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Article ; Online: Clinical and Socioeconomic Associations With Hospital Days and Emergency Department Visits Among Medically Complex Children: A Retrospective Cohort Study.

Sidra, Michael / Pietrosanu, Matthew / Ohinmaa, Arto / Zwicker, Jennifer / Round, Jeff / Johnson, David Wyatt

Hospital pediatrics

2024 Volume 14, Issue 2, Page(s) 93–101

Abstract: Objectives: To estimate associations between clinical and socioeconomic variables and hospital days and emergency department (ED) visits for children with medical complexity (CMCs) for 5 years after index admission.: Methods: Retrospective, ... ...

Abstract	Objectives: To estimate associations between clinical and socioeconomic variables and hospital days and emergency department (ED) visits for children with medical complexity (CMCs) for 5 years after index admission. Methods: Retrospective, longitudinal, population-based cohort study of CMCs in Alberta (n = 12 621) diagnosed between 2010 and 2013 using administrative data linked to socioeconomic data. The primary outcomes were annual cumulative numbers of hospital days and ED visits for 5 years after index admission. Data were analyzed using mixed-effect hurdle regression. Results: Among CMCs utilizing resources, those with more chronic medications had more hospital days (relative difference [RD] 3.331 for ≥5 vs 0 medications in year 1, SE 0.347, P value < .001) and ED visits (RD 1.836 for 0 vs ≥5 medications in year 1, SE 0.133, P value < .001). Among these CMCs, initial length of stay had significant, positive associations with hospital days (RD 1.960-5.097, SE 0.161-0.610, P value < .001 outside of the gastrointestinal and hematology and immunodeficiency groups). Those residing in rural or remote areas had more ED visits than those in urban or metropolitan locations (RD 1.727 for rural versus urban, SE 0.075, P < .001). Material and social deprivation had significant, positive associations with number of ED visits. Conclusions: Clinical factors are more strongly associated with hospitalizations and socioeconomic factors with ED visits. Policy administrators and researchers aiming to optimize resource use and improve outcomes for CMCs should consider interventions that include both clinical care and socioeconomic support.
MeSH term(s)	Child ; Humans ; Retrospective Studies ; Cohort Studies ; Emergency Room Visits ; Socioeconomic Factors ; Emergency Service, Hospital ; Hospitals
Language	English
Publishing date	2024-01-11
Publishing country	United States
Document type	Journal Article
ISSN	2154-1671
ISSN (online)	2154-1671
DOI	10.1542/hpeds.2023-007457
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Article ; Online: Croup.

Johnson, David Wyatt

American family physician

2016 Volume 94, Issue 6, Page(s) 476–478

MeSH term(s)	Administration, Inhalation ; Administration, Oral ; Anti-Inflammatory Agents/administration & dosage ; Croup/diagnosis ; Croup/therapy ; Dexamethasone/administration & dosage ; Helium ; Humans ; Injections, Intramuscular ; Oxygen
Chemical Substances	Anti-Inflammatory Agents ; Helium (206GF3GB41) ; heliox (58933-55-4) ; Dexamethasone (7S5I7G3JQL) ; Oxygen (S88TT14065)
Language	English
Publishing date	2016-09-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	412694-4
ISSN	1532-0650 ; 0002-838X ; 0572-3612
ISSN (online)	1532-0650
ISSN	0002-838X ; 0572-3612
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Article ; Online: Glycosaminoglycan-directed cobalt complexes.

Christian, Jessica M / Zoepfl, Mary / Johnson, Wyatt E / Ginsburg, Eric / Peterson, Erica J / Hampton, J David / Farrell, Nicholas P

Journal of inorganic biochemistry

2023 Volume 245, Page(s) 112254

Abstract: The biological activity of the 6+ Co containing Werner's Complex has been described and mechanistic considerations suggest that the highly anionic glycosaminoglycans (heparan sulfate, HS, GAGs) are implicated in this activity [Paiva et al. 2021]. To ... ...

Abstract	The biological activity of the 6+ Co containing Werner's Complex has been described and mechanistic considerations suggest that the highly anionic glycosaminoglycans (heparan sulfate, HS, GAGs) are implicated in this activity [Paiva et al. 2021]. To examine in detail the molecular basis of Werner's Complex biological properties we have examined a selection of simple mononuclear Co
MeSH term(s)	Glycosaminoglycans ; Cobalt/metabolism ; Heparin/chemistry ; Heparin/metabolism ; Heparitin Sulfate/chemistry ; Heparitin Sulfate/metabolism ; Heparitin Sulfate/pharmacology ; Extracellular Matrix/metabolism ; Fondaparinux
Chemical Substances	Glycosaminoglycans ; Cobalt (3G0H8C9362) ; Heparin (9005-49-6) ; Heparitin Sulfate (9050-30-0) ; Fondaparinux (J177FOW5JL)
Language	English
Publishing date	2023-05-09
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	162843-4
ISSN	1873-3344 ; 0162-0134
ISSN (online)	1873-3344
ISSN	0162-0134
DOI	10.1016/j.jinorgbio.2023.112254
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Article ; Online: Croup.

Johnson, David Wyatt

BMJ clinical evidence

2014 Volume 2014

Abstract: Introduction: Croup is characterised by the abrupt onset, most commonly at night, of a barking cough, inspiratory stridor, hoarseness, and respiratory distress due to upper airway obstruction. It leads to signs of upper airway obstruction, and must be ... ...

Abstract	Introduction: Croup is characterised by the abrupt onset, most commonly at night, of a barking cough, inspiratory stridor, hoarseness, and respiratory distress due to upper airway obstruction. It leads to signs of upper airway obstruction, and must be differentiated from acute epiglottitis, bacterial tracheitis, or an inhaled foreign body. Croup affects about 3% of children per year, usually between the ages of 6 months and 3 years, and 75% of infections are caused by parainfluenza virus. Symptoms usually resolve within 48 hours, but severe upper airway obstruction can, rarely, lead to respiratory failure and arrest. Methods and outcomes: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in children with mild croup and moderate to severe croup? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results: We found 19 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions: In this systematic review we present information relating to the effectiveness and safety of the following interventions: corticosteroids (dexamethasone, intramuscular and oral), nebulised budesonide, oral prednisolone, heliox, humidification, and nebulised adrenaline (racemate and L-adrenaline [ephinephrine]).
MeSH term(s)	Adrenal Cortex Hormones/therapeutic use ; Budesonide/therapeutic use ; Cough/drug therapy ; Cough/etiology ; Cough/therapy ; Croup/complications ; Croup/drug therapy ; Croup/therapy ; Epinephrine/therapeutic use ; Helium/therapeutic use ; Humans ; Humidity ; Oxygen/therapeutic use ; Prednisolone/therapeutic use
Chemical Substances	Adrenal Cortex Hormones ; Helium (206GF3GB41) ; Budesonide (51333-22-3) ; heliox (58933-55-4) ; Prednisolone (9PHQ9Y1OLM) ; Oxygen (S88TT14065) ; Epinephrine (YKH834O4BH)
Keywords	covid19
Language	English
Publishing date	2014-09-29
Publishing country	England
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	2393858-4
ISSN	1752-8526 ; 1757-0816 ; 1475-9225
ISSN (online)	1752-8526
ISSN	1757-0816 ; 1475-9225
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Article ; Online: Implementation of an Electronic Mental Health Platform for Youth and Young Adults in a School Context Across Alberta, Canada: Thematic Analysis of the Perspectives of Stakeholders.

Dimitropoulos, Gina / Bassi, Emilie M / Bright, Katherine S / Gondziola, Jason / Bradley, Jessica / Fersovitch, Melanie / Stamp, Leanne / LaMonica, Haley M / Iorfino, Frank / Gaskell, Tanya / Tomlinson, Sara / Johnson, David Wyatt

JMIR mental health

2024 Volume 11, Page(s) e49099

Abstract: Background: Youth, aged 15 to 24 years, are more likely to experience mental health (MH) or substance use issues than other age groups. This is a critical period for intervention because MH disorders, if left unattended, may become chronic and serious ... ...

Abstract	Background: Youth, aged 15 to 24 years, are more likely to experience mental health (MH) or substance use issues than other age groups. This is a critical period for intervention because MH disorders, if left unattended, may become chronic and serious and negatively affect many aspects of a young person's life. Even among those who are treated, poor outcomes will still occur for a percentage of youth. Electronic MH (eMH) tools have been implemented in traditional MH settings to reach youth requiring assistance with MH and substance use issues. However, the utility of eMH tools in school settings has yet to be investigated. Objective: The objective of this study was to gain an understanding of the perspectives of key school staff stakeholders regarding barriers and facilitators to the implementation of the Innowell eMH platform in secondary schools across the province of Alberta, Canada. Methods: Guided by a qualitative descriptive approach, focus groups were conducted to elicit stakeholder perspectives on the perceived implementation challenges and opportunities of embedding the Innowell eMH platform in secondary school MH services. In total, 8 focus groups were conducted with 52 key school staff stakeholders. Results: Themes related to barriers and facilitators to youth and school MH care professional (MHCP) capacity in implementing and using eMH tools were identified. With respect to youth capacity barriers, the following themes were inductively generated: (1) concerns about some students not being suitable for eMH services, (2) minors requiring consent from parents or caregivers to use eMH services as well as confidentiality and privacy concerns, and (3) limited access to technology and internet service among youth. A second theme related to school MHCP barriers to implementation, which included (1) feeling stretched with high caseloads and change fatigue, (2) concerns with risk and liability, and (3) unmasking MH issues in the face of limited resources. In contrast to the barriers to youth and MHCP capacity, many facilitators to implementation were discussed. Youth capacity facilitators included (1) the potential for youth to be empowered using eMH tools, (2) the platform fostering therapeutic relationships with school personnel, and (3) enhancing access to needed services and resources. MHCP capacity facilitators to implementation were (1) system transformation through flexibility and problem-solving, (2) opportunities for collaboration with youth and MHCPs and across different systems, and (3) an opportunity for the continuity of services. Conclusions: Our findings highlight nuanced school MHCP perspectives that demonstrate critical youth and MHCP capacity concerns, with consideration for organizational factors that may impede or enhance the implementation processes for embedding eMH in a school context. The barriers and facilitators to implementation provide future researchers and decision makers with challenges and opportunities that could be addressed in the preimplementation phase.
MeSH term(s)	Adolescent ; Young Adult ; Humans ; Alberta/epidemiology ; Mental Health ; Schools ; Electronics ; Substance-Related Disorders
Language	English
Publishing date	2024-01-17
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2798262-2
ISSN	2368-7959 ; 2368-7959
ISSN (online)	2368-7959
ISSN	2368-7959
DOI	10.2196/49099
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Article ; Online: Improving the Discharge Process for Opioid-Exposed Neonates.

Crook, Travis W / Munn, Erin K / Scott, Theresa A / Morad, Anna / Wyatt, Joshua / Johnson, David P / White, Mary / Patrick, Stephen W

Hospital pediatrics

2019 Volume 9, Issue 8, Page(s) 643–648

Abstract: Objectives: Opioid-exposed neonates (OENs) are a population at risk for postdischarge complications. Our objective was to improve completion of a discharge bundle to connect patients with outpatient resources to mitigate postdischarge risks.: Methods!# ...

Abstract	Objectives: Opioid-exposed neonates (OENs) are a population at risk for postdischarge complications. Our objective was to improve completion of a discharge bundle to connect patients with outpatient resources to mitigate postdischarge risks. Methods: Team Hope, a hospital-wide initiative to improve the care of OENs, examined the completion of a discharge bundle from September 2017 through February 2019. A complete discharge bundle was defined as referral to a primary care physician, referral to early intervention services, referral to in-home nursing assessment and educational services, referral to the development clinic if diagnosed with neonatal abstinence syndrome, and referral to the gastroenterology or infectious disease clinic if exposed to hepatitis C virus. After obtaining baseline data, simple interventions were employed as education of providers, social workers, and case management; reminder notes in the electronic health record; and biweekly reminders to resident physicians. A statistical process control chart was used to analyze our primary measure, with special cause variation resulting in a shift indicated by 8 consecutive points above or below the mean line. Results: One hundred nineteen OENs were examined with an initial discharge bundle completion of 2.6% preimplementation. Referral to early intervention services and the development clinic were the least successfully completed elements before intervention implementation. After the development of the discharge bundle in July 2018, special cause variation was achieved, resulting in a mean-line shift with 60.3% now having a complete bundle for 83 OENs. Conclusions: We implemented a standardized discharge bundle that improved our discharge processes for OENs.
MeSH term(s)	Analgesics, Opioid/adverse effects ; Female ; Hospitals, Pediatric ; Humans ; Infant, Newborn ; Male ; Neonatal Abstinence Syndrome/rehabilitation ; Patient Discharge ; Referral and Consultation ; Tennessee ; Urban Population
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2019-09-25
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2154-1671
ISSN (online)	2154-1671
DOI	10.1542/hpeds.2019-0088
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Article ; Online: Evaluating the quantity, quality and size distribution of cell-free DNA by multiplex droplet digital PCR.

Alcaide, Miguel / Cheung, Matthew / Hillman, Jack / Rassekh, S Rod / Deyell, Rebecca J / Batist, Gerald / Karsan, Aly / Wyatt, Alexander W / Johnson, Nathalie / Scott, David W / Morin, Ryan D

Scientific reports

2020 Volume 10, Issue 1, Page(s) 12564

Abstract: Cell-free DNA (cfDNA) has become a comprehensive biomarker in the fields of non-invasive cancer detection and monitoring, organ transplantation, prenatal genetic testing and pathogen detection. While cfDNA samples can be obtained using a broad variety of ...

Abstract	Cell-free DNA (cfDNA) has become a comprehensive biomarker in the fields of non-invasive cancer detection and monitoring, organ transplantation, prenatal genetic testing and pathogen detection. While cfDNA samples can be obtained using a broad variety of approaches, there is an urgent need to standardize analytical tools aimed at assessing its basic properties. Typical methods to determine the yield and fragment size distribution of cfDNA samples are usually either blind to genomic DNA contamination or the presence of enzymatic inhibitors, which can confound and undermine downstream analyses. Here, we present a novel droplet digital PCR assay to identify suboptimal samples and aberrant cfDNA size distributions, the latter typically associated with high levels of circulating tumour DNA (ctDNA). Our assay was designed to promiscuously cross-amplify members of the human olfactory receptor (OR) gene family and includes a customizable diploid locus for the determination of absolute cfDNA concentrations. We demonstrate here the utility of our assay to estimate the yield and quality of cfDNA extracts and deduce fragment size distributions that correlate well with those inferred by capillary electrophoresis and high throughput sequencing. The assay described herein is a powerful tool to establish quality controls and stratify cfDNA samples based on presumed ctDNA levels, then facilitating the implementation of robust, cost-effective and standardized analytical workflows into clinical practice.
MeSH term(s)	Biomarkers, Tumor/genetics ; Cell-Free Nucleic Acids/genetics ; Humans ; Polymerase Chain Reaction/methods ; Receptors, Odorant/genetics
Chemical Substances	Biomarkers, Tumor ; Cell-Free Nucleic Acids ; Receptors, Odorant
Language	English
Publishing date	2020-07-28
Publishing country	England
Document type	Evaluation Study ; Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-020-69432-x
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Article ; Online: On the Biology of Werner's Complex.

de Paiva, Raphael E F / Peterson, Erica J / Malina, Jaroslav / Zoepfl, Mary / Hampton, J David / Johnson, Wyatt E / Graminha, Angelica / Ourahmane, Amine / McVoy, Michael A / Brabec, Viktor / Berners-Price, Susan J / Farrell, Nicholas P

Angewandte Chemie (International ed. in English)

2021 Volume 60, Issue 31, Page(s) 17123–17130

Abstract: Werner's Complex, as a cationic coordination complex (CCC), has hitherto unappreciated biological properties derived from its binding affinity to highly anionic biomolecules such as glycosaminoglycans (GAGs) and nucleic acids. Competitive inhibitor and ... ...

Abstract	Werner's Complex, as a cationic coordination complex (CCC), has hitherto unappreciated biological properties derived from its binding affinity to highly anionic biomolecules such as glycosaminoglycans (GAGs) and nucleic acids. Competitive inhibitor and spectroscopic assays confirm the high affinity to GAGs heparin, heparan sulfate (HS), and its pentasaccharide mimetic Fondaparinux (FPX). Functional consequences of this affinity include inhibition of FPX cleavage by bacterial heparinase and mammalian heparanase enzymes with inhibition of cellular invasion and migration. Werner's Complex is a very efficient condensing agent for DNA and tRNA. In proof-of-principle for translational implications, it is demonstrated to display antiviral activity against human cytomegalovirus (HCMV) at micromolar concentrations with promising selectivity. Exploitation of non-covalent hydrogen-bonding and electrostatic interactions has motivated the unprecedented discovery of these properties, opening new avenues of research for this iconic compound.
MeSH term(s)	Antiviral Agents/chemistry ; Antiviral Agents/pharmacology ; Coordination Complexes/chemistry ; Coordination Complexes/pharmacology ; Cytomegalovirus/drug effects ; Fondaparinux/antagonists & inhibitors ; Glycosaminoglycans/chemistry ; Glycosaminoglycans/pharmacology ; Humans ; Microbial Sensitivity Tests
Chemical Substances	Antiviral Agents ; Coordination Complexes ; Glycosaminoglycans ; Fondaparinux (J177FOW5JL)
Language	English
Publishing date	2021-06-27
Publishing country	Germany
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2011836-3
ISSN	1521-3773 ; 1433-7851
ISSN (online)	1521-3773
ISSN	1433-7851
DOI	10.1002/anie.202105019
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Article ; Online: COPD and Rural Health: A Dialogue on the National Action Plan.

Moore, Paul / Atkins, Graham T / Cramb, Stephanie / Croft, Janet B / Davis, Lisa / Dolor, Rowena J / Doyle, Daniel / Elehwany, Maggie / James, Cara / Knudson, Alana / Linnell, John / Mannino, David / Rommes, Jean M / Sood, Akshay / Stockton, Eric / Weissman, David N / Witte, Mike / Wyatt, Eugenia / Yarbrough, William C /

Yawn, Barbara P / Johnson, Lenora / Morris, Tom / Kiley, James P / Ammary-Risch, Neyal J / Punturieri, Antonello

The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association

2019 Volume 35, Issue 4, Page(s) 424–428

MeSH term(s)	Humans ; Population Surveillance/methods ; Pulmonary Disease, Chronic Obstructive/therapy ; Rural Health/trends ; Self Care/methods ; Strategic Planning ; United States
Language	English
Publishing date	2019-01-24
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	639160-6
ISSN	1748-0361 ; 0890-765X
ISSN (online)	1748-0361
ISSN	0890-765X
DOI	10.1111/jrh.12346
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Article ; Online: Parents' Experiences of Receiving the Initial Positive Newborn Screening (NBS) Result for Cystic Fibrosis and Sickle Cell Disease.

Chudleigh, Jane / Buckingham, Sarah / Dignan, Jo / O'Driscoll, Sandra / Johnson, Kemi / Rees, David / Wyatt, Hilary / Metcalfe, Alison

Journal of genetic counseling

2016 Volume 25, Issue 6, Page(s) 1215–1226

Abstract: The clinical advantages of the newborn screening programme (NBS) in the UK are well described in the literature. However, there has been little exploration of the psychosocial impact on the family. This study followed the principles of grounded theory to ...

Abstract	The clinical advantages of the newborn screening programme (NBS) in the UK are well described in the literature. However, there has been little exploration of the psychosocial impact on the family. This study followed the principles of grounded theory to explore parents' experiences of receiving the initial positive NBS result for their child with cystic fibrosis (CF) or sickle cell disease (SCD). Semi-structured, qualitative interviews were conducted with 22 parents (12 mothers and 10 fathers) whose children had been diagnosed with CF or SCD via NBS and were under the age of 1 year at the time of interview. The main themes that arose from the data were; parents previous knowledge of the condition and the NBS programme, the method of delivery and parental reactions to the result, sharing the results with others, the impact on parental relationships and support strategies. Study conclusions indicate that most parents thought initial positive NBS results should be delivered by a health professional with condition specific knowledge, preferably with both parents present. Genetic counselling needs to include a focus on the impact of NBS results on parental relationships. Careful consideration needs to be given to strategies to support parents of babies who have positive NBS results both in terms of the psychological health and to assist them in sharing the diagnosis.
MeSH term(s)	Adaptation, Psychological ; Adult ; Anemia, Sickle Cell/diagnosis ; Anemia, Sickle Cell/genetics ; Cystic Fibrosis/diagnosis ; Cystic Fibrosis/genetics ; Female ; Genetic Counseling ; Genetic Testing ; Health Knowledge, Attitudes, Practice ; Humans ; Infant ; Infant, Newborn ; Male ; Neonatal Screening ; Parents/education ; Parents/psychology ; Surveys and Questionnaires
Language	English
Publishing date	2016-04-20
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1117799-8
ISSN	1573-3599 ; 1059-7700
ISSN (online)	1573-3599
ISSN	1059-7700
DOI	10.1007/s10897-016-9959-4
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