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Article ; Online: Response to "Additional Associated Factors for Venous Thromboembolism in Patients with Traumatic Brain Injury".

Nguyen, Sarah / Grandhi, Ramesh / Cole, Kyril L

2023 Volume 39, Issue 3, Page(s) 734–735

MeSH term(s)	Humans ; Venous Thromboembolism/etiology ; Brain Injuries, Traumatic/complications ; Pulmonary Embolism
Language	English
Publishing date	2023-08-28
Publishing country	United States
Document type	Letter
ZDB-ID	2381896-7
ISSN	1556-0961 ; 1541-6933
ISSN (online)	1556-0961
ISSN	1541-6933
DOI	10.1007/s12028-023-01826-x
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Article ; Online: A multifaceted stewardship intervention helps curb steroid overprescribing in hospitalized patients with acute exacerbations of COPD.

Cole, Jennifer L / Smith, Sarah E

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists

2021 Volume 79, Issue 8, Page(s) 643–650

Abstract: Purpose: Corticosteroid overprescribing is well documented in real-world practice. There is currently no evidence to guide best practices for steroid stewardship. The aim of this study was to assess the effects of a 3-part stewardship intervention ... ...

Abstract	Purpose: Corticosteroid overprescribing is well documented in real-world practice. There is currently no evidence to guide best practices for steroid stewardship. The aim of this study was to assess the effects of a 3-part stewardship intervention strategy on inpatient steroid prescribing in patients with acute exacerbations of COPD (AECOPD). Summary: Investigators implemented a 3-part stewardship initiative consisting of (1) an anonymous survey for providers on steroid prescribing in a simplified case of AECOPD, (2) face-to-face education and review of survey results, and (3) prospective audit and feedback from a clinical pharmacist. This was a quasi-experimental before-and-after study evaluating hospitalized adults diagnosed with AECOPD in two 12-month study periods before (April 2019-March 2020) and after (May 2020-April 2021) implementation. The primary outcome was mean inpatient steroid dosing. Secondary outcomes were duration of therapy, length of stay (LOS), 30-day readmissions, 30-day mortality, and incidence of hyperglycemia. Per power analysis, there were 27 patients per cohort. The interventions resulted in a significant reduction in prednisone equivalents during hospitalization: 118 mg vs 53 mg (P = 0.0003). This decrease was similar in ICU (160 mg vs 61 mg, P = 0.008) and non-ICU (102 mg vs 49 mg, P = 0.004) locations. There was no significant difference in duration of therapy (8 days vs 7 days, P = 0.44), length of stay (3.3 days vs 3.9 days, P = 0.21), 30-day mortality (4% vs 7%, P = 0.55), 30-day readmissions (15% vs 7%, P = 0.39), or rate of hyperglycemia (48% vs 44%, P = 0.78). Conclusion: A multifaceted stewardship intervention significantly reduced steroid dosing in hospitalized AECOPD patients. This reduction was not associated with known deleterious effects.
MeSH term(s)	Adrenal Cortex Hormones/therapeutic use ; Adult ; Humans ; Inappropriate Prescribing ; Prednisone ; Pulmonary Disease, Chronic Obstructive/diagnosis ; Pulmonary Disease, Chronic Obstructive/drug therapy ; Retrospective Studies
Chemical Substances	Adrenal Cortex Hormones ; Prednisone (VB0R961HZT)
Language	English
Publishing date	2021-12-06
Publishing country	England
Document type	Journal Article
ZDB-ID	1224627-x
ISSN	1535-2900 ; 1079-2082
ISSN (online)	1535-2900
ISSN	1079-2082
DOI	10.1093/ajhp/zxab468
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Article ; Online: Provider perceptions on steroid dosing in AECOPD: Laying the groundwork for steroid stewardship.

Cole, Jennifer L / Smith, Sarah

The clinical respiratory journal

2020 Volume 14, Issue 11, Page(s) 1105–1108

Abstract: Introduction: Steroid overprescribing is well documented in acute exacerbations of COPD (AECOPD). Given the myriad of unwanted side effects of corticosteroids, facilities should implement steroid stewardship efforts. The objective of this project was to ...

Abstract	Introduction: Steroid overprescribing is well documented in acute exacerbations of COPD (AECOPD). Given the myriad of unwanted side effects of corticosteroids, facilities should implement steroid stewardship efforts. The objective of this project was to evaluate the prescribing habits of steroids in AECOPD for needs assessment and to tailor interventions in a single centre. Methods: A questionnaire was developed to evaluate practices and beliefs around steroid dosing in a simplified case of uncomplicated AECOPD. There were 31 total responders: 12 inpatient clinicians, 9 medical residents and 10 emergency department (ED) clinicians. All steroid dosing was converted to prednisone equivalents for reporting. Subgroup analysis was conducted between provider groups. Results: Initial dosing ranged from 40 to 625 mg/day with only four responders (13%) selecting 40 mg/day. Dosing was not significantly different in newer providers ≤4 years' experience: mean 215 mg versus >4 years' experience: mean 312 mg (P = 0.23). Less experienced providers selected shorter treatment durations: median 5 days (IQR 5,6) versus 8.5 days (IQR 6,10.5) (P = 0.015). ED providers selected higher doses than non-ED providers: 447 mg versus 208 mg (P = 0.003). Most responders (81%) selected IV agents over oral steroids. The majority (65%) stated dosing choices were based on prescribing habits/clinical experience, while 36% felt their selections were based on current evidence. Five (16%) of responders correctly identified consensus treatment guidelines and the majority (77%) reported being "very likely" or "somewhat likely" to prescribe lower doses. Conclusion: Baseline knowledge was a significant barrier to guideline utilisation. Education will need to focus on the evidence behind using lower doses, oral agents and disease severity.
MeSH term(s)	Adrenal Cortex Hormones ; Emergency Service, Hospital ; Humans ; Perception ; Prednisone ; Pulmonary Disease, Chronic Obstructive/drug therapy
Chemical Substances	Adrenal Cortex Hormones ; Prednisone (VB0R961HZT)
Language	English
Publishing date	2020-08-18
Publishing country	England
Document type	Journal Article
ZDB-ID	2442214-9
ISSN	1752-699X ; 1752-6981
ISSN (online)	1752-699X
ISSN	1752-6981
DOI	10.1111/crj.13247
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Article ; Online: Development of a residents-as-teachers curriculum for neurosurgical training programs.

Nguyen, Sarah / Cole, Kyril L / Timme, Kathleen H / Jensen, Randy L

Neurosurgical focus

2022 Volume 53, Issue 2, Page(s) E6

Abstract: Neurosurgery residents spend a significant amount of their time teaching patients, families, students, residents, and other health professionals. To help ensure competence in their residents' teaching abilities, many specialties have established formal ... ...

Abstract	Neurosurgery residents spend a significant amount of their time teaching patients, families, students, residents, and other health professionals. To help ensure competence in their residents' teaching abilities, many specialties have established formal residents-as-teachers (RAT) curricula; however, such formalized curricula are often lacking in neurosurgery programs. The authors' goal was to develop and implement a formal RAT curriculum, designed with neurosurgery residents' other responsibilities in mind, to improve residents' formal and informal teaching abilities. Here, the authors report on the design of a formalized teaching curriculum tailored for the needs of neurosurgical residents, with a focus on deliberate practice and minimal time needed for preparation. The curriculum, designed using Kern's 6 steps of curriculum design as a framework, comprises 5 lecture series spread over 3 years, repeated twice through a resident's training, with each lecture series outlined with its respective topics and objectives. Opportunities for observed teaching as well as informal and formal evaluation will be provided to residents. The program will be evaluated on a yearly basis using direct and anonymized resident feedback on the RAT curriculum. Measures of program success will also include pre- and postprogram medical student and peer evaluation of residents. These data will be used for continual improvement of the curriculum as it is implemented. Successes and shortcomings of this program will be disseminated by publication, presentations, and placement on the authors' department website and social media. This paper may serve as a foundation for other neurosurgical programs to develop RAT curricula for greater enhancement of resident teaching abilities.
MeSH term(s)	Clinical Competence ; Curriculum ; Humans ; Internship and Residency ; Longitudinal Studies ; Neurosurgery
Language	English
Publishing date	2022-08-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2026589-X
ISSN	1092-0684 ; 1092-0684
ISSN (online)	1092-0684
ISSN	1092-0684
DOI	10.3171/2022.4.FOCUS22161
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Article: Rapid Diffuse Leptomeningeal Dissemination of an Anaplastic Pleomorphic Xanthoastrocytoma in an Adult Patient.

Bounajem, Michael / Cole, Kyril L / Menacho, Sarah T

Cureus

2021 Volume 13, Issue 11, Page(s) e19186

Abstract: Although pleomorphic xanthoastrocytomas generally carry a fair prognosis, anaplastic transformation has been identified in a subset of cases.We present the case of a patient with primary anaplastic pleomorphic xanthoastrocytoma (APXA) that demonstrated ... ...

Abstract	Although pleomorphic xanthoastrocytomas generally carry a fair prognosis, anaplastic transformation has been identified in a subset of cases.We present the case of a patient with primary anaplastic pleomorphic xanthoastrocytoma (APXA) that demonstrated rapid recurrence and diffuse leptomeningeal spread of disease three months postoperatively, causing severe visual impairment and acute ischemic strokes leading to death.We believe this is the fastest reported time to leptomeningeal dissemination and death from the initial diagnosis. Through this case, we show how anaplastic features can have a highly variable biological effect on disease progression. We believe earlier craniospinal imaging at the time of APXA diagnosis should be pursued to manage disease progression more aggressively with currently recommended adjuvant therapies.
Language	English
Publishing date	2021-11-01
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.19186
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Article ; Online: Parents' emotion socialization behaviors in response to preschool-aged children's justified and unjustified negative emotions.

Bailes, Lauren G / Ennis, Garrett / Lempres, Sarah M / Cole, David A / Humphreys, Kathryn L

PloS one

2023 Volume 18, Issue 4, Page(s) e0283689

Abstract: Parental socialization of children's negative emotions is believed to contribute to children's emotional development, with supportive, process-oriented responses (e.g., explicit acknowledgment of emotional expression and emotion processing) providing ... ...

Abstract	Parental socialization of children's negative emotions is believed to contribute to children's emotional development, with supportive, process-oriented responses (e.g., explicit acknowledgment of emotional expression and emotion processing) providing opportunities for children to experience and develop adaptive emotion regulation strategies for negative emotions. On the other hand, non-supportive, outcome-oriented responses (e.g., minimizing or punishing children for negative emotional expressions) tend to undermine such opportunities. Less clear, however, is the degree to which parents' own emotional and cognitive processes influence their emotion socialization behaviors. In particular, the perceived justifiability of children's negative emotions may be an important factor for parents' socialization behaviors as parents may only attend to emotional displays that they feel are reasonable. Using a sample of 234 mothers and fathers (parents of 146 unique preschool aged children), we examined the degree to which parents reported: (1) feeling specific emotions as a function of whether they viewed children's negative emotional expressions; (2) engaging in emotion socialization behaviors as a function of whether they viewed children's negative emotions. Last, we examined whether parents' reported emotions were related to their behaviors. For caregivers' emotions and behaviors, we examined whether patterns differed as a function of whether the children's emotions were perceived as justified or unjustified. Parents were more likely to report feeling emotions such as anger and frustration when they viewed children's negative emotions as unjustified relative to justified, and for these unjustified negative emotions, anger and frustration were related to more outcome-oriented behaviors. Emotions such as sadness and guilt, however, were related to more process-oriented behaviors, regardless of whether parents felt children's negative emotions were justified or unjustified. Findings highlight the interrelatedness of emotional and cognitive processes within the parenting context and their potential influence on emotion socialization behaviors.
MeSH term(s)	Female ; Humans ; Child, Preschool ; Child ; Socialization ; Parent-Child Relations ; Emotions/physiology ; Parents ; Mothers/psychology
Language	English
Publishing date	2023-04-19
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0283689
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Article ; Online: Understanding the Unique Challenges Faced by Homeless Patients With Acute Traumatic Neurosurgical Injuries.

Cole, Kyril L / Findlay, Matthew C / Earl, Emma / Sherrod, Brandon A / Cutler, Christopher B / Nguyen, Sarah / Grandhi, Ramesh / Menacho, Sarah T

Neurosurgery

2023 Volume 93, Issue 2, Page(s) 292–299

Abstract: Background: Homelessness is associated with high risk of acute neurotraumatic injury in the ∼600 000 Americans affected on any given night.: Objective: To compare care patterns and outcomes between homeless and nonhomeless individuals with acute ... ...

Abstract	Background: Homelessness is associated with high risk of acute neurotraumatic injury in the ∼600 000 Americans affected on any given night. Objective: To compare care patterns and outcomes between homeless and nonhomeless individuals with acute neurotraumatic injuries. Methods: Adults hospitalized for acute neurotraumatic injuries between January 1, 2015, and December 31, 2020, were identified in this retrospective cross-sectional study at our Level 1 trauma center. We evaluated demographics, in-hospital characteristics, discharge dispositions, readmissions, and adjusted readmission risk. Results: Of 1308 patients, 8.5% (n = 111) were homeless on admission to neurointensive care. Compared with nonhomeless individuals, homeless patients were younger ( P = .004), predominantly male ( P = .003), and less frail ( P = .003) but had similar presenting Glasgow Coma Scale scores ( P = .85), neurointensive care unit stay time ( P = .15), neurosurgical interventions ( P = .27), and in-hospital mortality ( P = .17). Nevertheless, homeless patients had longer hospital stays (11.8 vs 10.0 days, P = .02), more unplanned readmissions (15.3% vs 4.8%, P < .001), and more complications while hospitalized (54.1% vs 35.8%, P = .01), particularly myocardial infarctions (9.0% vs 1.3%, P < .001). Homeless patients were mainly discharged to their previous living situation (46.8%). Readmissions were primarily for acute-on-chronic intracranial hematomas (4.5%). Homelessness was an independent predictor of 30-day unplanned readmissions (odds ratio 2.41 [95% CI 1.33-4.38, P = .004]). Conclusion: Homeless individuals experience longer hospital stays, more inpatient complications such as myocardial infarction, and more unplanned readmissions after discharge compared with their housed counterparts. These findings combined with limited discharge options in the homeless population indicate that better guidance is needed to improve the postoperative disposition and long-term care of this vulnerable patient population.
MeSH term(s)	Adult ; Humans ; Male ; United States ; Female ; Retrospective Studies ; Cross-Sectional Studies ; Hospitalization ; Patient Readmission ; Ill-Housed Persons
Language	English
Publishing date	2023-03-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	135446-2
ISSN	1524-4040 ; 0148-396X
ISSN (online)	1524-4040
ISSN	0148-396X
DOI	10.1227/neu.0000000000002408
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Article ; Online: The "SEED" Study: The Feasibility of Selecting Patient-Specific Biologically Targeted Therapy with Sorafenib, Everolimus, Erlotinib or Dasatinib for Pediatric and Young Adult Patients with Recurrent or Refractory Brain Tumors.

Cole, Bonnie L / Starr, Kimberly / Lockwood, Christina M / Leary, Sarah E S

Frontiers in bioscience (Landmark edition)

2022 Volume 27, Issue 7, Page(s) 219

Abstract: Background: Pediatric brain tumors are the leading cause of cancer death in children and represent a variety of diseases and molecular subtypes. This study sought to evaluate a rapid immunohistochemistry testing panel to aid in therapy selection at the ... ...

Abstract	Background: Pediatric brain tumors are the leading cause of cancer death in children and represent a variety of diseases and molecular subtypes. This study sought to evaluate a rapid immunohistochemistry testing panel to aid in therapy selection at the time of malignant tumor recurrence. Methods: With IRB approval and appropriate informed consent, we conducted a single-institution prospective clinical trial of selected kinase inhibitor therapy. A laboratory-developed immunohistochemical testing panel was performed on tumor tissue, and therapy with one of four small molecule inhibitors was recommended in combination with oral chemotherapy consisting of temozolomide and etoposide. Results: All 20 enrolled subjects were assigned to Everolimus (n = 4), Erlotinib (n = 6) or Dasatinib (n = 10); 90% (18/20) within the pre-specified 14-day feasibility time period. Only two subjects elected treatment on study, 8 received targeted treatment based on testing results either alone (n = 5) or in combination with chemotherapy (n = 3). Other subjects received chemotherapy alone (n = 7), surgery alone (n = 2) or no further therapy (n = 3). Immunohistochemical targets were associated with correlative genetic changes in 28% (5/18) of those evaluated. Conclusions: It was feasible to rapidly select targeted therapy in recurrent pediatric brain tumors, but not feasible to treat with a uniform combination treatment regimen.
MeSH term(s)	Brain Neoplasms/drug therapy ; Child ; Dasatinib/therapeutic use ; Erlotinib Hydrochloride/therapeutic use ; Everolimus/therapeutic use ; Feasibility Studies ; Humans ; Neoplasm Recurrence, Local/drug therapy ; Patient Selection ; Prospective Studies ; Sorafenib/therapeutic use ; Young Adult
Chemical Substances	Everolimus (9HW64Q8G6G) ; Sorafenib (9ZOQ3TZI87) ; Erlotinib Hydrochloride (DA87705X9K) ; Dasatinib (RBZ1571X5H)
Language	English
Publishing date	2022-06-22
Publishing country	Singapore
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2704569-9
ISSN	2768-6698 ; 2768-6698
ISSN (online)	2768-6698
ISSN	2768-6698
DOI	10.31083/j.fbl2707219
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Article ; Online: Factors Associated with Venous Thromboembolism Development in Patients with Traumatic Brain Injury.

Cole, Kyril L / Nguyen, Sarah / Gelhard, Savannah / Hardy, Jeremy / Cortez, Janet / Nunez, Jade M / Menacho, Sarah T / Grandhi, Ramesh

Neurocritical care

2023 Volume 40, Issue 2, Page(s) 568–576

Abstract: Background: Venous thromboembolic (VTE) events are a major concern in trauma and intensive care, with the prothrombotic state caused by traumatic brain injury (TBI) increasing the risk in affected patients. We sought to identify critical demographic and ...

Abstract	Background: Venous thromboembolic (VTE) events are a major concern in trauma and intensive care, with the prothrombotic state caused by traumatic brain injury (TBI) increasing the risk in affected patients. We sought to identify critical demographic and clinical variables and determine their influence on subsequent VTE development in patients with TBI. Methods: This was a cross-sectional study with data retrospectively collected from 818 patients with TBI admitted to a level I trauma center in 2015-2020 and placed on VTE prophylaxis. Results: The overall VTE incidence was 9.1% (7.6% deep vein thrombosis, 3.2% pulmonary embolism, 1.7% both). The median time to diagnosis was 7 days (interquartile range 4-11) for deep vein thrombosis and 5 days (interquartile range 3-12) for pulmonary embolism. Compared with those who did not develop VTE, patients who developed VTE were younger (44 vs. 54 years, p = 0.02), had more severe injury (Glasgow Coma Scale 7.5 vs. 14, p = 0.002, Injury Severity Score 27 vs. 21, p < 0.001), were more likely to have experienced polytrauma (55.4% vs. 34.0%, p < 0.001), more often required neurosurgical intervention (45.9% vs. 30.5%, p = 0.007), more frequently missed ≥ 1 dose of VTE prophylaxis (39.2% vs. 28.4%, p = 0.04), and were more likely to have had a history of VTE (14.9% vs. 6.5%, p = 0.008). Univariate analysis demonstrated that 4-6 total missed doses predicted the highest VTE risk (odds ratio 4.08, 95% confidence interval 1.53-10.86, p = 0.005). Conclusions: Our study highlights patient-specific factors that are associated with VTE development in a cohort of patients with TBI. Although many of these are unmodifiable patient characteristics, a threshold of four missed doses of chemoprophylaxis may be particularly important in this critical patient population because it can be controlled by the care team. Development of intrainstitutional protocols and tools within the electronic medical record to avoid missed doses, particularly among patients who require operative interventions, may result in decreasing the likelihood of future VTE formation.
MeSH term(s)	Humans ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/etiology ; Venous Thromboembolism/prevention & control ; Retrospective Studies ; Cross-Sectional Studies ; Brain Injuries, Traumatic/complications ; Brain Injuries, Traumatic/epidemiology ; Brain Injuries, Traumatic/drug therapy ; Pulmonary Embolism/drug therapy ; Venous Thrombosis/drug therapy ; Risk Factors ; Anticoagulants/therapeutic use
Chemical Substances	Anticoagulants
Language	English
Publishing date	2023-07-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2381896-7
ISSN	1556-0961 ; 1541-6933
ISSN (online)	1556-0961
ISSN	1541-6933
DOI	10.1007/s12028-023-01780-8
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Article ; Online: Parents’ emotion socialization behaviors in response to preschool-aged children’s justified and unjustified negative emotions

Lauren G. Bailes / Garrett Ennis / Sarah M. Lempres / David A. Cole / Kathryn L. Humphreys

PLoS ONE, Vol 18, Iss

2023 Volume 4

Abstract: Parental socialization of children’s negative emotions is believed to contribute to children’s emotional development, with supportive, process-oriented responses (e.g., explicit acknowledgment of emotional expression and emotion processing) providing ... ...

Abstract	Parental socialization of children’s negative emotions is believed to contribute to children’s emotional development, with supportive, process-oriented responses (e.g., explicit acknowledgment of emotional expression and emotion processing) providing opportunities for children to experience and develop adaptive emotion regulation strategies for negative emotions. On the other hand, non-supportive, outcome-oriented responses (e.g., minimizing or punishing children for negative emotional expressions) tend to undermine such opportunities. Less clear, however, is the degree to which parents’ own emotional and cognitive processes influence their emotion socialization behaviors. In particular, the perceived justifiability of children’s negative emotions may be an important factor for parents’ socialization behaviors as parents may only attend to emotional displays that they feel are reasonable. Using a sample of 234 mothers and fathers (parents of 146 unique preschool aged children), we examined the degree to which parents reported: (1) feeling specific emotions as a function of whether they viewed children’s negative emotional expressions; (2) engaging in emotion socialization behaviors as a function of whether they viewed children’s negative emotions. Last, we examined whether parents’ reported emotions were related to their behaviors. For caregivers’ emotions and behaviors, we examined whether patterns differed as a function of whether the children’s emotions were perceived as justified or unjustified. Parents were more likely to report feeling emotions such as anger and frustration when they viewed children’s negative emotions as unjustified relative to justified, and for these unjustified negative emotions, anger and frustration were related to more outcome-oriented behaviors. Emotions such as sadness and guilt, however, were related to more process-oriented behaviors, regardless of whether parents felt children’s negative emotions were justified or unjustified. Findings highlight the interrelatedness of ...
Keywords	Medicine ; R ; Science ; Q
Subject code	370 ; 150
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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