Mental Health Symptoms in Parents of Infants 3 Months After Discharge Following Neonatal Cardiac Surgery.

Background: Parents of newborns with congenital heart disease (CHD) are at risk for anxiety, depression, and post-traumatic stress. Few studies have examined whether modifiable factors that influence parents' mental health after discharge are present during postoperative care in the pediatric cardiac intensive care unit (PCICU).

Objective: To describe mental health symptoms of parents of infants with CHD 3 months after PCICU discharge and to determine factors during the PCICU stay that are predictors of such symptoms.

Evaluating Consistency of Documented ICD Codes for Hospitalized Patients With Sickle Cell Disease.

Objectives: Conducting health services research relies on consistent diagnosis code documentation; however, it is unknown if consistent documentation in claims data occurs among patients with sickle cell disease (SCD) and/or trait (SCT). The objective of this study was to examine the consistency of International Classification of Diseases (ICD) code documentation for SCD/SCT and identify coding discrepancies between patients' hospitalizations.

Patients: A total of 80 031 hospitalization records across 528 hospitals belonging to 15 380 unique patients who had at least 1 documentation of SCD/SCT and 2 or more hospitalizations during the study period (April 2015-December 2016).

Anesthesia and Sedation Exposure and Neurodevelopmental Outcomes in Infants Undergoing Congenital Cardiac Surgery: A Retrospective Cohort Study.

Background: Children undergoing complex cardiac surgery are exposed to substantial cumulative doses of sedative medications and volatile anesthetics and are more frequently anesthetized with ketamine, compared with healthy children. This study hypothesized that greater exposure to sedation and anesthesia in this population is associated with lower neurodevelopmental scores at 18 months of age.

Methods: A secondary analysis was conducted of infants with congenital heart disease who participated in a prospective observational study of environmental exposures and neurodevelopmental outcomes to assess the impact of cumulative volatile anesthetic agents and sedative medications.

Segregation Predicts COVID-19 Fatalities in Less Densely Populated Counties.

Aim It is well known that social determinants of health (SDoH) have affected COVID-19 outcomes, but these determinants are broad and complex. Identifying essential determinants is a prerequisite to address widening health disparities during the evolving COVID-19 pandemic. Methods County-specific COVID-19 fatality data from California, Illinois, and New York, three US states with the highest county-cevel COVID-19 fatalities as of June 15, 2020, were analyzed.

Role alteration predicts anxiety and depressive symptoms in parents of infants with congenital heart disease: a pilot study.

Background: Parents of infants born with critical congenital heart disease are at risk for adverse mental health symptoms. The purpose of this study was to identify infant-, parent-, and environmental-based stressors for mothers and fathers after their infants' cardiac surgery, and to explore relationships between stressors and mental health symptoms of anxiety and depression.

Methods: This study enrolled 28 biological mother-father dyads from families admitted to the paediatric cardiac intensive care unit for cardiac surgery at one free-standing children's hospital in the Northeast.

Parental role alteration strongly influences depressive symptoms in mothers of preoperative infants with congenital heart disease.

Background: Mothers of infants with congenital heart disease are at risk for depression.

Objectives: This study explored the influence on maternal depressive symptoms of several known factors for mothers in the pediatric cardiac intensive care unit, including perceived stressors, attachment, and anxiety.

Methods: This study was a secondary analysis of 30 mothers of infants awaiting cardiac surgery.

Evaluating a child care-based social marketing approach for improving children's diet and physical activity: results from the Healthy Me, Healthy We cluster-randomized controlled trial.

Child care-based interventions offer an opportunity to reach children at a young and impressionable age to support healthy eating and physical activity behaviors. Ideally, these interventions engage caregivers, including both childcare providers and parents, in united effort. This study evaluated the impact of the Healthy Me, Healthy We intervention on children's diet quality and physical activity.

Skin-to-Skin Care is Associated with Reduced Stress, Anxiety, and Salivary Cortisol and Improved Attachment for Mothers of Infants With Critical Congenital Heart Disease.

Objective: To estimate the effect of skin-to-skin care (SSC) on biobehavioral measures of stress (anxiety and salivary cortisol) and attachment (attachment scores and salivary oxytocin) of mothers before and after their infants' neonatal cardiac surgery.

Design: A prospective interventional, baseline response-paired pilot study.

Setting: Cardiac center of a large, metropolitan, freestanding children's hospital.

Skin-to-Skin Care Is a Safe and Effective Comfort Measure for Infants Before and After Neonatal Cardiac Surgery.

Objectives: To determine the effect of skin-to-skin care on stress, pain, behavioral organization, and physiologic stability of infants with critical congenital heart disease before and after neonatal cardiac surgery.

Design: A baseline response-paired design was used, with infants acting as their own controls before, during, and after skin-to-skin care at two distinct time points: once in the preoperative period (T1) and once in the postoperative period (T2).

Setting: Cardiac ICU and step-down unit in a large metropolitan freestanding children's hospital.

ASD Screening with the Child Behavior Checklist/1.5-5 in the Study to Explore Early Development.

We analyzed CBCL/1½-5 Pervasive Developmental Problems (DSM-PDP) scores in 3- to 5-year-olds from the Study to Explore Early Development (SEED), a multi-site case control study, with the objective to discriminate children with ASD (N = 656) from children with Developmental Delay (DD) (N = 646), children with Developmental Delay (DD) plus ASD features (DD-AF) (N = 284), and population controls (POP) (N = 827). ASD diagnosis was confirmed with the ADOS and ADI-R. With a cut-point of T ≥ 65, sensitivity was 80% for ASD, with specificity varying across groups: POP (0.

Remote Ischemic Preconditioning Does Not Prevent White Matter Injury in Neonates.

Background: Remote ischemic preconditioning (RIPC) is a mechanism to protect tissues from injury during ischemia and reperfusion. We investigated the neuroprotective effects of RIPC in neonates undergoing cardiac surgery.

Methods: The outcome was white matter injury (WMI), assessed by the change in volume of WMI from preoperative to postoperative brain magnetic resonance imaging (MRI).

Fistulography of a Patent Hemodialysis Access: When Not to Treat and Implications for Establishing a Nontreatment Rate.

Purpose: To establish a rate of nonintervention in patients referred for hemodialysis access fistulography and to report clinical and fistulographic variables associated with nonintervention.

Materials And Methods: Encounters for fistulography were reviewed from 2001 to 2016 to determine annual rates of nontreatment over 15 years. Next, an access database was used to retrospectively identify patients undergoing fistulography from 2010 to 2016.

Unmasking of Previously Asymptomatic Central Venous Stenosis following Percutaneous Transluminal Angioplasty of Hemodialysis Access.

Purpose: To determine the frequency of new-onset symptoms of central venous stenosis (CVS) after percutaneous transluminal angioplasty (PTA) of a hemodialysis access-related stenosis in patients with previously asymptomatic CVS and to identify risk factors for this phenomenon.

Materials And Methods: Retrospective review was performed of patients treated with PTA for an access-related stenosis (excluding central vein interventions) between 2001 and 2016 who returned within 3 months with symptoms of CVS (ie, "unmasking"): 39 patients met these criteria. A control group of 122 patients who had untreated asymptomatic CVS and did not experience unmasking was selected.

Changes in Dietary Intake and Eating Behavior in Adolescents After Bariatric Surgery: an Ancillary Study to the Teen-LABS Consortium.

Background: A growing number of studies suggest that bariatric surgery is safe and effective for adolescents with severe obesity. However, surprisingly little is known about changes in dietary intake and eating behavior of adolescents who undergo bariatric surgery.

Objective: Investigate changes in dietary intake and eating behavior of adolescents with obesity who underwent bariatric surgery (n = 119) or lifestyle modification (LM) (n = 169).

Rates of autism and potential risk factors in children with congenital heart defects.

Objective: Atypical development, behavioral difficulties, and academic underachievement are common morbidities in children with a history of congenital heart defects and impact quality of life. Language and social-cognitive deficits have been described, which are associated with autism spectrum disorders. The current study aimed to assess the rates of autism spectrum disorders in a large sample of children with a history of congenital heart defects and to assess medical, behavioral, and individual factors that may be associated with the risk of autism spectrum disorders.

Persistence in Coil-Embolized Pulmonary Arteriovenous Malformations with Feeding Artery Diameters of 3 mm or Less: A Retrospective Single-Center Observational Study.

Purpose: To assess persistence in coil-embolized pulmonary arteriovenous malformations (PAVMs) with feeding artery diameters ≤ 3 mm.

Materials And Methods: Fifty-eight patients (21 male, 37 female; mean age, 43 y; range, 13-71 y) with 141 simple-type PAVMs treated from 2004 to 2014 were analyzed retrospectively. Inclusion criteria were one or more PAVMs with feeding artery diameters ≤ 3 mm ("small PAVMs"), treatment with coil embolization, and presence of a follow-up chest computed tomographic (CT) angiogram at approximately 6 months.

TAT-HSP70 Attenuates Experimental Lung Injury.

Sepsis, a poorly understood syndrome of disordered inflammation, is the leading cause of death in critically ill patients. Lung injury, in the form of acute respiratory distress syndrome (ARDS), is the most common form of organ injury in sepsis. The heat shock response, during which heat shock proteins (HSPs) are expressed, is an endogenous mechanism to protect cells from injury.

Central venous stenosis is more often symptomatic in hemodialysis patients with grafts compared with fistulas.

Purpose: To determine whether hemodialysis patients with central venous stenosis (CVS) are more frequently symptomatic if they have grafts versus fistulas.

Materials And Methods: A retrospective review was performed of 500 consecutive discrete patients, half with fistulas and half with grafts, who had fistulograms performed over a 4-year period. All fistulograms were evaluated for CVS, which was graded into quartiles.

GLP-1 plays a limited role in improved glycemia shortly after Roux-en-Y gastric bypass: a comparison with intensive lifestyle modification.

Rapid glycemic improvements following Roux-en-Y gastric bypass (RYGB) are frequently attributed to the enhanced GLP-1 response, but causality remains unclear. To determine the role of GLP-1 in improved glucose tolerance after surgery, we compared glucose and hormonal responses to a liquid meal test in 20 obese participants with type 2 diabetes mellitus who underwent RYGB or nonsurgical intensive lifestyle modification (ILM) (n = 10 per group) before and after equivalent short-term weight reduction. The GLP-1 receptor antagonist exendin(9-39)-amide (Ex-9) was administered, in random order and in double-blinded fashion, with saline during two separate visits after equivalent weight loss.

Opportunities in interdisciplinary care team adoption of electronic point-of-care documentation systems.

We conducted three evaluation studies in community and hospital settings to examine point-of-care documentation system adoption among interdisciplinary care team clinicians. In the community settings, quantitative methods included documentation time-to-completion and a clinician satisfaction survey. Qualitative methods included observations and follow-up interviews.

Challenges and facilitators to adoption of a point-of-care electronic health record in home care.

Electronic health records (EHRs), intended to improve the clinical process, are understudied in home care. The researchers assessed clinician satisfaction, informed by workflow and patient outcomes, to identify EHR adoption challenges. The mixed methods study setting was a Philadelphia agency with 137 clinicians.

Outcomes of percutaneous interventions in transposed hemodialysis fistulas compared with nontransposed fistulas and grafts.

Purpose: To compare postpercutaneous intervention outcomes of autogenous venous-transposition arteriovenous fistulas (AVFs) versus those of autogenous nontransposed AVFs (nAVFs) and prosthetic arteriovenous grafts (AVGs).

Materials And Methods: A total of 591 hemodialysis accesses (195 transposed AVFs [tAVFs], 205 nAVFs, 191 AVGs) in 522 patients (278 male; mean age, 57 y; range, 15–91 y) underwent percutaneous transluminal angioplasty (PTA) and/or mechanical thrombectomy (ie, declotting). Access characteristics, surgical history, percutaneous interventions, postinterventional primary and secondary access patency, and follow-up data were collected.

Interdisciplinary care team adoption of electronic point-of-care documentation systems: an unrealized opportunity.

We conducted three health care evaluation studies in community and hospital settings to examine adoption of point-of-care documentation systems among interdisciplinary care team clinicians. Both community studies used a mixed methods design to assess actual system usage and clinician satisfaction. In the hospitals, scenario testing was used.

Outpatient placement of subcutaneous venous access ports reduces the rate of infection and dehiscence compared with inpatient placement.

Purpose: To determine whether the inpatient versus outpatient status of patients at the time of port placement affects the infection rate.

Materials And Methods: Through a quality assurance database, all patients undergoing port insertion by interventional radiology personnel at a single institution between 2001 and 2010 were identified (N = 2,112). From this cohort, 1,030 patients with a known reason for port removal were retrospectively analyzed.

Objective and subjective assessment of physician labor and resource utilization in maintenance percutaneous transluminal angioplasty of nonthrombosed hemodialysis arteriovenous fistulas versus arteriovenous grafts.

Purpose: To complement prior studies that have shown that arteriovenous fistula (AVF) thrombectomies require more time and equipment than arteriovenous graft (AVG) thrombectomies by measuring work via established instruments to determine whether there is also a difference in maintenance percutaneous transluminal angioplasty (PTA) of nonthrombosed AVFs versus AVGs.

Materials And Methods: PTA procedures performed on a consecutive cohort of 42 patients with AVFs and 27 patients with AVGs were prospectively compared. To quantify resource utilization, procedure time and disposable equipment were measured.