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Article ; Online: A Scoping Review of Targeted Interventions and Training to Facilitate Medical Encounters for School-Aged Patients with an Autism Spectrum Disorder.

Kouo, Jennifer L / Kouo, Theodore S

Journal of autism and developmental disorders

2020 Volume 51, Issue 8, Page(s) 2829–2851

Abstract: Individuals with an autism spectrum disorder (ASD) have a greater number of healthcare provider interactions than individuals without ASD. The obstacles to patient-centered care for this population, which include inflexibility of hospital environments, ... ...

Abstract	Individuals with an autism spectrum disorder (ASD) have a greater number of healthcare provider interactions than individuals without ASD. The obstacles to patient-centered care for this population, which include inflexibility of hospital environments, limited resources, and inadequate training, has been documented. However, there is little knowledge on efforts to address such concerns. A scoping review was conducted and the systematic search of the literature resulted in 23 relevant studies. The predominant themes include the use of data collection instruments, application of evidence-based practices and resources, and training of providers. The results of this review have implications for practitioners and future research to adapt and improve upon the provision of medical care for individuals with ASD across the lifespan.
MeSH term(s)	Autism Spectrum Disorder/diagnosis ; Autism Spectrum Disorder/psychology ; Autism Spectrum Disorder/therapy ; Child ; Early Intervention, Educational/methods ; Health Personnel/education ; Health Personnel/psychology ; Humans ; Patient-Centered Care/methods ; Schools ; Students/psychology
Language	English
Publishing date	2020-10-17
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	391999-7
ISSN	1573-3432 ; 0162-3257
ISSN (online)	1573-3432
ISSN	0162-3257
DOI	10.1007/s10803-020-04716-9
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Zs.A 765: Show issues

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Article ; Online: Brief Report: The Experiences of Families of Children with an Autism Spectrum Disorder When Seeking Patient-and Family-Centered Care.

Kouo, Jennifer L / Kouo, Theodore S / Gallogly, Jillian

Journal of autism and developmental disorders

2021 Volume 52, Issue 9, Page(s) 4172–4180

Abstract: Patient-and family-centered care (PFCC) is a partnership among healthcare professionals, patients, and families that is grounded in mutual respect and is an approach that impacts delivery of care, decision-making, and information sharing. PFCC should be ... ...

Abstract	Patient-and family-centered care (PFCC) is a partnership among healthcare professionals, patients, and families that is grounded in mutual respect and is an approach that impacts delivery of care, decision-making, and information sharing. PFCC should be implemented for all, including individuals with Autism Spectrum Disorders (ASD), who experience adverse medical encounters despite increased prevalence and healthcare utilization. Insights into the experiences of families during medical experiences can inform clinical practice by increasing healthcare professionals' understanding of the population. Using a mixed-methods approach, the perspectives of 40 families were analyzed. The themes include barriers and opportunities to improve upon the delivery of PFCC, which help to advance healthcare interactions and inform solution-based initiatives to facilitate medical visits that may benefit all patients.
MeSH term(s)	Autism Spectrum Disorder/therapy ; Child ; Delivery of Health Care ; Health Personnel ; Humans ; Patient-Centered Care
Language	English
Publishing date	2021-09-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	391999-7
ISSN	1573-3432 ; 0162-3257
ISSN (online)	1573-3432
ISSN	0162-3257
DOI	10.1007/s10803-021-05272-6
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Article ; Online: SARS-CoV-2 as a superantigen in multisystem inflammatory syndrome in children.

Kouo, Theodore / Chaisawangwong, Worarat

The Journal of clinical investigation

2021 Volume 131, Issue 10

Abstract: Multisystem inflammatory syndrome in children (MIS-C) is a rare but deadly new disease in children that rapidly progresses to hyperinflammation and shock, and can lead to multiple organ failure if unrecognized. It has been found to be temporally ... ...

Abstract	Multisystem inflammatory syndrome in children (MIS-C) is a rare but deadly new disease in children that rapidly progresses to hyperinflammation and shock, and can lead to multiple organ failure if unrecognized. It has been found to be temporally associated with the COVID-19 pandemic and is often associated with SARS-CoV-2 exposure in children. In this issue of the JCI, Porritt, Paschold, et al. identify restricted T cell receptor (TCR) β-chain variable domain (Vβ) usage in patients with severe MIS-C, indicating a potential role for SARS-CoV-2 as a superantigen. These findings suggest that a blood test that determines the presence of specific TCRβ variable gene (TRBV) segments may identify patients at risk for severe MIS-C.
MeSH term(s)	COVID-19 ; Child ; Humans ; Pandemics ; SARS-CoV-2 ; Superantigens/genetics ; Systemic Inflammatory Response Syndrome ; T-Lymphocytes
Chemical Substances	Superantigens
Language	English
Publishing date	2021-04-12
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Comment
ZDB-ID	3067-3
ISSN	1558-8238 ; 0021-9738
ISSN (online)	1558-8238
ISSN	0021-9738
DOI	10.1172/JCI149327
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Article ; Online: Assessing Ease of Delivering Emergency Care for Patients with Autism Spectrum Disorders.

Kouo, Theodore / Bharadwaj, Neha / Kouo, Jennifer / Tackett, Sean / Ryan, Leticia

Journal of developmental and behavioral pediatrics : JDBP

2021 Volume 42, Issue 9, Page(s) 704–710

Abstract: Objective: The aim of this study was to develop a method for objectively assessing the delivery of care to children with autism spectrum disorder (ASD) in the emergency department (ED).: Methods: A case-control study of patients ages 2 to 18 years ... ...

Abstract	Objective: The aim of this study was to develop a method for objectively assessing the delivery of care to children with autism spectrum disorder (ASD) in the emergency department (ED). Methods: A case-control study of patients ages 2 to 18 years admitted to the hospital from January 2016 to January 2018. Cases were defined as patients with an International Classification of Diseases, Tenth Revision diagnosis of ASD or other pervasive developmental disorder (F84) in their medical record and were matched 1:1 with neurotypical controls. The primary outcome was ability to complete several core tasks clinically necessary within an ED visit and summarized into a Task Completion Index (TCI). Results: Overall, children with ASD had higher median TCIs of 0.25 (interquartile range [IQR] 0-0.45) versus 0 (IQR 0-0.25) when compared with children without ASD (p < 0.01). Children with ASD were 5 times more likely to have difficulty with triage vitals, 3 times more likely to require additional staff for peripheral intravenous placement, and 4 times more likely to experience delays or disruptions to their plan of care. The TCI was also associated with 8-fold increased odds of receiving pharmacologic or physical restraint. Conclusions: The TCI reflects difficulty accomplishing core tasks necessary to complete an ED visit. Children with ASD have higher TCIs than neurotypical controls, which puts them at higher risk for care disruptions. Evaluation of initiatives to improve quality of care for children with ASD should focus not only on metrics of overall experience and satisfaction but also how these initiatives affect the ability to effectively administer care.
MeSH term(s)	Adolescent ; Autism Spectrum Disorder/diagnosis ; Autism Spectrum Disorder/therapy ; Case-Control Studies ; Child ; Child, Preschool ; Emergency Medical Services ; Emergency Service, Hospital ; Hospitalization ; Humans
Language	English
Publishing date	2021-05-26
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	603379-9
ISSN	1536-7312 ; 0196-206X
ISSN (online)	1536-7312
ISSN	0196-206X
DOI	10.1097/DBP.0000000000000974
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Zs.A 1582: Show issues

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Article ; Online: Tracking Staff Mood and Concerns in a Pediatric Emergency Department During the COVID-19 Pandemic.

Odonkor, Michelle N / Vidal, Carol / Seligman, Eva / Kouo, Theodore / Husain, Amyna

Journal of emergency nursing

2023 Volume 50, Issue 1, Page(s) 117–125.e1

Abstract: Introduction: Few studies have monitored health care worker mood and job satisfaction changes longitudinally throughout an epidemic. The objective of this study was to track staff mood, job satisfaction, questions, and suggestions in a pediatric ... ...

Abstract	Introduction: Few studies have monitored health care worker mood and job satisfaction changes longitudinally throughout an epidemic. The objective of this study was to track staff mood, job satisfaction, questions, and suggestions in a pediatric emergency department over 1 year during the coronavirus disease 2019 pandemic. We hypothesized that staff would experience heightened negative emotions earlier in the pandemic due to uncertainty around hospital protocols and the coronavirus disease 2019 disease process. Methods: A voluntary, cross sectional descriptive study using an anonymous electronic survey assessed job satisfaction and mood over 4 domains (sad-happy, angry-peaceful, exhausted-energized, fearful-confident) in pediatric emergency department staff members. Responses were reported with Likert scales and free-text fields. Results: Of 272 survey responses, most were from nurses and clinical technicians (N = 173, 63.6%), followed by physicians and physician assistants (N = 55, 20.2%) and nonmedical staff (N = 44, 16.2%). Department-wide values for the fearful-confident and angry-peaceful domains increased over time (P = .001 and P = .01, respectively), indicating an overall more confident and peaceful mood in department staff. Job satisfaction did not change over time or by staff role. Nurses and clinical technicians reported the most exhaustion (P = .002), and physicians and physician assistants reported the most fear (P = .03). We received a total of 71 comments, which we grouped into 4 themes: protocols and procedures, personnel, infection risk, and miscellaneous. Comments submitted early in the pandemic centered around intradepartmental protocols and procedures, with a peak in staffing comments 5 months into the pandemic. Discussion: An electronic survey monitoring mood, job satisfaction, and concerns in a pediatric emergency department identified mood changes in staff over the course of the coronavirus disease 2019 pandemic.
MeSH term(s)	Child ; Humans ; COVID-19/epidemiology ; Pandemics ; Cross-Sectional Studies ; Health Personnel/psychology ; Emergency Service, Hospital ; Surveys and Questionnaires ; Job Satisfaction
Language	English
Publishing date	2023-10-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	604632-0
ISSN	1527-2966 ; 0099-1767
ISSN (online)	1527-2966
ISSN	0099-1767
DOI	10.1016/j.jen.2023.08.006
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Zs.B 2509: Show issues

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Article ; Online: Use of white cell count, age, and presence of other injuries in stratifying risk of intracranial injury in pediatric trauma.

Peyton, Margo A / Kouo, Theodore / Scott, Jennifer / Yanek, Lisa R / Ngo, Thuy L

Journal of investigative medicine : the official publication of the American Federation for Clinical Research

2020 Volume 69, Issue 2, Page(s) 408–410

Abstract: The Pediatric Emergency Care Applied Research Network (PECARN) Head Injury/Trauma Algorithm is a well-validated decision rule used to identify patients at low risk of clinically important traumatic brain injuries who may not need head CT. In adult ... ...

Abstract	The Pediatric Emergency Care Applied Research Network (PECARN) Head Injury/Trauma Algorithm is a well-validated decision rule used to identify patients at low risk of clinically important traumatic brain injuries who may not need head CT. In adult patients with mild head trauma, elevated serum glucose and white cell count (WCC) have been associated with abnormal head CT findings. Currently, glucose or WCC is not considered in pediatric patients. The objective of this study was to determine if elevations in glucose or WCC could be used as additional tools to risk-stratify pediatric trauma patients for intracranial injury (ICI). Data were abstracted from the Maryland Trauma Registry and from electronic medical records for patients at the Johns Hopkins Children's Center from 2017 to 2020. We evaluated 145 encounters that met the inclusion criteria. There were 33 cases of ICI on CT. In addition to higher median glucose and WCC, we found that patients with ICI had a younger median age and were less likely to have other clinically significant injuries than patients without ICI. Following multiple logistic regression analysis, WCC (OR 1.113, 95% CI 1.02 to 1.21), younger age (OR 0.89, 95% CI 0.8 to 0.98), and absence of other injuries (OR 0.41, 95% CI 0.23 to 0.73) were found to be associated with risk of ICI. The area under the curve for our model was 0.79. When used with the PECARN algorithm, our model could help determine which patients may avoid head CT or undergo a shorter observation period.
MeSH term(s)	Blood Glucose ; Child ; Craniocerebral Trauma/diagnosis ; Decision Support Techniques ; Emergency Service, Hospital ; Humans ; Leukocyte Count
Chemical Substances	Blood Glucose
Language	English
Publishing date	2020-12-18
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1217870-6
ISSN	1708-8267 ; 0009-9279 ; 1081-5589
ISSN (online)	1708-8267
ISSN	0009-9279 ; 1081-5589
DOI	10.1136/jim-2020-001509
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Article ; Online: Cross-reactivity of SARS-CoV-2- and influenza A-specific T cells in individuals exposed to SARS-CoV-2.

Chaisawangwong, Worarat / Wang, Hanzhi / Kouo, Theodore / Salathe, Sebastian F / Isser, Ariel / Bieler, Joan Glick / Zhang, Maya L / Livingston, Natalie K / Li, Shuyi / Horowitz, Joseph J / Samet, Ron E / Zyskind, Israel / Rosenberg, Avi Z / Schneck, Jonathan P

JCI insight

2022 Volume 7, Issue 18

Abstract: Cross-reactive immunity between SARS-CoV-2 and other related coronaviruses has been well-documented, and it may play a role in preventing severe COVID-19. Epidemiological studies early in the pandemic showed a geographical association between high ... ...

Abstract	Cross-reactive immunity between SARS-CoV-2 and other related coronaviruses has been well-documented, and it may play a role in preventing severe COVID-19. Epidemiological studies early in the pandemic showed a geographical association between high influenza vaccination rates and lower incidence of SARS-CoV-2 infection. We, therefore, analyzed whether exposure to influenza A virus (IAV) antigens could influence the T cell repertoire in response to SARS-CoV-2, indicating a heterologous immune response between these 2 unrelated viruses. Using artificial antigen-presenting cells (aAPCs) combined with real-time reverse-transcription PCR (RT-qPCR), we developed a sensitive assay to quickly screen for antigen-specific T cell responses and detected a significant correlation between responses to SARS-CoV-2 epitopes and IAV dominant epitope (M158-66). Further analysis showed that some COVID-19 convalescent donors exhibited both T cell receptor (TCR) specificity and functional cytokine responses to multiple SARS-CoV-2 epitopes and M158-66. Utilizing an aAPC-based stimulation/expansion assay, we detected cross-reactive T cells with specificity to SARS-CoV-2 and IAV. In addition, TCR sequencing of the cross-reactive and IAV-specific T cells revealed similarities between the TCR repertoires of the two populations. These results indicate that heterologous immunity shaped by our exposure to other unrelated endemic viruses may affect our immune response to novel viruses such as SARS-CoV-2.
MeSH term(s)	Antigens, Viral ; CD8-Positive T-Lymphocytes ; COVID-19 ; Cytokines ; Epitopes ; Humans ; Influenza, Human ; Receptors, Antigen, T-Cell ; SARS-CoV-2
Chemical Substances	Antigens, Viral ; Cytokines ; Epitopes ; Receptors, Antigen, T-Cell
Language	English
Publishing date	2022-09-22
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	2379-3708
ISSN (online)	2379-3708
DOI	10.1172/jci.insight.158308
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Article ; Online: A Resident-Led QI Initiative to Improve Pediatric Emergency Department Boarding Times.

Kouo, Theodore / Kleinman, Keith / Fujii-Rios, Hanae / Badaki-Makun, Oluwakemi / Kim, Julia / Falco, Lucas / Canares, Therese L

Pediatrics

2020 Volume 145, Issue 6

Abstract: Background: Pediatric emergency department (PED) overcrowding and prolonged boarding times (admission order to PED departure) decrease quality of care. Timely transfer of patients from the PED to inpatient units is a key driver that relieves ... ...

Abstract	Background: Pediatric emergency department (PED) overcrowding and prolonged boarding times (admission order to PED departure) decrease quality of care. Timely transfer of patients from the PED to inpatient units is a key driver that relieves overcrowding. In 2015, PED boarding time at our hospital was 10% longer than the national benchmark. We described a resident-led quality-improvement initiative to decrease PED mean boarding times by 10% (from 173 to 156 minutes) within 6 months among general pediatric admissions. Methods: We applied Plan-Do-Study-Act (PDSA) methodology. PDSA 1 (October 2016) interventions were bundled to include streamlined mobile communications, biweekly educational presentations, and reminder signs. PDSA 2 (August 2017) provided alternative workflows for senior residents. Outcomes were mean PED boarding times for general pediatrics admissions. The proportion of PICU transfers within 12 hours of admission served as a balancing measure. Statistical process control charts were used to analyze boarding times and PICU transfer rates. Results: Leading up to PDSA 1, monthly mean boarding times decreased from 173 to 145 minutes and were sustained throughout the study period and up to 1 year after study completion. The X-bar chart demonstrated a shift with 57 consecutive months of mean boarding times below the preintervention mean. There were no changes in PICU transfer rates within 12 hours of admission. Conculsions: Resident-led quality improvement efforts, including education and streamlined workflow, significantly improved PED boarding time without causing harm to patients.
MeSH term(s)	Baltimore/epidemiology ; Child ; Child, Preschool ; Emergency Service, Hospital/standards ; Emergency Service, Hospital/trends ; Female ; Hospitals, Urban/standards ; Hospitals, Urban/trends ; Humans ; Internship and Residency/standards ; Internship and Residency/trends ; Male ; Patient Admission/standards ; Patient Admission/trends ; Patient Transfer/standards ; Patient Transfer/trends ; Pediatric Emergency Medicine/standards ; Pediatric Emergency Medicine/trends ; Quality Improvement/standards ; Quality Improvement/trends ; Workflow
Language	English
Publishing date	2020-05-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	207677-9
ISSN	1098-4275 ; 0031-4005
ISSN (online)	1098-4275
ISSN	0031-4005
DOI	10.1542/peds.2019-1477
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Article ; Online: Cross-reactivity of SARS-CoV-2– and influenza A–specific T cells in individuals exposed to SARS-CoV-2

Worarat Chaisawangwong / Hanzhi Wang / Theodore Kouo / Sebastian F. Salathe / Ariel Isser / Joan Glick Bieler / Maya L. Zhang / Natalie K. Livingston / Shuyi Li / Joseph J. Horowitz / Ron E. Samet / Israel Zyskind / Avi Z. Rosenberg / Jonathan P. Schneck

JCI Insight, Vol 7, Iss

2022 Volume 18

Abstract	Cross-reactive immunity between SARS-CoV-2 and other related coronaviruses has been well-documented, and it may play a role in preventing severe COVID-19. Epidemiological studies early in the pandemic showed a geographical association between high influenza vaccination rates and lower incidence of SARS-CoV-2 infection. We, therefore, analyzed whether exposure to influenza A virus (IAV) antigens could influence the T cell repertoire in response to SARS-CoV-2, indicating a heterologous immune response between these 2 unrelated viruses. Using artificial antigen-presenting cells (aAPCs) combined with real-time reverse-transcription PCR (RT-qPCR), we developed a sensitive assay to quickly screen for antigen-specific T cell responses and detected a significant correlation between responses to SARS-CoV-2 epitopes and IAV dominant epitope (M158–66). Further analysis showed that some COVID-19 convalescent donors exhibited both T cell receptor (TCR) specificity and functional cytokine responses to multiple SARS-CoV-2 epitopes and M158–66. Utilizing an aAPC-based stimulation/expansion assay, we detected cross-reactive T cells with specificity to SARS-CoV-2 and IAV. In addition, TCR sequencing of the cross-reactive and IAV-specific T cells revealed similarities between the TCR repertoires of the two populations. These results indicate that heterologous immunity shaped by our exposure to other unrelated endemic viruses may affect our immune response to novel viruses such as SARS-CoV-2.
Keywords	COVID-19 ; Immunology ; Medicine ; R
Subject code	570
Language	English
Publishing date	2022-09-01T00:00:00Z
Publisher	American Society for Clinical investigation
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Distinct Cytokine and Chemokine Dysregulation in Hospitalized Children With Acute Coronavirus Disease 2019 and Multisystem Inflammatory Syndrome With Similar Levels of Nasopharyngeal Severe Acute Respiratory Syndrome Coronavirus 2 Shedding.

Peart Akindele, Nadine / Kouo, Theodore / Karaba, Andrew H / Gordon, Oren / Fenstermacher, Katherine Z J / Beaudry, Jeanette / Rubens, Jessica H / Atik, Christine C / Zhou, Weiqiang / Ji, Hongkai / Tao, Xueting / Vaidya, Dhananjay / Mostafa, Heba / Caturegli, Patrizio / Blair, Paul W / Sauer, Lauren / Cox, Andrea L / Persaud, Deborah

The Journal of infectious diseases

2021 Volume 224, Issue 4, Page(s) 606–615

Abstract: Background: Multisystem inflammatory syndrome in children (MIS-C) is a severe clinical phenotype of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that remains poorly understood.: Methods: Hospitalized children <18 years of ... ...

Abstract	Background: Multisystem inflammatory syndrome in children (MIS-C) is a severe clinical phenotype of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that remains poorly understood. Methods: Hospitalized children <18 years of age with suspected coronavirus disease 2019 (COVID-19) (N = 53) were recruited into a prospective cohort study; 32 had confirmed COVID-19, with 16 meeting the US Centers for Disease Control criteria for MIS-C. Differences in nasopharyngeal viral ribonucleic acid (RNA) levels, SARS-CoV-2 seropositivity, and cytokine/chemokine profiles were examined, including after adjustments for age and sex. Results: The median ages for those with and without MIS-C were 8.7 years (interquartile range [IQR], 5.5-13.9) and 2.2 years (IQR, 1.1-10.5), respectively (P = .18), and nasopharyngeal levels of SARS-CoV-2 RNA did not differ significantly between the 2 groups (median 63 848.25 copies/mL versus 307.1 copies/mL, P = .66); 75% of those with MIS-C were antibody positive compared with 44% without (P = .026). Levels of 14 of 37 cytokines/chemokines (interleukin [IL]-1RA, IL-2RA, IL-6, IL-8, tumor necrosis factor-α, IL-10, IL-15, IL-18, monocyte chemoattractant protein [MCP]-1, IP-10, macrophage-inflammatory protein [MIP]-1α, MCP-2, MIP-1β, eotaxin) were significantly higher in children with MIS-C compared to those without, irrespective of age or sex (false discovery rate <0.05; P < .05). Conclusions: The distinct pattern of heightened cytokine/chemokine dysregulation observed with MIS-C, compared with acute COVID-19, occurs across the pediatric age spectrum and with similar levels of nasopharyngeal SARS-CoV-2 RNA.
MeSH term(s)	Adolescent ; Age Factors ; Antibodies, Viral/immunology ; Biomarkers ; COVID-19/diagnosis ; COVID-19/epidemiology ; COVID-19/metabolism ; COVID-19/virology ; Chemokines/metabolism ; Child ; Child, Preschool ; Cytokines/metabolism ; Host-Pathogen Interactions ; Humans ; Male ; RNA, Viral ; SARS-CoV-2 ; Serologic Tests ; Severity of Illness Index ; Sex Factors ; Systemic Inflammatory Response Syndrome/diagnosis ; Systemic Inflammatory Response Syndrome/epidemiology ; Systemic Inflammatory Response Syndrome/metabolism ; Systemic Inflammatory Response Syndrome/virology ; Viral Load
Chemical Substances	Antibodies, Viral ; Biomarkers ; Chemokines ; Cytokines ; RNA, Viral
Language	English
Publishing date	2021-08-15
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	3019-3
ISSN	1537-6613 ; 0022-1899
ISSN (online)	1537-6613
ISSN	0022-1899
DOI	10.1093/infdis/jiab285
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