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Article ; Online: Caring for Children With Medical Complexity: A Clinical, Patient-Focused Curriculum.

Lattanza, Brittany / Lakhaney, Divya / Scott, Theresa / Croker-Benn, Ashley / Giordano, Mirna / Banker, Sumeet L

MedEdPORTAL : the journal of teaching and learning resources

2024 Volume 20, Page(s) 11380

Abstract: Introduction: Caring for children with medical complexity (CMC) requires specialized knowledge and skills. However, no standardized curricula are used across training programs as institutions have varying needs and resources.: Methods: We created a ... ...

Abstract	Introduction: Caring for children with medical complexity (CMC) requires specialized knowledge and skills. However, no standardized curricula are used across training programs as institutions have varying needs and resources. Methods: We created a patient-focused, interactive curriculum for two CMC topics: feeding/nutrition and pain/irritability. We integrated the 45-minute sessions into morning protected patient-care time on an inpatient pediatric team at an urban tertiary care hospital. Targeted toward all pediatric residents and medical students rotating in inpatient pediatrics over a 12-month period, the sessions used a mix of didactic, discussion, and hands-on activities. Learners on one of two inpatient teams received the curriculum, while those on the other received a curriculum unrelated to CMC and served as a control group. Both groups completed retrospective pre/post self-assessments to evaluate self-efficacy with respect to the learning objectives. Results: Over the 12-month period, 72 surveys were completed for the feeding/nutrition session, 78 surveys for the pain/irritability session, and 42 control surveys. The intervention group saw the greatest increase in self-efficacy scores generally in the feeding/nutrition session. All eight learning objectives saw significant improvement in self-efficacy scores for the intervention group. There was significantly greater improvement in self-efficacy for the intervention group compared to the control for all eight learning objectives. Discussion: Through this patient-focused curriculum, learners had improved self-efficacy scores compared to the natural learning occurring on the inpatient service. The curriculum could be adapted to fit the needs of other institutions and provides a practical, hands-on approach to learning about caring for CMC.
MeSH term(s)	Humans ; Child ; Retrospective Studies ; Internship and Residency ; Curriculum ; Learning ; Pain
Language	English
Publishing date	2024-01-30
Publishing country	United States
Document type	Journal Article
ISSN	2374-8265
ISSN (online)	2374-8265
DOI	10.15766/mep_2374-8265.11380
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Article ; Online: Menstruation-Induced Psychosis in a Pediatric Patient: A Case Report.

Garcia, Ambar / Gangopadhyay, Maalobeeka / Giordano, Mirna

Journal of the American Academy of Child and Adolescent Psychiatry

2022 Volume 62, Issue 4, Page(s) 385–388

Abstract: Menstruation-induced psychosis (MIP) is a rare disorder with limited documentation in the medical literature. Most cases have been described in case reports, although multiple literature reviews have demonstrated the relationship between menses and ... ...

Abstract	Menstruation-induced psychosis (MIP) is a rare disorder with limited documentation in the medical literature. Most cases have been described in case reports, although multiple literature reviews have demonstrated the relationship between menses and psychosis. Here, we describe 2 episodes of rapid-onset psychosis in a healthy 15-year-old girl. Written informed consent was obtained from the patient and their father. On first evaluation, autoimmune encephalitis was the leading diagnosis of consideration. The patient received intravenous immune globulin, returning to baseline within 24 hours of administration. Extensive neurological workup was unrevealing, aside from mild cerebrospinal fluid pleocytosis, serum anti-thyroid peroxidase (TPO) antibodies, and a fluid-attenuated inversion recovery (FLAIR) splenial lesion on magnetic resonance imaging. Psychotic symptoms began around the start of the patient's menstrual cycle, and both episodes were less than 1 week in duration. This report reviews the characteristics of MIP, details a case of recurrent psychosis that fits these characteristics, and adds a well-documented case to the growing series of reports. Given the rarity of MIP, it is essential to thoroughly document such cases. This case provides an example of the clinical presentation and disease course for pediatric patients presenting with MIP, and may serve as a reference for future work in understanding MIP. MIP is characterized by psychotic symptoms of acute onset and short duration that occur in association with the menstrual cycle.
MeSH term(s)	Humans ; Female ; Child ; Adolescent ; Menstruation ; Psychotic Disorders/drug therapy ; Immunoglobulins, Intravenous/therapeutic use
Chemical Substances	Immunoglobulins, Intravenous
Language	English
Publishing date	2022-11-01
Publishing country	United States
Document type	Case Reports ; Letter
ZDB-ID	392535-3
ISSN	1527-5418 ; 0890-8567
ISSN (online)	1527-5418
ISSN	0890-8567
DOI	10.1016/j.jaac.2022.10.004
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Article ; Online: Development and design of a mobile application for prescription opioid clinical decision-making: a feasibility study in New York City, USA.

Marziali, Megan E / Giordano, Mirna / Gleit, Zachary / Prigoff, Jake / Landau, Ruth / Martins, Silvia S

BMJ open

2023 Volume 13, Issue 2, Page(s) e066427

Abstract: Objectives: Excessive opioid prescribing is a contributing factor to the opioid epidemic in the USA. We aimed to develop, implement and evaluate the usability of a clinical decision-making mobile application (app) for opioid prescription after surgery.!# ...

Abstract	Objectives: Excessive opioid prescribing is a contributing factor to the opioid epidemic in the USA. We aimed to develop, implement and evaluate the usability of a clinical decision-making mobile application (app) for opioid prescription after surgery. Methods: We developed two clinical decision trees, one for opioid prescription after adult laparoscopic cholecystectomy and one for posterior spinal fusion surgery in adolescents. We developed a mobile app incorporating the two algorithms with embedded clinical decision-making, which was tested by opioid prescribers. A survey collected prescription intention prior to app use and participants' evaluation. Participants included opioid prescribers for patients undergoing (1) laparoscopic cholecystectomy in adults or (2) posterior spinal fusion in adolescents with idiopathic scoliosis. Results: Eighteen healthcare providers were included in this study (General Surgery: 8, Paediatrics: 10). Intended opioid prescription before app use varied between departments (General Surgery: 0-10 pills (mean=5.9); Paediatrics: 6-30 pills (mean=20.8)). Intention to continue using the app after using the app multiple times varied between departments (General Surgery: N=3/8; Paediatrics: N=7/10). The most reported reason for not using the app is lack of time. Conclusions: In this project evaluating the development and implementation of an app for opioid prescription after two common surgeries with different prescription patterns, the surgical procedure with higher intended and variable opioid prescription (adolescent posterior spinal fusion surgery) was associated with participants more willing to use the app. Future iterations of this opioid prescribing intervention should target surgical procedures with high variability in both patients' opioid use and providers' prescription patterns.
MeSH term(s)	Adolescent ; Adult ; Humans ; Child ; Analgesics, Opioid/therapeutic use ; Feasibility Studies ; New York City ; Mobile Applications ; Practice Patterns, Physicians' ; Clinical Decision-Making ; Prescriptions
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2023-02-28
Publishing country	England
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S. ; Research Support, N.I.H., Extramural
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-066427
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Article ; Online: Clinical Progress Note: Perioperative Pain Control in Hospitalized Pediatric Patients.

Giordano, Mirna / Knipper, Emily / Melwani, Anjna

Journal of hospital medicine

2020 Volume 16, Issue 6, Page(s) 358–360

MeSH term(s)	Child ; Humans ; Pain ; Pain Measurement ; Patients
Language	English
Publishing date	2020-03-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2233783-0
ISSN	1553-5606 ; 1553-5592
ISSN (online)	1553-5606
ISSN	1553-5592
DOI	10.12788/jhm.3388
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Article ; Online: Approach to New-Onset Psychosis in Pediatrics: A Review of Current Practice and an Interdisciplinary Consensus-Driven Clinical Pathway at a Single-Center Institution.

Jonokuchi, Alexander J / Fenster, Daniel B / McCann, Teresa A / Gangopadhyay, Maalobeeka / Giordano, Mirna / Maddocks, Alexis Br / Ekladios, Mina / Turek, Colleen M / Mroczkowski, Megan M / Jamal, Nazreen / Vargas, Wendy S

Journal of child neurology

2023 Volume 38, Issue 3-4, Page(s) 216–222

Abstract: New-onset psychosis in the pediatric population poses many diagnostic challenges. Given the diversity of underlying causes, which fall under the purview of multiple medical specialties, a timely, targeted, yet thorough workup requires a systematic and ... ...

Abstract	New-onset psychosis in the pediatric population poses many diagnostic challenges. Given the diversity of underlying causes, which fall under the purview of multiple medical specialties, a timely, targeted, yet thorough workup requires a systematic and coordinated approach. A committee of expert pediatric physicians from the divisions of emergency medicine, psychiatry, neurology, hospitalist medicine, and radiology convened to create and implement a novel clinical pathway and approach to the pediatric patient presenting with new-onset psychosis. Here we provide background and review the evidence supporting the investigations recommended in our pathway to screen for a comprehensive range of etiologies of pediatric psychosis.
MeSH term(s)	Humans ; Child ; Critical Pathways ; Consensus ; Psychotic Disorders/diagnosis ; Psychotic Disorders/etiology ; Psychotic Disorders/therapy ; Neurology ; Pediatrics
Language	English
Publishing date	2023-02-21
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	639288-x
ISSN	1708-8283 ; 0883-0738
ISSN (online)	1708-8283
ISSN	0883-0738
DOI	10.1177/08830738231156804
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Article ; Online: Multimodal Analgesia After Posterior Fossa Decompression With and Without Duraplasty for Children With Chiari Type I.

Shao, Belinda / Tariq, Abdul A / Goldstein, Hannah E / Alexiades, Nikita G / Mar, Krista M / Feldstein, Neil A / Anderson, Richard C E / Giordano, Mirna

Hospital pediatrics

2020 Volume 10, Issue 5, Page(s) 447–451

Abstract: Background: Multimodal analgesia (MMA) may reduce opioid use after surgery for Chiari malformation type I. An MMA protocol was implemented after both posterior fossa decompression without dural opening (PFD) and posterior fossa decompression with ... ...

Abstract	Background: Multimodal analgesia (MMA) may reduce opioid use after surgery for Chiari malformation type I. An MMA protocol was implemented after both posterior fossa decompression without dural opening (PFD) and posterior fossa decompression with duraplasty (PFDD). Methods: Scheduled nonsteroidal antiinflammatory drugs (ketorolac or ibuprofen) and diazepam were alternated with acetaminophen, and as-needed oxycodone or intravenous morphine. The primary outcome was total opioid requirement over postoperative days 0 to 2. Results: From 2012 to 2017, 49 PFD and 29 PFDD procedures were performed, and 46 of 78 patients used the protocol. Patients with PFD required less opioids than patients with PFDD. Among patients with PFDD, patients with MMA protocol usage had a lower mean opioid requirement than patients with no MMA protocol usage (0.53 ± 0.49 mgEq/kg versus 1.4 ± 1.0 mgEq/kg, Conclusions: A protocol of scheduled nonsteroidal antiinflammatory drugs alternating with scheduled acetaminophen and diazepam was associated with opioid use reductions.
MeSH term(s)	Analgesia/methods ; Analgesics, Opioid/therapeutic use ; Arnold-Chiari Malformation/surgery ; Child ; Decompression, Surgical ; Dura Mater/surgery ; Estrogens, Non-Steroidal/therapeutic use ; Humans ; Retrospective Studies ; Treatment Outcome
Chemical Substances	Analgesics, Opioid ; Estrogens, Non-Steroidal
Language	English
Publishing date	2020-04-22
Publishing country	United States
Document type	Journal Article
ISSN	2154-1671
ISSN (online)	2154-1671
DOI	10.1542/hpeds.2019-0298
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Article ; Online: Opioid-Sparing Multimodal Analgesia After Selective Dorsal Rhizotomy.

Shao, Belinda / Tariq, Abdul A / Goldstein, Hannah E / Alexiades, Nikita G / Mar, Krista M / Feldstein, Neil A / Anderson, Richard C E / Giordano, Mirna

Hospital pediatrics

2019 Volume 10, Issue 1, Page(s) 84–89

Abstract: Objectives: Multimodal analgesia (MMA) may reduce opioid use among children who are hospitalized, and may contribute toward enhanced recovery after selective dorsal rhizotomy (SDR) for patients with spasticity in pediatric cerebral palsy. In this ... ...

Abstract	Objectives: Multimodal analgesia (MMA) may reduce opioid use among children who are hospitalized, and may contribute toward enhanced recovery after selective dorsal rhizotomy (SDR) for patients with spasticity in pediatric cerebral palsy. In this retrospective cohort study, we assess an MMA protocol consisting of scheduled nonsteroidal antiinflammatory drug doses (ketorolac or ibuprofen), alternating with scheduled acetaminophen and diazepam doses, with as-needed opioids. It was hypothesized that protocol use would be associated with reductions in opioid requirements and other clinical improvements. Methods: Data were obtained for 52 patients undergoing SDR at an academic tertiary care pediatric hospital (2012-2017, with the protocol implemented in 2014). Using a retrospective cohort design, we compared outcomes between protocol and nonprotocol patients, employing both univariate Results: Twelve patients received the MMA protocol, and 40 patients did not. POD-0 MMA initiation was independently associated with a reduction of 0.14 morphine milligram equivalents per kilogram in mean opioid requirements over PODs 0 to 2 in the multiple regression analysis (95% confidence interval 0.01 to 0.28; Conclusions: This MMA protocol may help reduce opioid use after SDR. Improving protocol implementation in a prospective, multisite study will help elucidate further MMA effects on pain, costs, and recovery.
MeSH term(s)	Analgesia/methods ; Analgesics, Opioid/administration & dosage ; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage ; Child ; Humans ; Pain, Postoperative/drug therapy ; Retrospective Studies ; Rhizotomy
Chemical Substances	Analgesics, Opioid ; Anti-Inflammatory Agents, Non-Steroidal
Language	English
Publishing date	2019-12-18
Publishing country	United States
Document type	Journal Article
ISSN	2154-1671
ISSN (online)	2154-1671
DOI	10.1542/hpeds.2019-0016
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Article ; Online: A Clinical Pathway for Hospitalized Pediatric Patients With Initial SARS-CoV-2 Infection.

Diamond, Rebekah / Fischer, Avital / Hooe, Benjamin / Sewell, Taylor B / Schweickert, Adam / Ahn, Danielle / Jamal, Nazreen / Zachariah, Philip / Cheng, Jennifer / Abreu, Wanda / Giordano, Mirna

Hospital pediatrics

2020 Volume 10, Issue 9, Page(s) 810–819

Abstract: The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread quickly across the globe, creating unique and pressing challenges for today's physicians. Although this virus disproportionately affects adults, initial SARS- ... ...

Abstract	The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread quickly across the globe, creating unique and pressing challenges for today's physicians. Although this virus disproportionately affects adults, initial SARS-CoV-2 infection can present a significant disease burden for the pediatric population. A review of the literature yields descriptive studies in pediatric patients; however, no evidence-based or evidence-informed guidelines for the diagnosis and treatment of the hospitalized pediatric patient have been published in peer-reviewed journals. The authors, working at a quaternary care children's hospital in the national epicenter of the SARS-CoV-2 pandemic, found an urgent need to create a unified, multidisciplinary, evidence-informed set of guidelines for the diagnosis and management of coronavirus disease 2019 in children. In this article, the authors describe our institutional practices for the hospitalized pediatric patient with confirmed or suspected initial SARS-CoV-2 infection. The authors anticipate that developing evidence-informed and institution-specific guidelines will lead to improvements in care quality, efficiency, and consistency; minimization of staff risk of exposure to SARS-CoV-2; and increased provider comfort in caring for pediatric patients with SARS-CoV-2 infection.
MeSH term(s)	Betacoronavirus ; COVID-19 ; Child ; Child Welfare/statistics & numerical data ; Coronavirus Infections/diagnosis ; Coronavirus Infections/therapy ; Critical Pathways/organization & administration ; Diffusion of Innovation ; Disease Management ; Hospitals, Pediatric/organization & administration ; Humans ; Pandemics ; Patient Care Team/organization & administration ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/therapy ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-08-26
Publishing country	United States
Document type	Journal Article
ISSN	2154-1671
ISSN (online)	2154-1671
DOI	10.1542/hpeds.2020-0170
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Article: A Clinical Pathway for Hospitalized Pediatric Patients With Initial SARS-CoV-2 Infection

Diamond, Rebekah / Fischer, Avital / Hooe, Benjamin / Sewell, Taylor B / Schweickert, Adam / Ahn, Danielle / Jamal, Nazreen / Zachariah, Philip / Cheng, Jennifer / Abreu, Wanda / Giordano, Mirna

Hosp Pediatr

Abstract	The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread quickly across the globe, creating unique and pressing challenges for today's physicians. Although this virus disproportionately affects adults, initial SARS-CoV-2 infection can present a significant disease burden for the pediatric population. A review of the literature yields descriptive studies in pediatric patients; however, no evidence-based or evidence-informed guidelines for the diagnosis and treatment of the hospitalized pediatric patient have been published in peer-reviewed journals. The authors, working at a quaternary care children's hospital in the national epicenter of the SARS-CoV-2 pandemic, found an urgent need to create a unified, multidisciplinary, evidence-informed set of guidelines for the diagnosis and management of coronavirus disease 2019 in children. In this article, the authors describe our institutional practices for the hospitalized pediatric patient with confirmed or suspected initial SARS-CoV-2 infection. The authors anticipate that developing evidence-informed and institution-specific guidelines will lead to improvements in care quality, efficiency, and consistency; minimization of staff risk of exposure to SARS-CoV-2; and increased provider comfort in caring for pediatric patients with SARS-CoV-2 infection.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #732979
Database	COVID19

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Article ; Online: Epidemiology, Clinical Features, and Disease Severity in Patients With Coronavirus Disease 2019 (COVID-19) in a Children's Hospital in New York City, New York.

Zachariah, Philip / Johnson, Candace L / Halabi, Katia C / Ahn, Danielle / Sen, Anita I / Fischer, Avital / Banker, Sumeet L / Giordano, Mirna / Manice, Christina S / Diamond, Rebekah / Sewell, Taylor B / Schweickert, Adam J / Babineau, John R / Carter, R Colin / Fenster, Daniel B / Orange, Jordan S / McCann, Teresa A / Kernie, Steven G / Saiman, Lisa

JAMA pediatrics

2020 Volume 174, Issue 10, Page(s) e202430

Abstract: Importance: Descriptions of the coronavirus disease 2019 (COVID-19) experience in pediatrics will help inform clinical practices and infection prevention and control for pediatric facilities.: Objective: To describe the epidemiology, clinical, and ... ...

Abstract	Importance: Descriptions of the coronavirus disease 2019 (COVID-19) experience in pediatrics will help inform clinical practices and infection prevention and control for pediatric facilities. Objective: To describe the epidemiology, clinical, and laboratory features of patients with COVID-19 hospitalized at a children's hospital and to compare these parameters between patients hospitalized with and without severe disease. Design, setting, and participants: This retrospective review of electronic medical records from a tertiary care academically affiliated children's hospital in New York City, New York, included hospitalized children and adolescents (≤21 years) who were tested based on suspicion for COVID-19 between March 1 to April 15, 2020, and had positive results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Exposures: Detection of SARS-CoV-2 from a nasopharyngeal specimen using a reverse transcription-polymerase chain reaction assay. Main outcomes and measures: Severe disease as defined by the requirement for mechanical ventilation. Results: Among 50 patients, 27 (54%) were boys and 25 (50%) were Hispanic. The median days from onset of symptoms to admission was 2 days (interquartile range, 1-5 days). Most patients (40 [80%]) had fever or respiratory symptoms (32 [64%]), but 3 patients (6%) with only gastrointestinal tract presentations were identified. Obesity (11 [22%]) was the most prevalent comorbidity. Respiratory support was required for 16 patients (32%), including 9 patients (18%) who required mechanical ventilation. One patient (2%) died. None of 14 infants and 1 of 8 immunocompromised patients had severe disease. Obesity was significantly associated with mechanical ventilation in children 2 years or older (6 of 9 [67%] vs 5 of 25 [20%]; P = .03). Lymphopenia was commonly observed at admission (36 [72%]) but did not differ significantly between those with and without severe disease. Those with severe disease had significantly higher C-reactive protein (median, 8.978 mg/dL [to convert to milligrams per liter, multiply by 10] vs 0.64 mg/dL) and procalcitonin levels (median, 0.31 ng/mL vs 0.17 ng/mL) at admission (P < .001), as well as elevated peak interleukin 6, ferritin, and D-dimer levels during hospitalization. Hydroxychloroquine was administered to 15 patients (30%) but could not be completed for 3. Prolonged test positivity (maximum of 27 days) was observed in 4 patients (8%). Conclusions and relevance: In this case series study of children and adolescents hospitalized with COVID-19, the disease had diverse manifestations. Infants and immunocompromised patients were not at increased risk of severe disease. Obesity was significantly associated with disease severity. Elevated inflammatory markers were seen in those with severe disease.
MeSH term(s)	Adolescent ; COVID-19 ; Child ; Child, Preschool ; Coronavirus Infections/diagnosis ; Coronavirus Infections/epidemiology ; Female ; Hospitalization ; Hospitals, Pediatric ; Humans ; Infant ; Infant, Newborn ; Male ; New York City/epidemiology ; Pandemics ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/epidemiology ; Retrospective Studies ; Severity of Illness Index ; Young Adult
Keywords	covid19
Language	English
Publishing date	2020-10-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	2701223-2
ISSN	2168-6211 ; 2168-6203
ISSN (online)	2168-6211
ISSN	2168-6203
DOI	10.1001/jamapediatrics.2020.2430
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