Barriers and facilitators to effective electronic health record-based sepsis screening in the pediatric intensive care unit.

Introduction: The Pediatric Surviving Sepsis Campaign supports the implementation of automated tools for early sepsis recognition. In 2019 the C.S.

Laying the Groundwork for a Fulfilling Career in Pediatric Infectious Diseases: The Transition From Fellowship to Faculty.

There are limited resources for guidance on the transition from fellowship into a new faculty role in pediatric infectious diseases. This review aims to address this gap and provides a framework for a successful transition that is composed of four essential pillars-(1) stepping into your role, (2) finding your niche, (3) building your network, and (4) self-care-all of which are supported by strong mentorship/sponsorship and continual realignment with one's personal mission statement. In addition to providing general principles and guidance, this review also outlines specific steps that a junior faculty member can take to expand their influence and build a successful, fulfilling career in pediatric infectious diseases.

ACR Appropriateness Criteria® Central Venous Access Device and Site Selection.

The use of central venous access devices is ubiquitous in both inpatient and outpatient settings, whether for critical care, oncology, hemodialysis, parenteral nutrition, or diagnostic purposes. Radiology has a well-established role in the placement of these devices due to demonstrated benefits of radiologic placement in multiple clinical settings. A wide variety of devices are available for central venous access and optimal device selection is a common clinical challenge.

A multi-disciplinary, comprehensive approach to management of children with heterotaxy.

Heterotaxy (HTX) is a rare condition of abnormal thoraco-abdominal organ arrangement across the left-right axis of the body. The pathogenesis of HTX includes a derangement of the complex signaling at the left-right organizer early in embryogenesis involving motile and non-motile cilia. It can be inherited as a single-gene disorder, a phenotypic feature of a known genetic syndrome or without any clear genetic etiology.

Improving Access to Hepatitis C Treatment Using Clinical Pharmacist Services in an Uninsured, At-Risk Population at a Community Health Center.

While published cure rates for new hepatitis C virus (HCV) treatments exceed 90%, barriers such as cost, medication access, housing or phone service instability, and substance use complicate medication adherence for uninsured, at-risk populations. Lincoln Community Health Center (LCHC) Pharmacy, in collaboration with primary care providers and care coordination professionals, implemented clinical pharmacist services to facilitate treatment of HCV infection in uninsured patients using manufacturers' patient assistance programs (PAP). Eighty-four (84) uninsured patients initiated treatment at LCHC using PAP during the first two years of the program.

Not just vegetations: focal myocardial changes in patients with fungal infections.

Background: Fungal endocarditis classically involves dense heterogenous vegetations. However, several patients with fungal infections were noted to have myocardial changes ranging from focal brightening to nodular thickening of chordae or papillary muscles. This study evaluates whether these findings are associated with fungal infections.

Reaching the Hard-to-Reach: Outcomes of the Severe Hypertension Outreach Intervention.

Introduction: Severe hypertension (≥180 mmHg systolic or ≥110 mmHg diastolic) is associated with a twofold increase in the relative risk of death. At the authors' Federally Qualified Health Center in the Southeast, 39% of adults (n=8,695) had hypertension, and 3% (n=235) were severe. The purpose of this project was to lower blood pressure and improve the proportion of patients achieving the Agency for Healthcare Research and Quality goal for blood pressure.

Reducing high-risk medication use through pharmacist-led interventions in an outpatient setting.

Objective: This study aimed to reduce high-risk medication (HRM) prescribing by direct electronic medical record messaging to providers.

Setting: Lincoln Community Health Center is a federally qualified health center in the southeast United States.

Practice Description: This was a single-center, observational study performed with quality improvement methodology including define, measure, analyze, improve, and control phases.

Activities of β-Lactam-β-Lactamase Inhibitor Antimicrobial Agents against Cystic Fibrosis Respiratory Pathogens.

We tested the activities of ceftazidime-avibactam, ceftolozane-tazobactam, meropenem-vaborbactam, piperacillin-tazobactam, and 11 other antimicrobial agents against 420 , , , and strains, 89% of which were cultured from respiratory specimens from persons with cystic fibrosis. Among the β-lactam-β-lactamase inhibitor agents, meropenem-vaborbactam had the greatest activity against and , including multidrug-resistant and extensively-drug-resistant strains. None of the newer β-lactam-β-lactamase combination drugs showed increased activity compared to that of the older agents against or spp.

Enterovirus D68 infection induces IL-17-dependent neutrophilic airway inflammation and hyperresponsiveness.

Enterovirus D68 (EV-D68) shares biologic features with rhinovirus (RV). In 2014, a nationwide outbreak of EV-D68 was associated with severe asthma-like symptoms. We sought to develop a mouse model of EV-D68 infection and determine the mechanisms underlying airway disease.

Neonatal Adenovirus Infection Complicated by Hemophagocytic Lymphohistiocytosis Syndrome.

Two infants with disseminated adenoviral infections are described. Both these infants had a similar clinical course and were also diagnosed with secondary hemophagocytic lymphohistiocytosis (HLH). Previous reports of immunocompromised adults with adenovirus-associated HLH are in the literature; however, this is the first report that we are aware of with this pathology occurring in infants.

Infectious Risk after Allogeneic Hematopoietic Cell Transplantation Complicated by Acute Graft-versus-Host Disease.

The occurrence of infections after allogeneic hematopoietic stem cell transplantation (HCT) is nearly universal. However, the relationship between infections and graft-versus-host disease (GVHD) is complex and attribution of infectious-related mortality is highly inconsistent, making comparison of infectious complication rates across allogeneic HCT clinical studies difficult. We categorized infectious complications from diagnosis or 1 year before HCT (whichever occurred later) through 2 years after HCT according to timing, frequency, causative organism, severity, and contribution to mortality for 431 consecutive patients who underwent allogeneic HCT from 2008 to 2011.

A Quality Assessment of a Collaborative Model of a Pediatric Antimicrobial Stewardship Program.

Background: Infectious Diseases Society of America guidelines recommend that key antimicrobial stewardship program (ASP) personnel include an infectious disease (ID) physician leader and dedicated ID-trained clinical pharmacist. Limited resources prompted development of an alternative model by using ID physicians and service-based clinical pharmacists at a pediatric hospital. The aim of this study was to analyze the effectiveness and impact of this alternative ASP model.

What Transmission Precautions Best Control Influenza Spread in a Hospital?

Influenza is a significant problem within hospitals, leading to extended hospital stays, excess morbidity and mortality, and economic loss. Prevention and control strategies are generally "bundled"; therefore, the individual effects of particular strategies and the value of combined strategies cannot be determined directly, making it difficult to discern the optimal strategy. To quantify the individual and joint effectiveness of several known influenza infection control measures used in general hospitals, we simulated influenza transmission at a hypothetical hospital in Ann Arbor, Michigan, during a 1-year seasonal epidemic (June 2012-June 2013), using a susceptible-exposed-infected-recovered (SEIR) compartmental model.

Outbreak of KPC-3 Producing Carbapenem-Resistant Klebsiella pneumoniae in a US Pediatric Hospital.

Background: The increase in carbapenem-resistant Enterobacteriaceae (CRE) infections is a critical public health issue. We recently experienced the largest single-center pediatric outbreak of carbapenem-resistant Klebsiella pneumoniae (CRKP) at our hospital. The objective of this study was to describe the molecular epidemiology of this outbreak before and after infection-prevention interventions.

Immune Abnormalities in Fontan Protein-Losing Enteropathy: A Case-Control Study.

Objective: To comprehensively characterize the immunologic characteristics of patients with protein-losing enteropathy (PLE) post-Fontan and compare them with patients without PLE post-Fontan.

Study Design: Patients with PLE post-Fontan and age-matched controls post-Fontan were prospectively studied with laboratory markers of immune function. Infectious history was obtained by interview and chart review.

Gentamicin resistance among Escherichia coli strains isolated in neonatal sepsis.

Neonatal sepsis is a significant cause of morbidity and mortality among term and preterm infants. Ampicillin and gentamicin are standard empiric therapy for early onset sepsis. Four cases of neonatal sepsis secondary to Escherichia coli (E.

Integrating patient safety and clinical pharmacy services into the care of a high-risk, ambulatory population: a collaborative approach.

Objectives: Lincoln Community Health Center participated in a Health Resources and Services Administration-sponsored Patient Safety and Clinical Pharmacy Services Collaborative aimed at facilitating integration of pharmacy services proven to enhance patient safety into care provided to a high-risk, ambulatory population.

Methods: The Collaborative used the Plan-Do-Study-Act (PDSA) cycle of learning from the Model for Improvement endorsed by the Institute for Healthcare Improvement to guide changes. Outcomes targeted for improvement included medication reconciliation, obesity screening and follow-up planning, adverse drug events (patient safety), and delivery of clinical pharmacy services.

Accuracy of hospital administrative data in reporting central line-associated bloodstream infections in newborns.

Objectives: Central line-associated bloodstream infections (CLABSIs) are a significant source of morbidity and mortality in the NICU. In 2010, Medicaid was mandated not to pay hospitals for treatment of CLABSI; however, the source of CLABSI data for this policy was not specified. Our objective was to evaluate the accuracy of hospital administrative data compared with CLABSI confirmed by an infection control service.

Formulary expansion to provide access to medications prescribed by a specialist in a low-income population.

The process of expanding a medication formulary as a tool for providing access to medications prescribed by a specialist in a low-income population is described. The formulary optimized use of the 340B Drug Pricing Program and reserved patient assistance programs for costly medications. Collaborating with community physicians and organizations aided success.

Urethrovaginal reconstruction using a perineal artery axial flap.

A 19-year-old woman was born with a cloacal malformation and a common urogenital sinus. We describe a method of urethral and vaginal reconstruction to correct these anomalous problems. A neourethra was constructed from tubularized anterior vaginal epithelium.

Acute management of the zipper-entrapped penis.

A zipper-entrapped penis is a painful predicament that can be made worse by overzealous intervention. Described is a simple, basic approach to release, that is the least traumatic to both patient and provider.

Bladder carcinoma presenting with rectal obstruction.

Two patients with bladder carcinoma that caused annular constriction of the rectum are described. A mechanism of local invasion by genitourinary malignancies (bladder and prostate) involves penetration of the rectovesical fascia of Denonvillier and circumferential rectal spread. Treatment of complete or partial obstructing lesions includes surgery, radiotherapy, or chemotherapy (or combination), as well as several new techniques, notably laser destruction and transrectal tumor resection.