5 mg/kg group. Decreases in SnMP groups were significant (p

Published
2021
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3. Contributors

Author

David Adams, Sherri L. Adams, Chhavi Agarwal, Elizabeth R. Alpern, Armand H. Matheny Antommaria, Megan H. Bair-Merritt, Lourival Baptista-Neto, Jill Baren, Carl R. Baum, Eric D. Baum, Pamela J. Beasley, Suzanne Beno, Laurie A. Bernard, Stacey E. Bernstein, Chad K. Brands, Laura K. Brennan, Marisa B. Brett-Fleegler, Manish J. Butte, Julie Story Byerley, Diane P. Calello, Deirdre Caplin, Rebecca G. Carlisle, Douglas W. Carlson, Jean Marie Carroll, Mary Wu Chang, Grace M. Cheng, Aaron S. Chidekel, Denesh K. Chitkara, Bill Chiu, Christine S. Cho, Jeanne S. Chow, Bartley G. Cilento, Susan E. Coffin, Bernard A. Cohen, Kristina A. Cole, Patrick H. Conway, Maura Cooper, Timothy Cornell, Kate M. Cronan, Catherine Cross, Bari B. Cunningham, Melody J. Cunningham, Jennifer A. Daru, Ian J. Davis, Matthew A. Deardorff, Barbara Degar, Michael DelVecchio, David Ray DeMaso, Marissa de Ungria, Stephanie B. Dewar, Craig C. DeWolfe, Martha Dimmers, James G.H. Dinulos, Ed Donovan, Kenneth J. Dooley, Emmanuel Doyne, Christine N. Duncan, Marie Egan, Lawrence F. Eichenfield, Moussa El-hallak, Scott A. Elisofon, Stephen C. Eppes, Michele Burns Ewald, Mirna M. Farah, Chris Feudtner, Andrew M. Fine, Susan Hetzel Frangiskakis, Gary Frank, Eric Frehm, Nicole R. Frei, Ilona J. Frieden, Eron Y. Friedlaender, Jeremy Friedman, Robert Hugh Fryer, David R. Fulton, Paul J. Galardy, Mirabai Galashan, Mary Pat Gallagher, Beth D. Gamulka, Rupali Gandhi, Mary B. Garza, Maria C. Garzon, Robert L. Geggel, Michael H. Gewitz, Timothy Gibson, Amy E. Gilliam, Katherine B. Ginnis, Amy Goldberg, Anna M. Golja, Melissa J. Gregory, April A. Harper, Mary Catherine Harris, Natalie Hayes, Matthew M. Heeney, Diana M. Heinzman, Meredith Lee Heltzer, Keith D. Herzog, Malinda Ann Hill, Jessica L. Hills, Alejandro Hoberman, K. Sarah Hoehn, Amber M. Hoffman, Robert J. Hoffman, Amy P. Holst, Charles J. Homer, Paul J. Honig, Patricia M. Hopkins, Mark D. Hormann, B. David Horn, Michael S. Isakoff, Katherine A. Janeway, Katherine Ahn Jin, Maureen M. Jonas, Tammy Kang, Krista Keilty, Ron Keren, Anupam Kharbanda, Marin Kiesau, Caroline C. Kim, Jason Y. Kim, Juliann Lipps Kim, Nicola Klein, Paul K. Kleinman, Joel B. Korin, Uma Kotagal, Lisa K. Kresnicka, Rana N. Kronfol, Cynthia L. Kuelbs, Subra Kugathasan, Amethyst C. Kurbegov, Christopher P. Landrigan, Miriam Laufer, Christine Lauren, Daniel J. Lebovitz, Natasha Leibel, Lucinda P. Leung, Leonard J. Levine, Jason A. Levy, Phyllis A. Lewis, Marilyn G. Liang, Daniel J. Licht, Carolyn M. Long, Jeffrey P. Louie, Barry A. Love, Patricia V. Lowery, Ian B. MacLusky, Katarzyna Madejczyk, Mary Beth Madonna, Sanjay Mahant, Paul E. Manicone, Jennifer Maniscalco, Keith Mann, Rebekah Mannix, Jonathan M. Mansbach, Peter Mattei, Oscar H. Mayer, Sarah C. McBride, Kevin D. McBryde, Michele R. McKee, William McNett, Sanford M. Melzer, Talene A. Metjian, Denise W. Metry, Stephen E. Muething, Emily E. Milliken, Laura J. Mirkinson, Manoj K. Mittal, Angela C. Mix, Debra Monzack, Kimberly D. Morel, Douglas E. Moses, Eugene M. Mowad, Elizabeth A. Mullen, John B. Mulliken, Sharon Muret-Wagstaff, Nancy Murphy, Frances M. Nadel, Joshua Nagler, James A. Nard, Mark I. Neuman, Jason G. Newland, Alice W. Newton, Peter F. Nichol, Lise E. Nigrovic, Richard J. Noel, Sharon E. Oberfield, Maureen M. O'Brien, Karen J. O'Connell, Kevin C. Osterhoudt, Mary Ottolini, Raj Padman, Horacio M. Padua, Alka Patel, Susmita Pati, Jack M. Percelay, Jeannette M. Perez-Rossello, Kieran J. Phelan, Annapurna Poduri, J. Rainer Poley, Jill C. Posner, Sampath Prahalad, Howard B. Pride, Daniel Rauch, David J. Rawat, Scott Reeves, Daniel H. Reirden, Brandie J. Roberts, Jack Rodgers, José R. Romero, Paul Rosen, David M. Rubin, Esther Maria Sampayo, Lisa Samson-Fang, Gina Santucci, Julie V. Schaffer, Karen E. Schetzina, Sandra Schwab, Donald F. Schwarz, Jordan Scott, Steven M. Selbst, Kara N. Shah, Samir S. Shah, Nader Shaikh, Michael W. Shannon, Adhi N. Sharma, George K. Siberry, Karen Smith, Michael J. Smith, Michael J.G. Somers, Neal Sondheimer, Steven J. Spalding, Philip R. Spandorfer, Jonathan M. Spergel, Jeffrey L. Sperring, David A. Spiegel, Rajendu Srivastava, Keith H. St. John, Michael C. Stephens, Christopher C. Stewart, Bryan L. Stone, Erin R. Stucky, Eric R. Sundel, Robert Sundel, Suzanne Swanson, Lesli Taylor, E. Douglas Thompson, Avram Z. Traum, Harsh K. Trivedi, Bryan D. Upham, Andrea M. Vandeven, Brigid L. Vaughan, Charles P. Venditti, Venus M. Villalva, Robert N. Vincent, Samuel Volchenboum, Michael T. Vossmeyer, Robert M. Wachter, Daniel J. Weiner, Michael Weinstein, Elizabeth A. Wharff, Stephen D. Wilson, Jerry A. Winkelstein, Heidi Wolf, George A. Woodward, Albert C. Yan, Elaine H. Zackai, Andrea L. Zaenglein, Theoklis E. Zaoutis, and David Zipes

Published
2007
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4. Pancreatitis

Author

Patricia V. Lowery and J. Rainer Poley

Subjects
medicine.medical_specialty, business.industry, Internal medicine, Medicine, Pancreatitis, business, medicine.disease, Gastroenterology
Published
2007
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5. Step in the right direction

Author

Darryl V. Lowery

Subjects
Advanced and Specialized Nursing, Assessment and Diagnosis, Emergency Nursing, LPN and LVN, Critical Care Nursing
Published
2007
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7. Eliminating Contamination in Umbilical Cord Blood Culture Sampling for Early-Onset Neonatal Sepsis.

Author

Quinones Cardona V, Lowery V, Cooperberg D, Anday EK, and Carey AJ

Abstract

Introduction: Despite the advantages of umbilical cord blood culture (UCBC) use for diagnosis of early onset sepsis (EOS), contamination rates have deterred neonatologists from its widespread use. We aimed to implement UCBC collection in a level III neonatal intensive care unit (NICU) and apply quality improvement (QI) methods to reduce contamination in the diagnosis of early onset sepsis. Methods: Single-center implementation study utilizing quality improvement methodology to achieve 0% contamination rate in UCBC samples using the Plan-Do-Study-Act (PDSA) model for improvement. UCBC was obtained in conjunction with peripheral blood cultures (PBC) in neonates admitted to the NICU due to maternal chorioamnionitis. Maternal and neonatal characteristics between clinical sepsis and asymptomatic groups were compared. Process, outcome, and balancing measures were monitored. Results: Eighty-two UCBC samples were collected in addition to peripheral blood culture from neonates admitted due to maternal chorioamnionitis. Ten (12%) neonates had a diagnosis of clinical sepsis. All PBCs were negative and 5 UCBCs were positive in the study period. After 2 PDSA cycles, there was special cause variation with improvement in the percent of contaminated samples from 7.3 to 0%. There was no change in antibiotic duration among asymptomatic neonates. Conclusions: Implementation of UCBC for the diagnosis of EOS in term infants is feasible and contamination can be minimized with the implementation of a core team of trained providers and a proper sterile technique without increasing antibiotic duration., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Quinones Cardona, Lowery, Cooperberg, Anday and Carey.)

Published
2021
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