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Article ; Online: Safety, Efficacy, and Clinical Outcomes of Dexmedetomidine for Sedation in Traumatic Brain Injury: A Scoping Review.

Hatfield, Jordan / Soto, Alexandria L / Kelly-Hedrick, Margot / Kaplan, Samantha / Komisarow, Jordan M / Ohnuma, Tetsu / Krishnamoorthy, Vijay

Journal of neurosurgical anesthesiology

2023 Volume 36, Issue 2, Page(s) 101–108

Abstract: Dexmedetomidine is a promising alternative sedative agent for moderate-severe Traumatic brain injury (TBI) patients. Although the data are limited, the posited benefits of dexmedetomidine in this population are a reduction in secondary brain injury ... ...

Abstract	Dexmedetomidine is a promising alternative sedative agent for moderate-severe Traumatic brain injury (TBI) patients. Although the data are limited, the posited benefits of dexmedetomidine in this population are a reduction in secondary brain injury compared with current standard sedative regimens. In this scoping review, we critically appraised the literature to examine the effects of dexmedetomidine in patients with moderate-severe TBI to examine the safety, efficacy, and cerebral and systemic physiological outcomes within this population. We sought to identify gaps in the literature and generate directions for future research. Two researchers and a librarian queried PubMed, Embase, Scopus, and APA PsycINFO databases. Of 920 studies imported for screening, 11 were identified for inclusion in the review. The primary outcomes in the included studied were cerebral physiology, systemic hemodynamics, sedation levels and delirium, and the presence of paroxysmal sympathetic hyperactivity. Dexmedetomidine dosing ranged from 0.2 to 1 ug/kg/h, with 3 studies using initial boluses of 0.8 to 1.0 ug/kg over 10 minutes. Dexmedetomidine used independently or as an adjunct seems to exhibit a similar hemodynamic safety profile compared with standard sedation regimens, albeit with transient episodes of bradycardia and hypotension, decrease episodes of agitation and may serve to alleviate symptoms of sympathetic hyperactivity. This scoping review suggests that dexmedetomidine is a safe and efficacious sedation strategy in patients with TBI. Given its rapid onset of action and anxiolytic properties, dexmedetomidine may serve as a feasible sedative for TBI patients.
MeSH term(s)	Humans ; Dexmedetomidine/adverse effects ; Hypnotics and Sedatives/adverse effects ; Brain Injuries, Traumatic/drug therapy ; Pain ; Brain Injuries
Chemical Substances	Dexmedetomidine (67VB76HONO) ; Hypnotics and Sedatives
Language	English
Publishing date	2023-02-15
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	1018119-2
ISSN	1537-1921 ; 0898-4921
ISSN (online)	1537-1921
ISSN	0898-4921
DOI	10.1097/ANA.0000000000000907
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Article: Specific and comprehensive genetic targeting reveals brain-wide distribution and synaptic input patterns of GABAergic axo-axonic interneurons.

Raudales, Ricardo / Kim, Gukhan / Kelly, Sean M / Hatfield, Joshua / Guan, Wuqiang / Zhao, Shengli / Paul, Anirban / Qian, Yongjun / Li, Bo / Huang, Z Josh

bioRxiv : the preprint server for biology

2024

Abstract: Axo-axonic cells (AACs), also called chandelier cells (ChCs) in the cerebral cortex, are the most distinctive type of GABAergic interneurons described in the neocortex, hippocampus, and basolateral amygdala (BLA). AACs selectively innervate glutamatergic ...

Abstract	Axo-axonic cells (AACs), also called chandelier cells (ChCs) in the cerebral cortex, are the most distinctive type of GABAergic interneurons described in the neocortex, hippocampus, and basolateral amygdala (BLA). AACs selectively innervate glutamatergic projection neurons (PNs) at their axon initial segment (AIS), thus may exert decisive control over PN spiking and regulate PN functional ensembles. However, the brain-wide distribution, synaptic connectivity, and circuit function of AACs remains poorly understood, largely due to the lack of specific and reliable experimental tools. Here, we have established an intersectional genetic strategy that achieves specific and comprehensive targeting of AACs throughout the mouse brain based on their lineage (
Language	English
Publishing date	2024-03-25
Publishing country	United States
Document type	Preprint
DOI	10.1101/2023.11.07.566059
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Article ; Online: Screening for Covid-19 in Skilled Nursing Facilities. Reply.

Hatfield, Kelly M / Reddy, Sujan C / Jernigan, John A

The New England journal of medicine

2020 Volume 383, Issue 2, Page(s) 192

MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections ; Humans ; Pandemics ; Pneumonia, Viral ; SARS-CoV-2 ; Skilled Nursing Facilities
Keywords	covid19
Language	English
Publishing date	2020-05-29
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJMc2017362
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Article ; Online: Early Beta-Blocker Utilization in Critically Ill Patients With Moderate-Severe Traumatic Brain Injury: A Retrospective Cohort Study.

Kelly-Hedrick, Margot / Liu, Sunny Yang / Komisarow, Jordan / Hatfield, Jordan / Ohnuma, Tetsu / Treggiari, Miriam M / Colton, Katharine / Arulraja, Evangeline / Vavilala, Monica S / Laskowitz, Daniel T / Mathew, Joseph P / Hernandez, Adrian / James, Michael L / Raghunathan, Karthik / Krishnamoorthy, Vijay

Journal of intensive care medicine

2024 , Page(s) 8850666241236724

Abstract: Background: There is limited evidence that beta-blockers may provide benefit for patients with moderate-severe traumatic brain injury (TBI) during the acute injury period. Larger studies on utilization patterns and impact on outcomes in clinical ... ...

Abstract	Background: There is limited evidence that beta-blockers may provide benefit for patients with moderate-severe traumatic brain injury (TBI) during the acute injury period. Larger studies on utilization patterns and impact on outcomes in clinical practice are lacking. Objective: The present study uses a large, national hospital claims-based dataset to examine early beta-blocker utilization patterns and its association with clinical outcomes among critically ill patients with moderate-severe TBI. Methods: We conducted a retrospective cohort study of the administrative claims Premier Healthcare Database of adults (≥17 years) with moderate-severe TBI admitted to the intensive care unit (ICU) from 2016 to 2020. The exposure was receipt of a beta-blocker during day 1 or 2 of ICU stay (BB Results: A total of 109 665 participants met inclusion criteria and 39% (n = 42 489) were exposed to beta-blockers during the first 2 days of hospitalization. Of those, 42% received cardioselective only, 43% received noncardioselective only, and 14% received both. After adjustment, there was no association with hospital mortality in the BB Conclusion: In this retrospective cohort study, we found variation in use of beta-blockers and early exposure was not associated with hospital mortality. Further research is necessary to understand the optimal type, dose, and timing of beta-blockers for this population.
Language	English
Publishing date	2024-03-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	632828-3
ISSN	1525-1489 ; 0885-0666
ISSN (online)	1525-1489
ISSN	0885-0666
DOI	10.1177/08850666241236724
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Article ; Online: Association of Early Dexmedetomidine Utilization With Clinical Outcomes After Moderate-Severe Traumatic Brain Injury: A Retrospective Cohort Study.

Liu, Sunny Yang / Kelly-Hedrick, Margot / Komisarow, Jordan / Hatfield, Jordan / Ohnuma, Tetsu / Treggiari, Miriam M / Colton, Katharine / Arulraja, Evangeline / Vavilala, Monica S / Laskowitz, Daniel T / Mathew, Joseph P / Hernandez, Adrian / James, Michael L / Raghunathan, Karthik / Krishnamoorthy, Vijay

Anesthesia and analgesia

2024

Abstract: Background: Traumatic brain injury (TBI) is an expensive and common public health problem. Management of TBI oftentimes includes sedation to facilitate mechanical ventilation (MV) for airway protection. Dexmedetomidine has emerged as a potential ... ...

Abstract	Background: Traumatic brain injury (TBI) is an expensive and common public health problem. Management of TBI oftentimes includes sedation to facilitate mechanical ventilation (MV) for airway protection. Dexmedetomidine has emerged as a potential candidate for improved patient outcomes when used for early sedation after TBI due to its potential modulation of autonomic dysfunction. We examined early sedation patterns, as well as the association of dexmedetomidine exposure with clinical and functional outcomes among mechanically ventilated patients with moderate-severe TBI (msTBI) in the United States. Methods: We conducted a retrospective cohort study using data from the Premier dataset and identified a cohort of critically ill adult patients with msTBI who required MV from January 2016 to June 2020. msTBI was defined by head-neck abbreviated injury scale (AIS) values of 3 (serious), 4 (severe), and 5 (critical). We described early continuous sedative utilization patterns. Using propensity-matched models, we examined the association of early dexmedetomidine exposure (within 2 days of intensive care unit [ICU] admission) with the primary outcome of hospital mortality and the following secondary outcomes: hospital length of stay (LOS), days on MV, vasopressor use after the first 2 days of admission, hemodialysis (HD) after the first 2 days of admission, hospital costs, and discharge disposition. All medications, treatments, and procedures were identified using date-stamped hospital charge codes. Results: The study population included 19,751 subjects who required MV within 2 days of ICU admission. The patients were majority male and white. From 2016 to 2020, the annual percent utilization of dexmedetomidine increased from 4.05% to 8.60%. After propensity score matching, early dexmedetomidine exposure was associated with reduced odds of hospital mortality (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.47-0.74; P < .0001), increased risk for liberation from MV (hazard ratio [HR], 1.20; 95% CI, 1.09-1.33; P = .0003), and reduced LOS (HR, 1.11; 95% CI, 1.01-1.22; P = .033). Exposure to early dexmedetomidine was not associated with odds of HD (OR, 1.14; 95% CI, 0.73-1.78; P = .56), vasopressor utilization (OR, 1.10; 95% CI, 0.78-1.55; P = .60), or increased hospital costs (relative cost ratio, 1.98; 95% CI, 0.93-1.03; P = .66). Conclusions: Dexmedetomidine is being utilized increasingly as a sedative for mechanically ventilated patients with msTBI. Early dexmedetomidine exposure may lead to improved patient outcomes in this population.
Language	English
Publishing date	2024-02-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/ANE.0000000000006869
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Article ; Online: Length of antibiotic therapy among adults hospitalized with uncomplicated community-acquired pneumonia, 2013-2020.

McCarthy, Natalie L / Baggs, James / Wolford, Hannah / Kazakova, Sophia V / Kabbani, Sarah / Attell, Brandon K / Neuhauser, Melinda M / Walker, Lindsey / Yi, Sarah H / Hatfield, Kelly M / Reddy, Sujan / Hicks, Lauri A

Infection control and hospital epidemiology

2024 , Page(s) 1–7

Abstract: Objective: The 2014 US National Strategy for Combating Antibiotic-Resistant Bacteria (CARB) aimed to reduce inappropriate inpatient antibiotic use by 20% for monitored conditions, such as community-acquired pneumonia (CAP), by 2020. We evaluated annual ... ...

Abstract	Objective: The 2014 US National Strategy for Combating Antibiotic-Resistant Bacteria (CARB) aimed to reduce inappropriate inpatient antibiotic use by 20% for monitored conditions, such as community-acquired pneumonia (CAP), by 2020. We evaluated annual trends in length of therapy (LOT) in adults hospitalized with uncomplicated CAP from 2013 through 2020. Methods: We conducted a retrospective cohort study among adults with a primary diagnosis of bacterial or unspecified pneumonia using Results: There were 44,976 and 400,928 uncomplicated CAP hospitalizations among patients aged 18-64 years and ≥65 years, respectively. From 2013 to 2020, the proportion of patients with total LOT >7 days decreased by 25% (68% to 51%) among patients aged 18-64 years and by 27% (68%-50%) among patients aged ≥65 years. Conclusions: Although likely excessive LOT for uncomplicated CAP patients decreased since 2013, the proportion of patients treated with LOT >7 days still exceeded 50% in 2020. Antibiotic stewardship programs should continue to pursue interventions to reduce likely excessive LOT for common infections.
Language	English
Publishing date	2024-02-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	639378-0
ISSN	1559-6834 ; 0195-9417 ; 0899-823X
ISSN (online)	1559-6834
ISSN	0195-9417 ; 0899-823X
DOI	10.1017/ice.2024.14
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Article ; Online: A cytoskeletal protein complex is essential for division of intracellular amastigotes of

Kelly, Felice D / Tran, Khoa D / Hatfield, Jess / Schmidt, Kat / Sanchez, Marco A / Landfear, Scott M

The Journal of biological chemistry

2020 Volume 295, Issue 37, Page(s) 13106–13122

Abstract: Previous studies ... ...

Abstract	Previous studies in
MeSH term(s)	Cell Division ; Cytoskeletal Proteins/genetics ; Cytoskeletal Proteins/metabolism ; Flagella/genetics ; Flagella/metabolism ; Leishmania mexicana/genetics ; Leishmania mexicana/metabolism ; Microtubules/genetics ; Microtubules/metabolism ; Multiprotein Complexes/genetics ; Multiprotein Complexes/metabolism ; Protein Transport ; Protozoan Proteins/genetics ; Protozoan Proteins/metabolism
Chemical Substances	Cytoskeletal Proteins ; Multiprotein Complexes ; Protozoan Proteins
Language	English
Publishing date	2020-07-22
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2997-x
ISSN	1083-351X ; 0021-9258
ISSN (online)	1083-351X
ISSN	0021-9258
DOI	10.1074/jbc.RA120.014065
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Article ; Online: Assessment of Hospital-Onset SARS-CoV-2 Infection Rates and Testing Practices in the US, 2020-2022.

Hatfield, Kelly M / Baggs, James / Maillis, Alexander / Warner, Sarah / Jernigan, John A / Kadri, Sameer S / Klompas, Michael / Reddy, Sujan C

JAMA network open

2023 Volume 6, Issue 8, Page(s) e2329441

Abstract: Importance: Characterizing the scale and factors associated with hospital-onset SARS-CoV-2 infections could help inform hospital and public health policies regarding prevention and surveillance needs for these infections.: Objective: To evaluate ... ...

Abstract	Importance: Characterizing the scale and factors associated with hospital-onset SARS-CoV-2 infections could help inform hospital and public health policies regarding prevention and surveillance needs for these infections. Objective: To evaluate associations of hospital-onset SARS-CoV-2 infection rates with different periods of the COVID-19 pandemic, hospital characteristics, and testing practices. Design, setting, and participants: This cohort study of US hospitals reporting SARS-CoV-2 testing data in the PINC AI Healthcare Database COVID-19 special release files was conducted from July 2020 through June 2022. Data were collected from hospitals that reported at least 1 SARS-CoV-2 reverse transcription-polymerase chain reaction or antigen test during hospitalizations discharged that month. For each hospital-month where the hospital reported sufficient data, all hospitalizations discharged in that month were included in the cohort. SARS-CoV-2 viral tests and results reported in the microbiology files for all hospitalizations in the study period by discharge month were identified. Data analysis was conducted from September 2022 to March 2023. Exposure: Hospitalizations discharged in an included hospital-month. Main outcomes and measures: Multivariable generalized estimating equation negative-binomial regression models were used to assess associations of monthly rates of hospital-onset SARS-CoV-2 infections per 1000 patient-days (defined as a first positive SARS-CoV-2 test during after hospitalization day 7) with the phase of the pandemic (defined as the predominant SARS-CoV-2 variant in circulation), admission testing rates, and hospital characteristics (hospital bed size, teaching status, urban vs rural designation, Census region, and patient distribution variables). Results: A total of 5687 hospital-months from 288 distinct hospitals were included, which contributed 4 421 268 hospitalization records. Among 171 564 hospitalizations with a positive SARS-CoV-2 test, 7591 (4.4%) were found to be hospital onset and 6455 (3.8%) were indeterminate onset. The mean monthly hospital-onset infection rate per 1000 patient-days was 0.27 (95 CI, 0.26-0.29). Hospital-onset infections occurred in 2217 of 5687 hospital-months (39.0%). The monthly percentage of discharged patients tested for SARS-CoV-2 at admission varied; 1673 hospital-months (29.4%) had less than 25% of hospitalizations tested at admission; 2199 hospital-months (38.7%) had 25% to 50% of all hospitalizations tested, and 1815 hospital months (31.9%) had more than 50% of all hospitalizations tested at admission. Postadmission testing rates and community-onset infection rates increased with admission testing rates. In multivariable models restricted to hospital-months testing at least 25% of hospitalizations at admission, a 10% increase in community-onset SARS-CoV-2 infection rate was associated with a 178% increase in the hospital-onset infection rate (rate ratio, 2.78; 95% CI, 2.52-3.07). Additionally, the phase of the COVID-19 pandemic, the admission testing rate, Census region, and bed size were all significantly associated with hospital-onset SARS-CoV-2 infection rates. Conclusions and relevance: In this cohort study of hospitals reporting SARS-CoV-2 infections, there was an increase of hospital-onset SARS-CoV-2 infections when community-onset infections were higher, indicating a need for ongoing and enhanced surveillance and prevention efforts to reduce in-hospital transmission of SARS-CoV-2 infections, particularly when community-incidence of SARS-CoV-2 infections is high.
MeSH term(s)	Humans ; SARS-CoV-2 ; COVID-19/diagnosis ; COVID-19/epidemiology ; COVID-19 Testing ; Cohort Studies ; Pandemics ; Hospitals ; Cross Infection/diagnosis ; Cross Infection/epidemiology
Language	English
Publishing date	2023-08-01
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2023.29441
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Article: Screening for Covid-19 in Skilled Nursing Facilities. Reply

Hatfield, Kelly M / Reddy, Sujan C / Jernigan, John A

N Engl J Med

Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #425654
Database	COVID19

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Article ; Online: Effectiveness of Coronavirus Disease 2019 (COVID-19) Vaccination Against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection Among Residents of US Nursing Homes Before and During the Delta Variant Predominance, December 2020-November 2021.

Hatfield, Kelly M / Baggs, James / Wolford, Hannah / Fang, Michael / Sattar, Ammarah A / Montgomery, Kelsey S / Jin, Steven / Jernigan, John / Pilishvili, Tamara

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2022 Volume 75, Issue Supplement_2, Page(s) S147–S154

Abstract: Background: Residents of nursing homes experience disproportionate morbidity and mortality related to coronavirus disease 2019 (COVID-19) and were prioritized for vaccine introduction. We evaluated COVID-19 vaccine effectiveness (VE) in preventing ... ...

Abstract	Background: Residents of nursing homes experience disproportionate morbidity and mortality related to coronavirus disease 2019 (COVID-19) and were prioritized for vaccine introduction. We evaluated COVID-19 vaccine effectiveness (VE) in preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections among nursing home residents. Methods: We used a retrospective cohort of 4315 nursing home residents during 14 December 2020-9 November 2021. A Cox proportional hazards model was used to estimate hazard ratios comparing residents with a completed vaccination series with unvaccinated among those with and without prior SARS-CoV-2 infection, by vaccine product, and by time period. Results: Overall adjusted VE was 58% (95% confidence interval [CI], 44% to 69%) among residents without a history of SARS-CoV-2 infection. During the pre-Delta period, the VE within 150 days of receipt of the second dose of Pfizer-BioNTech (67%; 95% CI, 40% to 82%) and Moderna (75%; 95% CI, 32% to 91%) was similar. During the Delta period, VE measured >150 days after the second dose was 33% (95% CI, -2% to 56%) for Pfizer-BioNTech and 77% (95% CI, 48% to 91%) for Moderna. Rates of infection were 78% lower (95% CI, 67% to 85%) among residents with prior SARS-CoV-2 infection and completed vaccination series compared with unvaccinated residents without a history of SARS-CoV-2 infection. Conclusions: COVID-19 vaccines were effective in preventing SARS-CoV-2 infections among nursing home residents, and history of prior SARS-CoV-2 infection provided additional protection. Maintaining high coverage of recommended doses of COVID-19 vaccines remains a critical tool for preventing infections in nursing homes.
MeSH term(s)	COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19 Vaccines ; Humans ; Nursing Homes ; Retrospective Studies ; SARS-CoV-2 ; Vaccination
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2022-07-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciac562
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