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Article: Simulation: Keeping Pace With Pandemics.

Alessi, Lauren J / Fiedor Hamilton, Melinda

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

2020 Volume 21, Issue 8, Page(s) 772–773

MeSH term(s)	Airway Management ; Betacoronavirus ; COVID-19 ; Coronavirus ; Coronavirus Infections ; Humans ; Pandemics ; Pneumonia, Viral ; SARS-CoV-2 ; Workflow
Keywords	covid19
Language	English
Publishing date	2020-02-12
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	2052349-X
ISSN	1947-3893 ; 1529-7535
ISSN (online)	1947-3893
ISSN	1529-7535
DOI	10.1097/PCC.0000000000002509
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Zs.MO 472: Show issues

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Article ; Online: Development and Implementation of Pediatric ICU-based Mobility Guidelines: A Quality Improvement Initiative.

Ames, Stefanie G / Alessi, Lauren J / Chrisman, Maddie / Stanger, Meg / Corboy, Devin / Sinha, Amit / Fink, Ericka L

Pediatric quality & safety

2021 Volume 6, Issue 3, Page(s) e414

Abstract: Critical illness results in physical impairments which may be mitigated by intensive care unit (ICU)-based early mobility. This initiative aimed to develop and implement ICU-based mobility guidelines for critically ill children.: Methods: A ... ...

Abstract	Critical illness results in physical impairments which may be mitigated by intensive care unit (ICU)-based early mobility. This initiative aimed to develop and implement ICU-based mobility guidelines for critically ill children. Methods: A multidisciplinary team developed and implemented ICU-based mobility guidelines. Guideline implementation success was determined by comparing utilization of physical (PT) and occupational therapies (OT) and changes in functional status scale scores in preimplementation and postimplementation cohorts. The team also assessed barriers and adverse events. Results: Thirty-four patients were identified preimplementation and 55 patients postimplementation. PT/OT consultation by 72 hours occurred in 44 (81.5%) of patients postimplementation compared to 6 (17%) preimplementation ( Conclusions: Implementation of ICU-based mobility guidelines resulted in a 4-fold increase in PT/OT consultation. They did not result in increased treatment sessions due to frequent deferrals. Future guidelines should focus on interventions to address identified barriers to treatment in a critically ill pediatric population.
Language	English
Publishing date	2021-05-19
Publishing country	United States
Document type	Journal Article
ISSN	2472-0054
ISSN (online)	2472-0054
DOI	10.1097/pq9.0000000000000414
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Article ; Online: Successful Use of Cidofovir in an Immunocompetent Child With Severe Adenoviral Sepsis.

Alcamo, Alicia M / Wolf, Michael S / Alessi, Lauren J / Chong, Hey J / Green, Michael / Williams, John V / Simon, Dennis W

Pediatrics

2019 Volume 145, Issue 1

Abstract: Adenovirus infection is common in childhood and is generally associated with self-limited disease. Cidofovir, a viral DNA polymerase inhibitor, is used to treat adenovirus infection in select populations but is not often recommended for immunocompetent ... ...

Abstract	Adenovirus infection is common in childhood and is generally associated with self-limited disease. Cidofovir, a viral DNA polymerase inhibitor, is used to treat adenovirus infection in select populations but is not often recommended for immunocompetent patients because of limited antiviral activity and nephrotoxicity. Here, we report a case of fulminant adenovirus infection associated with lymphopenia and multiple organ failure requiring extracorporeal membrane oxygenation support in a previously healthy child. After 1 week of supportive therapy, the patient had persistent organ failure and continued to have adenoviremia of >560 000 copies per mL. Weekly doses of cidofovir with concurrent probenecid for renal protection was initiated. Adenovirus blood load declined after the first cidofovir dose, becoming undetectable after 3 doses. The patient was successfully decannulated from extracorporeal membrane oxygenation, extubated, and eventually discharged at his functional baseline without need for ongoing respiratory support. Lymphopenia improved after viremia resolved, and a subsequent immunologic workup revealed no evidence of primary immunodeficiency. The viral isolate was genotyped as adenovirus type 7. This case reveals the successful use of cidofovir for management of severe adenovirus infection in a previously healthy child. To date, there are no universally accepted recommendations for the use of cidofovir in this population. Further study is warranted to determine the potential role of cidofovir in treating severe adenovirus infections in immunocompetent children.
MeSH term(s)	Adenoviridae/isolation & purification ; Adenoviridae Infections/complications ; Adenoviridae Infections/drug therapy ; Antiviral Agents/therapeutic use ; Child, Preschool ; Cidofovir/therapeutic use ; Combined Modality Therapy ; Consciousness Disorders/etiology ; Extracorporeal Membrane Oxygenation ; Humans ; Immunocompetence ; Male ; Multiple Organ Failure/etiology ; Nose/virology ; Patient Acuity ; Pneumonia, Viral/diagnostic imaging ; Polymerase Chain Reaction ; Radiography, Thoracic ; Respiratory Distress Syndrome/etiology ; Respiratory Distress Syndrome/therapy ; Shock/etiology
Chemical Substances	Antiviral Agents ; Cidofovir (JIL713Q00N)
Language	English
Publishing date	2019-12-11
Publishing country	United States
Document type	Case Reports ; Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	207677-9
ISSN	1098-4275 ; 0031-4005
ISSN (online)	1098-4275
ISSN	0031-4005
DOI	10.1542/peds.2019-1632
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Zs.MO 357: Show issues

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Article: The authors reply.

Alcamo, Alicia M / Alessi, Lauren J / Vehovic, S Noona / Bansal, Neha / Bond, Geoffrey J / Carcillo, Joseph A / Green, Michael / Michaels, Marian G / Aneja, Rajesh K

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

2019 Volume 20, Issue 11, Page(s) 1103–1104

MeSH term(s)	Child ; Drug Resistance, Multiple, Bacterial ; Humans ; Liver Transplantation ; Sepsis
Language	English
Publishing date	2019-10-30
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2052349-X
ISSN	1947-3893 ; 1529-7535
ISSN (online)	1947-3893
ISSN	1529-7535
DOI	10.1097/PCC.0000000000002140
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Article ; Online: A Computable Definition of Sepsis Facilitates Screening and Performance Improvement Tracking.

Alessi, Lauren J / Warmus, Holly R / Schaffner, Erin K / Kantawala, Sajel / Carcillo, Joseph / Rosen, Johanna / Horvat, Christopher M

Pediatric quality & safety

2018 Volume 3, Issue 2, Page(s) e067

Abstract: Background: Sepsis kills almost 5,000 children annually, accounting for 16% of pediatric health care spending in the United States.: Objectives: We sought to identify sepsis within the Electronic Health Record (EHR) of a quaternary children's ... ...

Abstract	Background: Sepsis kills almost 5,000 children annually, accounting for 16% of pediatric health care spending in the United States. Objectives: We sought to identify sepsis within the Electronic Health Record (EHR) of a quaternary children's hospital to characterize disease incidence, improve recognition and response, and track performance metrics. Methods: Methods are organized in a plan-do-study-act cycle. During the "plan" phase, electronic definitions of sepsis (blood culture and antibiotic within 24 hours) and septic shock (sepsis plus vasoactive medication) were created to establish benchmark data and track progress with statistical process control. The performance of a screening tool was evaluated in the emergency department. During the "do" phase, a novel inpatient workflow is being piloted, which involves regular sepsis screening by nurses using the tool, and a regimented response to high risk patients. Results: Screening tool use in the emergency department reduced time to antibiotics (Fig. 1). Of the 6,159 admissions, EHR definitions identified 1,433 (23.3%) between July and December 2016 with sepsis, of which 159 (11.1%) had septic shock. Hospital mortality for all sepsis patients was 2.2% and 15.7% for septic shock (Table 1). These findings approximate epidemiologic studies of sepsis and severe sepsis, which report a prevalence range of 0.45-8.2% and mortality range of 8.2-25% (Table 2). Conclusions/implications: Implementation of a sepsis screening tool is associated with improved performance. The prevalence of sepsis conditions identified with electronic definitions approximates the epidemiologic landscape characterized by other point-prevalence and administrative studies, providing face validity to this approach, and proving useful for tracking performance improvement.
Language	English
Publishing date	2018-04-10
Publishing country	United States
Document type	Journal Article
ISSN	2472-0054
ISSN (online)	2472-0054
DOI	10.1097/pq9.0000000000000067
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Article: Severe Sepsis in Pediatric Liver Transplant Patients: The Emergence of Multidrug-Resistant Organisms.

Alcamo, Alicia M / Alessi, Lauren J / Vehovic, S Noona / Bansal, Neha / Bond, Geoffrey J / Carcillo, Joseph A / Green, Michael / Michaels, Marian G / Aneja, Rajesh K

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

2019 Volume 20, Issue 7, Page(s) e326–e332

Abstract: Objectives: To describe characteristics of liver transplant patients with severe sepsis in the PICU.: Design: Retrospective descriptive analysis.: Setting: Tertiary children's hospital PICU.: Patients: Liver transplant recipients admitted ... ...

Abstract	Objectives: To describe characteristics of liver transplant patients with severe sepsis in the PICU. Design: Retrospective descriptive analysis. Setting: Tertiary children's hospital PICU. Patients: Liver transplant recipients admitted January 2010 to July 2016 for pediatric severe sepsis. Interventions: None. Measurements and main results: Between January 2010 and July 2016, 173 liver transplants were performed, and 36 of these patients (21%) were admitted with severe sepsis (54 episodes total). Median age at admission was 2 years (1-6.5 yr), 47.2% were male. Bacterial infections were the most common (77.8%), followed by culture negative (12.9%) and viral infections (7.4%). Fungal infections accounted for only 1.9%. Median time from transplant for viral and culture negative infections was 18 days (8.25-39.75 d) and 25 days (9-41 d), whereas 54.5 days (17-131.25 d) for bacterial infections. Bloodstream and intra-abdominal were the most common bacterial sites (45% and 22.5%, respectively). Multidrug-resistant organisms accounted for 47.6% of bacterial sepsis. Vancomycin-resistant Enterococcus and extended-spectrum beta-lactamase producers were the most frequently identified multidrug-resistant organisms. Patients with multidrug-resistant organism sepsis demonstrated higher admission Pediatric Logistic Organ Dysfunction scores (p = 0.043) and were noted to have an odds ratio of 3.8 and 3.6 for mechanical ventilation and multiple organ dysfunction syndrome, respectively (p = 0.047 and p = 0.044). Overall mortality was 5.5% (n = 2 patients), with both deaths occurring in multidrug-resistant organism episodes. Conclusions: We report that multidrug-resistant organisms are increasingly being identified as causative pathogens for sepsis in pediatric liver transplant recipients and are associated with significantly higher odds for mechanical ventilation and higher organ failure. The emergence of multidrug-resistant organism infections in pediatric liver transplant patients has implications for patient outcomes, antibiotic stewardship, and infection prevention strategies.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Bacteremia/complications ; Bacteremia/drug therapy ; Bacteremia/microbiology ; Child ; Child, Preschool ; Coinfection/microbiology ; Drug Resistance, Multiple, Bacterial ; Female ; Fungemia/complications ; Fungemia/microbiology ; Hepatic Artery ; Humans ; Infant ; Intraabdominal Infections ; Liver Transplantation/adverse effects ; Male ; Multiple Organ Failure/microbiology ; Respiration, Artificial ; Retrospective Studies ; Thrombosis/microbiology ; Virus Diseases/complications ; Virus Diseases/virology ; beta-Lactam Resistance
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2019-05-16
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2052349-X
ISSN	1947-3893 ; 1529-7535
ISSN (online)	1947-3893
ISSN	1529-7535
DOI	10.1097/PCC.0000000000001983
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Zs.MO 472: Show issues

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Article ; Online: Improving the Evaluation and Management of Abnormal Uterine Bleeding in Female Adolescents Presenting for Emergency Care.

Close, Allison G / Sequeira, Gina M / Montano, Gerald T / Alessi, Lauren J / McCormick, Meghan C / Cooper, James D / Epperly, Rebecca A / Zuckerbraun, Noel S

Journal of pediatric and adolescent gynecology

2018 Volume 32, Issue 2, Page(s) 128–134

Abstract: Study objective: We sought to improve emergency care for adolescents with abnormal uterine bleeding (AUB) by developing a clinical effectiveness guideline (CEG) and assessing its effect on quality of care.: Design, setting, participants, and ... ...

Abstract	Study objective: We sought to improve emergency care for adolescents with abnormal uterine bleeding (AUB) by developing a clinical effectiveness guideline (CEG) and assessing its effect on quality of care. Design, setting, participants, and interventions: A stakeholder engagement group designed a CEG algorithm for emergency AUB management. Pediatric residents received CEG training and their knowledge and attitudes were assessed using pre- and post intervention surveys. International Classification of Diseases ninth and 10th revision codes identified electronic health record data for patients who presented to the pediatric emergency department for AUB 6 months before and after CEG implementation. A weighted, 20-point scoring system consisting of prioritized aspects of history, laboratory studies, and management was developed to quantify the quality of care provided. Main outcome measures: Descriptive statistics, χ Results: Pediatric residents reported higher confidence and knowledge scores post CEG implementation. Of the 91 patients identified, 62 met inclusion criteria. Median score was 14 ± 7 before CEG implementation and 15.5 ± 6 after. The Wilcoxon rank sum test showed a difference in AUB evaluation and management scores (P = .09) after implementation of the CEG. Run chart data showed no shifts or trends (overall median score, 14 points). Pre- and post implementation, points were deducted most frequently for not assessing personal/family clotting disorder history. The largest improvements in care were with appropriate medication dosing and disposition. Conclusion: We designed a CEG and educational intervention for AUB management in a pediatric emergency department. These findings suggest our CEG might be an effective tool to improve emergency AUB care for adolescents and could increase trainees' confidence in managing this condition, although additional cycles are needed.
MeSH term(s)	Adolescent ; Algorithms ; Clinical Competence/statistics & numerical data ; Emergency Medical Services/methods ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Internship and Residency/methods ; Practice Guidelines as Topic ; Quality Improvement/statistics & numerical data ; Quality of Health Care/standards ; Retrospective Studies ; Treatment Outcome ; Uterine Hemorrhage/therapy
Language	English
Publishing date	2018-11-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	1325079-6
ISSN	1873-4332 ; 1083-3188
ISSN (online)	1873-4332
ISSN	1083-3188
DOI	10.1016/j.jpag.2018.11.002
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Article ; Online: Fragility Fractures: Diagnosis and Treatment.

Bledsoe, Lauren / Alessi, Kaitlyn / Toro, Jose B / Giordano, Brian / Hanypsiak, Bryan T

American journal of orthopedics (Belle Mead, N.J.)

2019 Volume 47, Issue 12

Abstract: Fragility fractures are estimated to affect 3 million people annually in the United States. As they are associated with a significant mortality rate, the prevention of these fractures should be a priority for orthopedists. At-risk patients include the ... ...

Abstract	Fragility fractures are estimated to affect 3 million people annually in the United States. As they are associated with a significant mortality rate, the prevention of these fractures should be a priority for orthopedists. At-risk patients include the elderly and those with thyroid disease, diabetes, hypertension, and heart disease. Osteoporosis is diagnosed by the presence of a fragility fracture or by dual-energy x-ray absorptiometry (DXA) in the absence of a fragility fracture. In 2011, the United States Preventive Services Task Force (USPSTF) recommended that all women ≥65 years should be screened for osteoporosis by DXA. Women <65 years with a 10-year fracture risk =∕> than that of a 65-year-old white woman should also be screened for osteoporosis. Lifestyle changes, such as calcium and vitamin D supplementation, exercise, and smoking cessation, are non-pharmacologic treatment options. The National Osteoporosis Foundation recommends treating osteoporosis with pharmacotherapy in patients with a high risk for fracture (T score <-2.5) or history of fragility fracture. Understanding risk factors and eliminating medications known to cause decreased BMD are vital to prevention and will be necessary to limit these fractures and their associated expenses in the future.
MeSH term(s)	Absorptiometry, Photon ; Bone Density/physiology ; Bone Density Conservation Agents/therapeutic use ; Humans ; Osteoporosis/diagnostic imaging ; Osteoporosis/drug therapy ; Osteoporotic Fractures/diagnostic imaging ; Osteoporotic Fractures/drug therapy
Chemical Substances	Bone Density Conservation Agents
Language	English
Publishing date	2019-01-16
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1235120-9
ISSN	1934-3418 ; 1078-4519
ISSN (online)	1934-3418
ISSN	1078-4519
DOI	10.12788/ajo.2018.0112
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Article ; Online: Atypical antipsychotics and hyperglycemic emergencies: multicentre, retrospective cohort study of administrative data.

Lipscombe, Lorraine L / Austin, Peter C / Alessi-Severini, Silvia / Blackburn, David F / Blais, Lucie / Bresee, Lauren / Filion, Kristian B / Kawasumi, Yuko / Kurdyak, Paul / Platt, Robert W / Tamim, Hala / Paterson, J Michael

Schizophrenia research

2014 Volume 154, Issue 1-3, Page(s) 54–60

Abstract: Objective: To evaluate the relationship between initiation of atypical antipsychotic agents and the risk of hyperglycemic emergencies.: Method: We conducted a multicentre retrospective cohort study using administrative health data from 7 Canadian ... ...

Abstract	Objective: To evaluate the relationship between initiation of atypical antipsychotic agents and the risk of hyperglycemic emergencies. Method: We conducted a multicentre retrospective cohort study using administrative health data from 7 Canadian provinces and the UK Clinical Practice Research Datalink. Hospitalizations for hyperglycemic emergencies (hyperglycemia, diabetic ketoacidosis, hyperosmolar hyperglycemic state) were compared between new users of risperidone (reference), and new users of olanzapine, other atypical antipsychotics, and typical antipsychotics. We used propensity scores with inverse probability of treatment weighting and proportional hazard models to estimate the site-specific hazard ratios of hyperglycemic emergencies in the year following drug initiation separately for adults under and over age 66 years. Site-level results were pooled using meta-analytic methods. Results: Among 725,489 patients, 55% were aged 66+years; 5% of younger and 19% of older patients had pre-existing diabetes. Hyperglycemic emergencies were rare (1-2 per 1000 person years), but more frequent in patients with pre-existing diabetes (6-12 per 1000 person years). We did not find a significant difference in risk of hyperglycemic emergencies with initiation of olanzapine versus risperidone; however heterogeneity existed between sites. The risk of an event was significantly lower with other atypical (99% quetiapine) compared to risperidone use in older patients [adjusted hazard ratio, 95% confidence interval (CI): 0.69, 0.53-0.90]. Conclusions: Risk for hyperglycemic emergencies is low after initiation of antipsychotics, but patients with pre-existing diabetes may be at greater risk. The risk appeared lower with the use of quetiapine in older patients, but the clinical significance of the findings requires further study.
MeSH term(s)	Adolescent ; Adult ; Aged ; Antipsychotic Agents/adverse effects ; Antipsychotic Agents/therapeutic use ; Benzodiazepines/adverse effects ; Benzodiazepines/therapeutic use ; Diabetes Complications/epidemiology ; Female ; Humans ; Hyperglycemia/chemically induced ; Hyperglycemia/epidemiology ; Male ; Meta-Analysis as Topic ; Middle Aged ; Proportional Hazards Models ; Retrospective Studies ; Risk ; Risperidone/adverse effects ; Risperidone/therapeutic use ; Schizophrenia/drug therapy ; Schizophrenia/epidemiology ; Young Adult
Chemical Substances	Antipsychotic Agents ; Benzodiazepines (12794-10-4) ; Risperidone (L6UH7ZF8HC) ; olanzapine (N7U69T4SZR)
Language	English
Publishing date	2014-04
Publishing country	Netherlands
Document type	Comparative Study ; Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	639422-x
ISSN	1573-2509 ; 0920-9964
ISSN (online)	1573-2509
ISSN	0920-9964
DOI	10.1016/j.schres.2014.01.043
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Zs.MO 543: Show issues

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Article ; Online: Measurement of macular fractal dimension using a computer-assisted program.

Thomas, George N / Ong, Shin-Yeu / Tham, Yih Chung / Hsu, Wynne / Lee, Mong Li / Lau, Qiangfeng Peter / Tay, Wanting / Alessi-Calandro, Jessica / Hodgson, Lauren / Kawasaki, Ryo / Wong, Tien Yin / Cheung, Carol Y

Investigative ophthalmology & visual science

2014 Volume 55, Issue 4, Page(s) 2237–2243

Abstract: Purpose: Macular diseases may be associated with an altered retinal vasculature. We describe and test new software for the measurement of retinal vascular fractal dimension to quantify the complexity of retinal vasculature at the macula (D mac) and to ... ...

Abstract	Purpose: Macular diseases may be associated with an altered retinal vasculature. We describe and test new software for the measurement of retinal vascular fractal dimension to quantify the complexity of retinal vasculature at the macula (D mac) and to compare this with fractal dimension measured around the optic disc (D disc). Methods: A total of 342 macular-centered and optic disc-centered digital retinal photographs from 171 subjects was selected randomly from a population-based study. Retinal vascular fractional dimension (Df) was measured by two trained graders using a computer-assisted program (SIVA-FA, software version 1.0, National University of Singapore) on macula-centered (D mac) and optic disc-centered (D disc) photographs, to assess intergrader reliability. Measurements were repeated after two weeks to determine intragrader reliability. A separate 50 pairs of consecutively repeated images were selected and measured using SIVA-FA to assess intrasession reliability. Reliability analyses were conducted using intraclass correlation coefficients (ICC), and multiple linear regression analyses were performed to compare factors associated with D mac and D disc measurements. Results: The mean (SD) D mac and D disc values were 1.453 (0.060) and 1.484 (0.043), respectively, and were highly correlated (r = 0.70, P < 0.001). Intragrader, intergrader, and intrasession reliability for both Df measures was high (ICCs ranging from 0.88-0.99). In multiple regression analyses, age (both β = -0.03, P < 0.001) and hypertension (β = -0.02, P = 0.011; β = -0.02, P = 0.021, respectively) were independently associated with D mac and D disc. Conclusions: The complexity of the retinal vasculature in the macula can be measured reliably and may be a useful tool to study parafoveal vascular networks in macula diseases, such as diabetic maculopathy.
MeSH term(s)	Adult ; Female ; Fractals ; Humans ; Image Processing, Computer-Assisted/methods ; Macula Lutea/pathology ; Macular Degeneration/diagnosis ; Male ; Middle Aged ; Reproducibility of Results ; Software
Language	English
Publishing date	2014-04-09
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	391794-0
ISSN	1552-5783 ; 0146-0404
ISSN (online)	1552-5783
ISSN	0146-0404
DOI	10.1167/iovs.13-13315
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