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Article ; Online: Deviation From National Dosing Recommendations for Children Having Out-of-Hospital Emergencies.

Ramgopal, Sriram / Martin-Gill, Christian

2023 Volume 152, Issue 2

Abstract: Background: Previous evaluations of medication dosing variance for children in the prehospital setting have been limited regionally or to specific conditions. We sought to describe pediatric dosing deviations from nationally recommended guidelines for ... ...

Abstract	Background: Previous evaluations of medication dosing variance for children in the prehospital setting have been limited regionally or to specific conditions. We sought to describe pediatric dosing deviations from nationally recommended guidelines for commonly administered medications from a registry of prehospital encounters. Methods: We evaluated prehospital patient care records for children (<18 years) from approximately 2000 emergency medical services agencies from 2020 to 2021. We investigated dosing deviations (defined as being ≥20% of the weight-appropriate dose from national guidelines) for the following: lorazepam, diazepam, and midazolam for seizures; fentanyl, hydromorphone, morphine, and ketorolac; intramuscular epinephrine and diphenhydramine for children with allergy or anaphylaxis; intravenous epinephrine; and methylprednisolone. Results: Of 990 497 pediatric encounters, 63 963 (6.4%) received at least 1 nonnebulized medication. Among nonnebulized doses, 53.9% were for the studied drugs. Among encounters who received a study drug and which had a documented weight (80.3%), the overall consistency with national guidelines was 42.6 per 100 administrations. Appropriate dosing was most common with methylprednisolone (75.1%), intramuscular epinephrine (67.9%), and ketorolac (56.4%). Medications with the lowest consistency with national guidelines were diazepam (19.5%) and lorazepam (21.2%). Most deviations represented an underdose, which was greatest with lorazepam (74.7%) and morphine (73.8%). Results were similar when estimating dosages from weights calculated by age. Conclusions: We identified variance in weight-based dosing from national guidelines for common pediatric medications in the prehospital setting, which may be attributable to protocol differences or dosing errors. Addressing these should be a target for future educational, quality improvement, and research activities.
MeSH term(s)	Child ; Humans ; Lorazepam ; Ketorolac ; Emergencies ; Diazepam ; Epinephrine ; Emergency Medical Services/methods ; Morphine ; Methylprednisolone ; Hospitals
Chemical Substances	Lorazepam (O26FZP769L) ; Ketorolac (YZI5105V0L) ; Diazepam (Q3JTX2Q7TU) ; Epinephrine (YKH834O4BH) ; Morphine (76I7G6D29C) ; Methylprednisolone (X4W7ZR7023)
Language	English
Publishing date	2023-07-10
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.2023-061223
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Article ; Online: Neurologic Complications of COVID-19.

Gill, Christine / Cho, Tracey A

Continuum (Minneapolis, Minn.)

2023 Volume 29, Issue 3, Page(s) 946–965

Abstract: Objective: This article describes the spectrum of neurologic complications occurring in acute or postacute infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as well as the neurologic risks and benefits of vaccination against ... ...

Abstract	Objective: This article describes the spectrum of neurologic complications occurring in acute or postacute infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as well as the neurologic risks and benefits of vaccination against SARS-CoV-2. Latest developments: Early in the COVID-19 pandemic, reports of neurologic complications of COVID-19 began to surface. A variety of neurologic conditions have since been reported in association with COVID-19. Understanding of the underlying mechanism of COVID-19 neurologic involvement continues to evolve; however, the evidence seems to suggest that aberrant inflammatory responses may play a role. In addition to neurologic symptoms in acute COVID-19, neurologic post-COVID-19 conditions are increasingly recognized. The development of COVID-19 vaccines has been essential in preventing the spread of COVID-19. With increasing numbers of vaccine doses administered, various neurologic adverse events have been reported. Essential points: Neurologists must be aware of the potential acute, postacute, and vaccine-associated neurologic complications associated with COVID-19 and be poised to serve as integral members of multidisciplinary care teams for patients with COVID-19-related conditions.
MeSH term(s)	Humans ; COVID-19/complications ; COVID-19/prevention & control ; COVID-19 Vaccines ; SARS-CoV-2 ; Pandemics/prevention & control ; Nervous System Diseases/etiology
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2023-06-19
Publishing country	United States
Document type	Journal Article
ISSN	1538-6899
ISSN (online)	1538-6899
DOI	10.1212/CON.0000000000001272
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Article: Primary Care in the Spinal Cord Injury Population: Things to Consider in the Ongoing Discussion.

Gibson-Gill, Carol / Mingo, Tatiyanna

Current physical medicine and rehabilitation reports

2023 Volume 11, Issue 1, Page(s) 74–85

Abstract: Purpose of review: Spinal cord injury (SCI) creates unique needs that if not recognized and addressed timely can have detrimental effects on the health and quality of life (QOL) of people living with a SCI. Primary preventive health care is shown to ... ...

Abstract	Purpose of review: Spinal cord injury (SCI) creates unique needs that if not recognized and addressed timely can have detrimental effects on the health and quality of life (QOL) of people living with a SCI. Primary preventive health care is shown to decrease morbidity and mortality, yet the SCI population reportedly faces challenges getting access to this care. This area in SCI health care is still largely understudied with no consensus on the ideal way or which health care provider is best to provide primary care for this population. Findings: Preventive care is generally provided by general primary care providers, but not all primary care providers are trained in recognizing and addressing spinal cord injury-specific needs. SCI providers generally are not trained in addressing all aspects of preventive care. Knowing the recommended preventive care screenings, recognizing and managing specific conditions seen after a SCI, and seamless coordination of care between general practitioners and SCI specialists are some of the interventions to help prevent health complications, decrease morbidity and mortality, improve health outcomes, and promote QOL in this patient population. Summary: Prioritized focus on preventive care is necessary for a positive impact on the overall health and QOL in this population. Addressing the knowledge gap reported by primary care providers and SCI providers may help increase the probability of SCI patients getting their preventive and specialty care needs addressed. We present a "cheat sheet" of recommendations for the preventive care evaluation of a person living with a SCI.
Language	English
Publishing date	2023-02-18
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2167-4833
ISSN	2167-4833
DOI	10.1007/s40141-023-00379-6
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Article ; Online: Prehospital Seizure Management in Children: An Evaluation of a Nationally Representative Sample.

Ramgopal, Sriram / Martin-Gill, Christian

The Journal of pediatrics

2023 Volume 257, Page(s) 113379

Abstract: Objective: To describe the characteristics and emergency medical services (EMS) interventions, appropriateness of medication dosing, and factors associated with use of any or multiple doses of benzodiazepines for children with seizures in the ... ...

Abstract	Objective: To describe the characteristics and emergency medical services (EMS) interventions, appropriateness of medication dosing, and factors associated with use of any or multiple doses of benzodiazepines for children with seizures in the prehospital setting from a nationally representative dataset. Methods: We performed a retrospective study of EMS encounters within the National EMS Information System between 2019 and 2021, including children (<18 years) with an impression of seizures. We identified (1) factors associated with the use of benzodiazepines in a logistic regression model and (2) factors associated with multiple doses of benzodiazepines in an ordinal regression model. Results: We included 361 177 encounters for seizure. Among transports with an Advanced Life Support clinician, 89.9% were given no benzodiazepines and 7.7%, 1.9%, and 0.4% were given 1, 2, and ≥3 doses of benzodiazepines, respectively. Encounters given more doses of benzodiazepines had increased use of supplemental oxygen. A high proportion (43.4%) of EMS-provided initial benzodiazepine doses were inappropriately low. EMS-provided benzodiazepine use was associated with use of benzodiazepine prior to EMS arrival. Provision of multiple doses of EMS-provided benzodiazepines was associated with use of a low initial dose of benzodiazepine and use of lorazepam or diazepam compared with midazolam. Conclusion: A large proportion of prehospital pediatric patients with seizure are given inappropriately low dose of benzodiazepines. Use of a low dose of benzodiazepine and use of benzodiazepines other than midazolam are associated with additional benzodiazepine usage. Our findings have implications for future research and quality improvement needs in pediatric prehospital seizure management.
MeSH term(s)	Child ; Humans ; Midazolam/therapeutic use ; Retrospective Studies ; Seizures/drug therapy ; Benzodiazepines/therapeutic use ; Emergency Medical Services
Chemical Substances	Midazolam (R60L0SM5BC) ; Benzodiazepines (12794-10-4)
Language	English
Publishing date	2023-03-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2023.02.023
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Article ; Online: A State-of-the-Science Review of Alcoholic Beverages and Polycyclic Aromatic Hydrocarbons.

King, Liam / Aplin, Rebekah / Gill, Chris / Naimi, Timothy

Environmental health perspectives

2024 Volume 132, Issue 1, Page(s) 16001

Abstract: Background: The association between alcohol and certain cancers is well established, yet beyond ethanol and its metabolite acetaldehyde, little is known about the presence of other carcinogenic compounds in alcoholic beverages, including polycyclic ... ...

Abstract	Background: The association between alcohol and certain cancers is well established, yet beyond ethanol and its metabolite acetaldehyde, little is known about the presence of other carcinogenic compounds in alcoholic beverages, including polycyclic aromatic hydrocarbons (PAHs), such as benzo[a]pyrene (a Group I carcinogen). Objectives: We summarized the published literature on PAH levels in alcoholic beverages to identify potential gaps in knowledge to inform future research. Methods: Medline and Scopus were searched for primary research published from January 1966 to November 2023 that quantified PAH levels among various types of alcoholic beverages, including whisky, rum, brandy, gin, vodka, wine, and beer. Studies that were not primary literature were excluded; only studies that quantified PAH content in the specified alcoholic beverages were included. Results: Ten studies published from 1966 to 2019 met the criteria for review. Other than beverage type, no publication reported selection criteria for their samples of tested alcohol products. Studies used a variety of analytical methods to detect PAHs. Of the 10 studies, 7 were published after 2000, and 6 assessed Discussion: PAHs are found in some alcohol products and appear to vary by beverage type. However, there is an incomplete understanding of their presence and levels among large, representative samples from the range of currently available alcohol products. Addressing this gap could improve understanding of alcohol-cancer relationships and may have important implications for public health and the regulation of alcohol products. In addition, novel methods, such as direct mass spectroscopy, may facilitate more thorough testing of samples to further investigate this relationship. https://doi.org/10.1289/EHP13506.
MeSH term(s)	Polycyclic Aromatic Hydrocarbons ; Benzo(a)pyrene ; Alcoholic Beverages/analysis ; Beer/analysis ; Wine/analysis ; Ethanol/metabolism ; Carcinogens
Chemical Substances	Polycyclic Aromatic Hydrocarbons ; Benzo(a)pyrene (3417WMA06D) ; Ethanol (3K9958V90M) ; Carcinogens
Language	English
Publishing date	2024-01-19
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	195189-0
ISSN	1552-9924 ; 0091-6765 ; 1078-0475
ISSN (online)	1552-9924
ISSN	0091-6765 ; 1078-0475
DOI	10.1289/EHP13506
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Article ; Online: Methodology for Evidence Evaluation and Reporting of the NAEMSP Trauma Compendium Position Statements.

Martin-Gill, Christian / Lyng, John W

Prehospital emergency care

2024 , Page(s) 1–6

Abstract: Background: Position statements from national organizations commonly vary in methodology for the evaluation of existing literature and the development of recommendations. Recent national recommendations have highlighted important components for evidence- ...

Abstract	Background: Position statements from national organizations commonly vary in methodology for the evaluation of existing literature and the development of recommendations. Recent national recommendations have highlighted important components for evidence-based guidelines that can be feasibly incorporated in the creation of position statements and their resource documents. We describe the methodology developed to guide the creation of a compendium of 16 trauma-related position statements led by NAEMSP and partner organizations. Methods: Each position statement group developed trauma-related topic areas, primarily guided by the Population, Intervention, Comparison, and Outcome (PICO) framework. A structured literature search comprised of search terms aimed to identify relevant EMS and trauma-related scientific publications was performed for each topic area. Resource documents for each position statement included a description of the literature considered in forming recommendations, reported through evidence tables and a narrative description of the available literature. Where evidence was limited, consensus-based recommendations were developed using content experts and reviewed by the NAEMSP Standards and Clinical Practice Committee. Conclusion: We report a standardized methodology for literature review and development of recommendations as part of a compendium of trauma-related position statements from NAEMSP and partner organizations. This methodology can serve as a template for future position statements with ongoing refinement.
Language	English
Publishing date	2024-03-27
Publishing country	England
Document type	Journal Article
ZDB-ID	1461751-1
ISSN	1545-0066 ; 1090-3127
ISSN (online)	1545-0066
ISSN	1090-3127
DOI	10.1080/10903127.2024.2329217
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Article ; Online: Gabapentinoids and Acetaminophen as Adjuvants for Managing Postoperative Pain.

Gill, Christopher / Giuliano, Karen

AANA journal

2022 Volume 90, Issue 3, Page(s) 181–187

Abstract: With the current opiate epidemic in the United States, there is renewed interest in evaluating non-opiate adjuvant medications as effective alternatives for the prevention and treatment of postoperative pain. A systematic review of randomized, controlled ...

Abstract	With the current opiate epidemic in the United States, there is renewed interest in evaluating non-opiate adjuvant medications as effective alternatives for the prevention and treatment of postoperative pain. A systematic review of randomized, controlled trials on Pub Med, Medline, and Embase was conducted looking on postoperative pain management from 2008 to 2018. Studies were included if they used a gabapentenoid with or without acetaminophen and evaluated supplemental opiate use. All adult (18 years or older) surgical populations were considered for inclusion, and fourteen clinical trials met inclusion criteria. Gabapentenoid dosing varied among studies. In nine of fourteen studies, there was a finding of superiority as compared to placebo in managing postoperative pain and decreasing supplemental opiate use. Pregabalin was used in twelve of the fourteen studies and gabapentin was used in two of the fourteen studies. Of the nine studies that found a benefit from using a gabapentoid, all included pregabalin. While the rate of adverse effects was low in all studies, it was found to increase as dosages increased. Results support that pregabalin has a role in decreasing postoperative pain intensity and supplemental opiate use; however, the optimal dose or dosing regimen is not yet well understood.
MeSH term(s)	Acetaminophen/therapeutic use ; Adult ; Analgesics/therapeutic use ; Analgesics, Opioid/therapeutic use ; Cyclohexanecarboxylic Acids/adverse effects ; Humans ; Opiate Alkaloids/therapeutic use ; Pain, Postoperative/drug therapy ; Pregabalin/therapeutic use ; gamma-Aminobutyric Acid/therapeutic use
Chemical Substances	Analgesics ; Analgesics, Opioid ; Cyclohexanecarboxylic Acids ; Opiate Alkaloids ; Acetaminophen (362O9ITL9D) ; Pregabalin (55JG375S6M) ; gamma-Aminobutyric Acid (56-12-2)
Language	English
Publishing date	2022-04-14
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	603605-3
ISSN	2162-5239 ; 0094-6354
ISSN (online)	2162-5239
ISSN	0094-6354
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Article ; Online: Effect of Electrical Stimulation on Meat Spoilage Floras.

Gill, C O

Journal of food protection

2019 Volume 43, Issue 3, Page(s) 190

Abstract: Sheep carcasses were electrically stimulated after removal of one leg. There was no difference between the growth of spoilage bacteria on stimulated and non-stimulated legs, or in minces prepared from either type of leg, with either the natural or an ... ...

Abstract	Sheep carcasses were electrically stimulated after removal of one leg. There was no difference between the growth of spoilage bacteria on stimulated and non-stimulated legs, or in minces prepared from either type of leg, with either the natural or an inoculated flora.
Language	English
Publishing date	2019-01-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	243284-5
ISSN	1944-9097 ; 0362-028X
ISSN (online)	1944-9097
ISSN	0362-028X
DOI	10.4315/0362-028X-43.3.190
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Article ; Online: Meat Spoilage and Evaluation of the Potential Storage Life of Fresh Meat.

Gill, C O

Journal of food protection

2019 Volume 46, Issue 5, Page(s) 444–452

Abstract: Microbiological processes by which meat develops qualities unacceptable to consumers vary with the composition of the meat and spoilage microflora. Composition of the spoilage microflora is affected by meat composition and storage conditions. Aerobic ... ...

Abstract	Microbiological processes by which meat develops qualities unacceptable to consumers vary with the composition of the meat and spoilage microflora. Composition of the spoilage microflora is affected by meat composition and storage conditions. Aerobic spoilage microfloras are usually dominated by pseudomonads. With this type of microflora, spoilage occurs when glucose in meat is no longer sufficient for the requirements of the spoilage microflora and the bacteria start to degrade amino acids. When meat is deficient in glucose, spoilage becomes evident while bacterial numbers are relatively small. Anaerobic microfloras are usually dominated by lactobacilli which produce spoilage by the slow accumulation of volatile organic acids. Meat of high utimate pH packaged anaerobically spoils rapidly because the high pH allows anaerobic growth of bacterial species of higher spoilage potential than the lactobacilli. Before overt spoilage develops, the spoilage status of meat can be accurately assessed from the bacterial numbers on meat only when there is assumption or knowledge of meat composition, storage conditions and the types of bacteria present. Methods for estimating spoilage which depend upon detection of products of amino acid degradation have little predictive value as such products will only be present after attack on amino acids has commenced and are irrelevant to spoilage under anaerobic conditions. Estimation of the concentrations of other spoilage products may be the only method applicable to assessment of incipient spoilage of meat stored anaerobically. It is, therefore, unlikely that any single test can give unequivocal information on meat quality under all circumstances, but rapid tests for meat quality could be of value for specific commercial purposes. provided such tests are appropriate to the circumstances and the inherent limitations of any test are recognized.
Language	English
Publishing date	2019-03-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	243284-5
ISSN	1944-9097 ; 0362-028X
ISSN (online)	1944-9097
ISSN	0362-028X
DOI	10.4315/0362-028X-46.5.444
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Article ; Online: Pediatric Utilization of Emergency Medical Services from Outpatient Offices and Urgent Care Centers.

Saper, Jennifer K / Macy, Michelle L / Martin-Gill, Christian / Ramgopal, Sriram

Academic pediatrics

2024

Abstract: Objective: National efforts have highlighted the need for pediatric emergency readiness across all settings where children receive care. Outpatient offices and urgent care centers are frequent starting points for acutely injured and ill children, ... ...

Abstract	Objective: National efforts have highlighted the need for pediatric emergency readiness across all settings where children receive care. Outpatient offices and urgent care centers are frequent starting points for acutely injured and ill children, emphasizing the need to maintain pediatric readiness in these settings. We aimed to characterize emergency medical services (EMS) utilization from outpatient offices and urgent care centers to better understand pediatric readiness needs. Methods: We performed a retrospective cross-sectional analysis of EMS encounters using the National Emergency Medical Services Information System, a nationally representative EMS registry (2019-2022). We included four years of EMS encounters of children (<18 years old) that originated from an outpatient office or urgent care center. We described characteristics, including patient demographics, prehospital clinician impression, therapies, and procedures performed. Results: Of 179,854,336 EMS encounters during the study period, 164,387 pediatric encounters originated at an outpatient setting. Most EMS encounters originated from outpatient offices. Evening and weekend EMS encounters more frequently originated from urgent care centers. The most common impressions were respiratory distress (n = 60,716), systemic illness (n = 23,583), and psychiatric/behavioral health (n = 13,273). Ninety-four percent of EMS encounters resulted in transportation to a hospital. Conclusions: EMS encounters from outpatient settings most commonly originate from outpatient offices, relative to urgent care settings, where pediatric emergency readiness may be limited. It is important that outpatient settings and providers are ready for varied emergencies, including those occurring for a behavioral health concern, and that readiness guidelines are updated to address these needs.
Language	English
Publishing date	2024-03-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	2483385-X
ISSN	1876-2867 ; 1876-2859
ISSN (online)	1876-2867
ISSN	1876-2859
DOI	10.1016/j.acap.2024.03.008
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