scholarly journals Trends in Pediatric Candidemia: Epidemiology, Anti-Fungal Susceptibility, and Patient Characteristics in a Children’s Hospital

2021 ◽  
Vol 7 (2) ◽  
pp. 78
Author(s):  
Anabel Piqueras ◽  
Lakshmi Ganapathi ◽  
Jane F. Carpenter ◽  
Thomas Rubio ◽  
Thomas J. Sandora ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Clinical Decision Making ◽  
Species Distributions ◽  
The United States ◽  
Morbidity And Mortality ◽  
Fungal Resistance ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Anti Fungal ◽  
Susceptibility Patterns

Candida bloodstream infections (CBSIs) have decreased among pediatric populations in the United States, but remain an important cause of morbidity and mortality. Species distributions and susceptibility patterns of CBSI isolates diverge widely between children and adults. The awareness of these patterns can inform clinical decision-making for empiric or pre-emptive therapy of children at risk for candidemia. CBSIs occurring from 2006–2016 among patients in a large children’s hospital were analyzed for age specific trends in incidence rate, risk factors for breakthrough-CBSI, and death, as well as underlying conditions. Candida species distributions and susceptibility patterns were evaluated in addition to the anti-fungal agent use. The overall incidence rate of CBSI among this complex patient population was 1.97/1000 patient-days. About half of CBSI episodes occurred in immunocompetent children and 14% in neonatal intensive care unit (NICU) patients. Anti-fungal resistance was minimal: 96.7% of isolates were fluconazole, 99% were micafungin, and all were amphotericin susceptible. Liposomal amphotericin was the most commonly prescribed anti-fungal agent included for NICU patients. Overall, CBSI-associated mortality was 13.7%; there were no deaths associated with CBSI among NICU patients after 2011. Pediatric CBSI characteristics differ substantially from those in adults. The improved management of underlying diseases and antimicrobial stewardship may further decrease morbidity and mortality from CBSI, while continuing to maintain low resistance rates among Candida isolates.

scholarly journals Trends in Pediatric Candidemia: Epidemiology, Anti-Fungal Susceptibility and Patient Characteristics in a Children’s Hospital

2020 ◽  
Author(s):  
Anabel Piqueras ◽  
Lakshmi Ganapathi ◽  
Jane F. Carpenter ◽  
Thomas Rubio ◽  
Thomas J. Sandora ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Antifungal Agent ◽  
Neonatal Intensive Care ◽  
Clinical Decision Making ◽  
Species Distributions ◽  
Bloodstream Infections ◽  
Clinical Decision ◽  
The United States ◽  
Morbidity And Mortality ◽  
Susceptibility Patterns

Background. Candida bloodstream infections (CBSIs) have decreased among pediatric populations in the United States, but remain an important cause of morbidity and mortality. Species distributions and susceptibility patterns of CBSI isolates diverge widely between children and adults. Awareness of these patterns can inform clinical decision-making for empiric or pre-emptive therapy of children at risk for candidemia. Methods. CBSIs occurring from 2006-2016 among patients in a large children’s hospital were analyzed for age specific trends in incidence rate, risk factors for breakthrough-CBSI and death, as well as underlying conditions. Candida species distributions and susceptibility patterns were evaluated in addition to antifungal agent use. Results. The overall incidence rate of CBSI among this complex patient population was 1.97/1,000 patient-days. About half of CBSI episodes occurred in immunocompetent children and 14% in Neonatal Intensive Care Unit (NICU) patients. Antifungal resistance was minimal: 96.7% of isolates were fluconazole-, 99% were micafungin-, and all were amphotericin susceptible. Liposomal amphotericin was the most commonly prescribed antifungal agent including for NICU patients. Overall CBSI-associated mortality was 13.7%; there were no deaths associated with CBSI among NICU patients after 2011. Conclusions. Pediatric CBSI characteristics differ substantially from those in adults. Improved management of underlying diseases and antimicrobial stewardship may further decrease morbidity and mortality from CBSI while continuing to maintain low resistance rates among Candida isolates.

Hospital Use Patterns for Children in the United States, 1983 and 1984

PEDIATRICS ◽  
1987 ◽  
Vol 80 (4) ◽  
pp. 481-490 ◽  
Author(s):  
Lola Jean Kozak ◽  
Catherine Norton ◽  
Margaret McManus ◽  
Eileen McCarthy
Keyword(s):  
Health Status ◽  
Hospital Discharge ◽  
Discharge Rate ◽  
The United States ◽  
National Hospital Discharge Survey ◽  
Children's Hospital ◽  
Use Patterns ◽  
Discharge Rates ◽  
Children’S Hospital ◽  
Hospital Use

The hospital discharge rate of children less than 15 years of age in the United States declined 12% from 1983 to 1984. This was the first time in the 20-year history of the National Hospital Discharge Survey that there was a statistically significant decrease in children's hospital discharge rates in a 1-year period. The change occurred during a period when prospective hospital payment systems were introduced and when prepaid group health plans and alternative systems of providing health care were expanding. The unprecedented decrease in children's hospital use was evaluated using data from the National Hospital Discharge Survey. This is a continuous survey in which data from a national sample of medical records of discharged patients are collected. Children's hospital use rates were reviewed by age, sex, region, and expected principal source of payment. Significant decreases in discharge rates were found for the age group 1 to 4 years and for all children with private insurance. The patterns and changes in hospital use by diagnostic category were also investigated. The major finding was a 19% decrease in children's discharge rate for diseases of the respiratory system. Mortality statistics and data from the National Health Interview Survey were evaluated for indications of changes in children's health status or use of physician services accompanying the decline in hospital use. Although there were fewer deaths due to respiratory diseases for children less than 5 years of age in 1984 than in 1983, most measures of health status were unchanged. The only significant change in physician use was a decrease in the percentage of acute conditions that were medically attended, also among children less than 5 years of age. It is important to continue monitoring children's hospital use patterns, as well as their health status and use of alternative health services, to further assess the impact of changes in the organization and financing of health services.

DIAGNOSTIC INERTIA

PEDIATRICS ◽  
1961 ◽  
Vol 28 (5) ◽  
pp. 695-696
Author(s):  
R. J. MCKAY
Keyword(s):  
United States ◽  
Patient Care ◽  
The United States ◽  
Interim Report ◽  
Children's Hospital ◽  
Medical Centers ◽  
Pediatric Education ◽  
Children’S Hospital ◽  
Pediatric Services

In this issue of Pediatrics the article entitled "A New Design for Patient Care and Pediatric Education in a Children's Hospital: An Interim Report," by Green and Segar, represents a challenging approach to problems that are of increasing concern to pediatric educators and pediatric services of medical centers throughout the United States. It should be emphasized that the authors' plan is a proposed solution to the problems involved, and that the question as to whether it will constitute an answer will have to await analysis not only of their results but of the results of other approaches to the same problems.

DEFECTIVE STEROIDAL BIOGENESIS IN CONGENITAL ADRENAL HYPERPLASIA

PEDIATRICS ◽  
1958 ◽  
Vol 21 (4) ◽  
pp. 661-672
Author(s):  
Alfred M. Bongiovanni ◽  
Walter R. Eberlein
Keyword(s):  
Research Work ◽  
Assistant Professor ◽  
The United States ◽  
University Of Pennsylvania ◽  
Rockefeller Institute ◽  
Children's Hospital ◽  
Research Division ◽  
Children’S Hospital ◽  
The University

Dr. Alfred M. Bongiovanni is a young man who started research work as an investigator at the Marine Biological Laboratory, Woods Hole, Massachusetts, even before he received his B.S. degree from Villanova College in 1940. While at Villanova, Dr. Bongiovanni received the Kolmer Medal for Excellence in Science. In 1943 he received his M.D. from the University of Pennsylvania, following which he immediately served a 2-year tour of duty in the United States Navy. After discharge from the Navy, he filled residencies at the Children's Hospital of Philadelphia from 1947 to 1949. During the years 1949 and 1950, Dr. Bongiovanni served as Assistant Physician at the Rockefeller Institute in New York and in 1950-51 returned to the Children's Hospital of Philadelphia as Assistant Director of Clinics. In 1951 he was appointed the National Foundation of Infantile Paralysis Fellow to the Research Division of the Children's Hospital of Philadelphia. New opportunities and promotions quickly followed with an appointment as Assistant Professor of Pediatrics at Johns Hopkins in 1952; Senior Research Associate in the Pediatric Endocrine Division and Assistant Professor of Pediatrics at the University of Pennsylvania in 1954; and in 1955 Associate Professor of Pediatrics at the same university. Dr. Bongiovanni is a Diplomate of the American Board of Pediatrics and a member of the Editorial Board of the American Journal of Medical Sciences and of numerous professional societies. In 1956 Dr. Bongiovanni received the Ciba Award. Dr. Bongiovanni has been author of about 50 articles, the great majority of which are on endocrinology and at least 23 of them with Dr. Eberlein, who is the co-recipient with Dr. Bongiovanni of this Award, as a co-author.

scholarly journals The Squibb Travelling Fellowship

1988 ◽  
Vol 12 (10) ◽  
pp. 449-451
Author(s):  
Carol Fitzpatrick
Keyword(s):  
United States ◽  
Trinity College ◽  
Medical Center ◽  
Emotional Adjustment ◽  
The United States ◽  
Children's Hospital ◽  
Trinity College Dublin ◽  
Future Paper ◽  
Children’S Hospital ◽  
The Subject

In 1986 I was awarded the Squibb Travelling Fellowship by the Royal College of Psychiatrists. The funding this provided, combined with funding provided by the Henry Hutchinson Stewart Scholarship in Psychiatry awarded by Trinity College, Dublin, enabled me to spend a three month period in the summer of 1987 at the Children's Hospital Medical Center, Boston, doing research in the area of emotional adjustment in adolescents with chronic physical illnesses. The research will be the subject of a future paper. The purpose of this communication is to outline some of the steps en route between winning the Fellowship and starting on the project at Children's Hospital. The amount of paperwork involved was time consuming, confusing and, at times, overwhelming, and I hope that other doctors planning to travel to the United States to carry out research will benefit from my expeience.

scholarly journals Readiness for an Increase in Congenital Zika Virus Infections in the United States: Geographic Distance to Pediatric Subspecialist Care

2018 ◽  
Vol 13 (03) ◽  
pp. 476-486 ◽  
Author(s):  
Jeanne Bertolli ◽  
Joseph Holbrook ◽  
Nina D. Dutton ◽  
Bryant Jones ◽  
Nicole F. Dowling ◽  
...  
Keyword(s):  
United States ◽  
Zika Virus ◽  
Full Range ◽  
Geographic Distance ◽  
Virus Transmission ◽  
The United States ◽  
Travel Distance ◽  
Mosquito Vector ◽  
Children's Hospital ◽  
Children’S Hospital

ABSTRACTObjectiveThe study’s purpose was to investigate readiness for an increase in the congenital Zika infection (CZI) by describing the distribution of pediatric subspecialists needed for the care of children with CZI.MethodsWe applied county-level subspecialist counts to US maps, overlaying the geocoded locations of children’s hospitals to assess the correlation of hospital and subspecialist locations. We calculated travel distance from census tract centroids to the nearest in-state children’s hospital by state (with/without > 100 reported adult Zika virus cases) and by regions corresponding to the likely local Zika virus transmission area and to the full range of the mosquito vector. Travel distance percentiles reflect the population of children < 5 years old.ResultsOverall, 95% of pediatric subspecialists across the United States are located in the same county or neighboring county as a children’s hospital. In the states where Zika virus transmission is likely, 25% of children must travel more than 50 miles for subspecialty care; in one state, 50% of children must travel > 100 miles.ConclusionThe travel distance to pediatric subspecialty care varies widely by state and is likely to be an access barrier in some areas, particularly states bordering the Gulf of Mexico, which may have increasing numbers of CZI cases. (Disaster Med Public Health Preparedness. 2019;13:476-486)

Introduction

2006 ◽  
Vol 16 (S3) ◽  
pp. 1-3 ◽  
Author(s):  
Jeffrey P. Jacobs
Keyword(s):  
United States ◽  
Nursing Education ◽  
Congenital Heart ◽  
The United States ◽  
Collaborative Project ◽  
Heart Institute ◽  
Children's Hospital ◽  
Congenital Cardiac Disease ◽  
Children’S Hospital ◽  
Children And Young Adults

As I have emphasized in previous supplements, Florida is the fourth largest state in the United States of America. The programme for care of children with congenital cardiac malformations at Children's Hospital of Philadelphia is one of the largest, and most prestigious and comprehensive in the world. The Congenital Heart Institute of Florida is the largest programme providing services for patients with congenital cardiac disease in Florida. “Heart Week in Florida”, the joint collaborative project sponsored by the Children's Hospital of Philadelphia together with the Congenital Heart Institute of Florida, has now become recognized as one of the major planks of continuing medical and nursing education for those working in the fields of diagnosis and treatment of heart disease in neonates, infants, children, and young adults. In 2006, however, we broke from our previous mould, since the component of our “week” organized by the group from Philadelphia was organized in Phoenix, Arizona, thanks to the support provided by our colleagues working at Children's Hospital in Phoenix. It was a huge success, diminished only slightly by the inclement weather facing those who needed to journey back from sunny Arizona and Florida to the frozen and snowy northeast coast of the United States. All institutions involved with the organization of the events of 2006, nonetheless, are very grateful to Bob Anderson, and the team at Cardiology in the Young, for their support of “Heart Week in Florida”, and for the opportunity to publish this Supplement.

Perceived benefits and barriers to a career in pediatric neurosurgery: a survey of neurosurgical residents

2013 ◽  
Vol 12 (5) ◽  
pp. 422-433 ◽  
Author(s):  
Mark S. Dias ◽  
Jeffrey S. Sussman ◽  
Susan Durham ◽  
Mark R. Iantosca
Keyword(s):  
Brain Injuries ◽  
Pediatric Neurosurgery ◽  
The United States ◽  
Fellowship Training ◽  
Web Based ◽  
Intrinsic Nature ◽  
Children's Hospital ◽  
Resident Perceptions ◽  
Children’S Hospital ◽  
Fast Healing

Object Research suggests that there may be a growing disparity between the supply of and demand for both pediatric specialists and neurosurgeons. Whether pediatric neurosurgeons are facing such a disparity is disputable, but interest in pediatric neurosurgery (PNS) has waxed and waned as evidenced by the number of applicants for PNS fellowships. The authors undertook a survey to analyze current neurosurgical residents' perceptions of both benefits and deterrents to a pediatric neurosurgical career. Methods All residents and PNS fellows in the United States and Canada during the academic year 2008–2009 were invited to complete a Web-based survey that assessed 1) demographic and educational information about residents and their residency training, particularly as it related to training in PNS; 2) residents' exposure to mentoring opportunities from pediatric neurosurgical faculty and their plans for the future; and 3) residents' perceptions about how likely 40 various factors were to influence their decision about whether to pursue a PNS career. Results Four hundred ninety-six responses were obtained: 89% of the respondents were male, 63% were married, 75% were in at least their 3rd year of postgraduate training, 61% trained in a children's hospital and 29% in a children's “hospital within a hospital,” and 72% were in programs having one or more dedicated PNS faculty members. The residencies of 56% of respondents offered 6–11 months of PNS training and nearly three-quarters of respondents had completed 2 months of PNS training. During medical school, 92% had been exposed to neurosurgery and 45% to PNS during a clinical rotation, but only 7% identified a PNS mentor. Nearly half (43%) are considering a PNS career, and of these, 61% are definitely or probably considering post-residency fellowship. On the other hand, 68% would prefer an enfolded fellowship during residency. Perceived strengths of PNS included working with children, developing lasting relationships, wider variety of operations, fast healing and lack of comorbidities, and altruism. Perceived significant deterrents included shunts, lower reimbursement, cross-coverage issues, higher malpractice premiums and greater legal exposure, and working with parents and pediatric health professionals. The intrinsic nature of PNS was listed as the most significant deterrent (46%) followed by financial concerns (25%), additional training (12%), longer work hours (12%), and medicolegal issues (4%). The majority felt that fellowship training and PNS certification should be recommended for surgeons treating of all but traumatic brain injuries and Chiari I malformations and performing simple shunt-related procedures, although they felt that these credentials should be required only for treating complex craniosynostosis. Conclusions The nature of PNS is the most significant barrier to attracting residents, although reimbursement, cross-coverage, and legal issues are also important to residents. The authors provide several recommendations that might enhance resident perceptions of PNS and attract trainees to the specialty.

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