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  1. Article ; Online: Parathyroid Autofluorescence in Pediatric Thyroid Surgery: Experience With False Positive and False Negative Results.

    Su-Velez, Brooke M / Hartman, Gary E / Seeley, Hilary / Orloff, Lisa A / Noel, Julia E / Meister, Kara D

    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery

    2023  Volume 169, Issue 1, Page(s) 185–189

    Abstract: Devices for near-infrared light stimulation of autofluorescence (NIRAF) allow for intraoperative identification of parathyroid glands with high sensitivity in adults. However, their performance in the pediatric population is unknown. In this case series ... ...

    Abstract Devices for near-infrared light stimulation of autofluorescence (NIRAF) allow for intraoperative identification of parathyroid glands with high sensitivity in adults. However, their performance in the pediatric population is unknown. In this case series with chart review at a tertiary academic children's hospital, we investigated pediatric patients undergoing thyroid surgery and concurrent use of a probe-based NIRAF device. Thirteen patients (ages 6-18 years) underwent thyroid and/or neck dissection procedures, and 2 patients had revision procedures for a total of 15 cases with the NIRAF device. Eight cases had NIRAF values that matched surgeon opinion of parathyroid tissue or histology when available. Six cases had false positive NIRAF readings (40.0%) and 1 case had false negative readings (6.7%). Compared with surgeon opinion or histology, the NIRAF device confirmed 26 of 34 parathyroid gland candidates (76.5%). These devices need further investigation in pediatric patients, whose tissues may have different autofluorescence characteristics.
    MeSH term(s) Adult ; Humans ; Child ; Parathyroid Glands/diagnostic imaging ; Parathyroid Glands/surgery ; Thyroid Gland/surgery ; Parathyroidectomy/methods ; Thyroidectomy/methods ; Optical Imaging/methods
    Language English
    Publishing date 2023-01-29
    Publishing country England
    Document type Journal Article
    ZDB-ID 392085-9
    ISSN 1097-6817 ; 0161-6439 ; 0194-5998
    ISSN (online) 1097-6817
    ISSN 0161-6439 ; 0194-5998
    DOI 10.1002/ohn.272
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  2. Article ; Online: Sociodemographic Disparities in the Diagnostic Management of Pediatric Thyroid Nodules.

    Moon, Peter K / Qian, Z Jason / Noel, Julia E / Orloff, Lisa A / Seeley, Hilary / Hartman, Gary E / Josephs, Shellie / Meister, Kara D

    JAMA otolaryngology-- head & neck surgery

    2022  

    Abstract: Importance: Thyroid cancer is the most common pediatric endocrine malignant neoplasm. Disparities in the workup of thyroid nodules may be significantly associated with thyroid cancer outcomes.: Objective: To determine the association of ... ...

    Abstract Importance: Thyroid cancer is the most common pediatric endocrine malignant neoplasm. Disparities in the workup of thyroid nodules may be significantly associated with thyroid cancer outcomes.
    Objective: To determine the association of sociodemographic factors with the odds of receiving a biopsy, timeliness of the procedure, and risk of nodule malignancy.
    Design, setting, and participants: This was a retrospective cross-sectional study using insurance claims data from the Optum Clinformatics Data Mart database. The study cohort comprised pediatric patients diagnosed with single thyroid nodules between 2003 and 2020. Data analysis was performed from January 1, 2003, to June 30, 2020.
    Main outcomes and measures: Multivariable logistic regression models were used to identify demographic variables associated with biopsy and nodule malignant neoplasm. A multivariable linear regression model was used to assess the time between thyroid nodule diagnosis and biopsy.
    Results: Of 11 643 children (median [IQR] age at diagnosis or procedure, 15 [12-17] years; 8549 [73.2%] were female and 3126 [26.8%] were male) diagnosed with single thyroid nodules, 2117 (18.2%) received a biopsy. Among the patients who received a biopsy, 304 (14.4%) were found to have a malignant nodule. Greater parental education was associated with a shorter diagnosis-to-biopsy interval (mean difference, -7.24 days; 95% CI, -13.75 to -0.73). Older age at nodule diagnosis (odds ratio [OR], 1.11; 95% CI, 1.09-1.13) and female gender (OR, 1.25; 95% CI, 1.11-1.40) were associated with increased odds of receiving a biopsy, while Black/African American (OR, 0.80; 95% CI, 0.65-0.99) and Hispanic (OR, 0.84; 95% CI, 0.72-0.99) patients had lower odds of receiving a biopsy compared with White patients. Finally, female gender (OR, 1.08; 95% CI, 0.80-1.47) was not associated with lower odds of nodule malignant neoplasm.
    Conclusions and relevance: Findings of this cross-sectional study highlight disparities in the diagnostic management of pediatric thyroid nodules. These results call for future work to ensure equitable access to thyroid care for all children.
    Language English
    Publishing date 2022-10-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2701825-8
    ISSN 2168-619X ; 2168-6181
    ISSN (online) 2168-619X
    ISSN 2168-6181
    DOI 10.1001/jamaoto.2022.3167
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  3. Article ; Online: Optimizing Professional Practice Evaluation to Enable a Nonpunitive Learning Health System Approach to Peer Review.

    Sandborg, Christy I / Hartman, Gary E / Su, Felice / Williams, Glyn / Teufe, Beate / Wixson, Nina / Larson, David B / Donnelly, Lane F

    Pediatric quality & safety

    2020  Volume 6, Issue 1, Page(s) e375

    Abstract: Healthcare organizations are focused on 2 different and sometimes conflicting tasks; (1) accelerate the improvement of clinical care delivery and (2) collect provider-specific data to determine the competency of providers. We describe creating a process ... ...

    Abstract Healthcare organizations are focused on 2 different and sometimes conflicting tasks; (1) accelerate the improvement of clinical care delivery and (2) collect provider-specific data to determine the competency of providers. We describe creating a process to meet both of these aims while maintaining a culture that fosters improvement and teamwork.
    Methods: We created a new process to sequester activities related to learning and improvement from those focused on individual provider performance. We describe this process, including data on the number and type of cases reviewed and survey results of the participant's perception of the new process.
    Results: In the new model, professional practice evaluation committees evaluate events purely to identify system issues and human factors related to medical decision-making, resulting in actional improvements. There are separate and sequestered processes that evaluate concerns around an individual provider's clinical competence or behavior. During the first 5 years of this process, 207 of 217 activities (99.5%) related to system issues rather than issues concerning individual provider competence or behavior. Participants perceived the new process as focused on identifying system errors (4.3/5), nonpunitive (4.2/5), an improvement (4.0/5), and helped with engagement in our system and contributed to wellness (4.0/5).
    Conclusion: We believe this sequestered approach has enabled us to achieve both the oversight mandates to ensure provider competence while enabling a learning health systems approach to build the cultural aspects of trust and teamwork that are essential to driving continuous improvement in our system of care.
    Language English
    Publishing date 2020-12-28
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2472-0054
    ISSN (online) 2472-0054
    DOI 10.1097/pq9.0000000000000375
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  4. Article ; Online: Laparoscopic Excision of Congenital Hepatic Cysts in the Pediatric Population: A Case Series and Literature Review.

    Linden, Allison F / Pulcrano, Marisa E / Duffy, Brian J / Lange, Patricia A / Tsung, David Y / Hartman, Gary E / Kane, Timothy / Chahine, A Alfred

    Journal of laparoendoscopic & advanced surgical techniques. Part A

    2016  Volume 26, Issue 6, Page(s) 493–497

    Abstract: Purpose: Congenital hepatic cysts are rare. Surgical excision is indicated for symptoms, complications, and to rule out malignancy. Laparoscopic management in the pediatric population has not been extensively documented. We present a series involving ... ...

    Abstract Purpose: Congenital hepatic cysts are rare. Surgical excision is indicated for symptoms, complications, and to rule out malignancy. Laparoscopic management in the pediatric population has not been extensively documented. We present a series involving laparoscopic excision of pediatric congenital hepatic cysts and review the literature.
    Methods: Data were collected over 15 years from two pediatric surgeons at three medical centers. Presence of a hepatic cyst excised laparoscopically was the only inclusion criterion. Data were collected on the cyst size, type, pathology, and location, as well as on length of hospital stay, complications, and 1 year recurrence rate.
    Results: Four patients were identified: a 7-week-old male presenting with feeding intolerance due to a hepatic cyst; a 6-year-old male presenting with a hepatic cyst identified by ultrasound during evaluation for appendicitis; a male neonate diagnosed at birth with a left thoracic cyst that communicated through the diaphragm with a hepatic cystic lesion; and a 14-year-old male presenting with a 25 cm × 11 cm hepatic cyst. All lesions were excised laparoscopically.
    Conclusion: Our series is the largest documenting complete laparoscopic excision of congenital solitary hepatic cysts in the pediatric population. Laparoscopic excision is a safe and effective approach for the pediatric population.
    MeSH term(s) Adolescent ; Child ; Cysts/congenital ; Cysts/surgery ; Humans ; Infant ; Infant, Newborn ; Laparoscopy/methods ; Liver/surgery ; Liver Diseases/congenital ; Liver Diseases/surgery ; Male
    Language English
    Publishing date 2016-06
    Publishing country United States
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 2608063-1
    ISSN 1557-9034 ; 1092-6429
    ISSN (online) 1557-9034
    ISSN 1092-6429
    DOI 10.1089/lap.2016.0115
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  5. Article ; Online: The giant umbilical cord: an unusual presentation of a patent urachus.

    Nobuhara, Kerilyn K / Lukish, Jeffrey R / Hartman, Gary E / Gilbert, James C

    Journal of pediatric surgery

    2004  Volume 39, Issue 1, Page(s) 128–129

    Abstract: Umbilical cord anomalies remain a frequent newborn nursery consultation for the pediatric surgeon. The authors report on a giant umbilical cord associated with a patent urachus. Although it is an uncommon anomaly, operative exploration must be carried ... ...

    Abstract Umbilical cord anomalies remain a frequent newborn nursery consultation for the pediatric surgeon. The authors report on a giant umbilical cord associated with a patent urachus. Although it is an uncommon anomaly, operative exploration must be carried out to repair the associated urachal remnant.
    MeSH term(s) Humans ; Infant, Newborn ; Male ; Umbilical Cord/abnormalities ; Urachus/abnormalities
    Language English
    Publishing date 2004-01
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 80165-3
    ISSN 1531-5037 ; 0022-3468
    ISSN (online) 1531-5037
    ISSN 0022-3468
    DOI 10.1016/j.jpedsurg.2003.09.023
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  6. Article: Right Diaphragmatic Eventration Simulating a Congenital Diaphragmatic Hernia

    Rais-Bahrami, Khodayar / Gilbert, James C. / Hartman, Gary E. / Chandra, Roma S. / Short, Billie L.

    American Journal of Perinatology

    1996  Volume 13, Issue 04, Page(s) 241–243

    Abstract: We describe an infant with severe eventration of the right diaphragm and pulmonary hypoplasia who presented like a newborn with congenital diaphragmatic hernia complicated by persistent pulmonary hypertension. Surgical correction while on extracorporeal ... ...

    Abstract We describe an infant with severe eventration of the right diaphragm and pulmonary hypoplasia who presented like a newborn with congenital diaphragmatic hernia complicated by persistent pulmonary hypertension. Surgical correction while on extracorporeal life support was unsuccessful due to attachments of the liver which prevented reduction into the abdominal cavity and our inability to distinguish the true defect from complete agenesis of the right hemidiaphragm. At autopsy the pulmonary remnant and the fibrous membrane separating it from the liver were identified.
    Keywords Right diaphragmatic eventration ; congenital diaphragmatic hernia
    Language English
    Publishing date 1996-05-01
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 605671-4
    ISSN 1098-8785 ; 0735-1631
    ISSN (online) 1098-8785
    ISSN 0735-1631
    DOI 10.1055/s-2007-994372
    Database Thieme publisher's database

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  7. Article ; Online: Routine MRI evaluation of low imperforate anus reveals unexpected high incidence of tethered spinal cord.

    Golonka, Naomi R / Haga, Linda J / Keating, Robert P / Eichelberger, Martin R / Gilbert, James C / Hartman, Gary E / Powell, David M / Vezina, Gilbert / Newman, Kurt D

    Journal of pediatric surgery

    2002  Volume 37, Issue 7, Page(s) 966–9; discussion 966–9

    Abstract: Background/purpose: Previous clinical practice has included evaluation for the presence of tethered cord in those children who have imperforate anus with a high lesion. To define the incidence in children with low lesions, the authors reviewed their ... ...

    Abstract Background/purpose: Previous clinical practice has included evaluation for the presence of tethered cord in those children who have imperforate anus with a high lesion. To define the incidence in children with low lesions, the authors reviewed their experience with a protocol employing routine magnetic resonance imaging (MRI), regardless of the level of the lesion, to determine the presence of a tethered cord in all children with imperforate anus.
    Methods: A retrospective review of children with imperforate anus was conducted over the last 13 years at our institution. Lesions were categorized as high versus low based on the supralevator or infralevator position of the fistula.
    Results: Sixty-three patients completed evaluation for a tethered cord. Twenty-two (34.9%) of these 63 patients had a tethered cord: 11 of 41 (26.8%) patients with high lesions and 11 of 22 (50.0%) of those with low lesions. Of those children with a low lesion, 83% of the boys had a tethered cord, whereas 38% of the girls had a tethered cord. Forty-five percent of the patients with low lesions and a tethered cord did not have any other lumbosacral anomalies. All 22 children with a tethered cord underwent surgical release.
    Conclusions: The incidence of tethered cord in children with low lesions of imperforate anus is not lower than those with high lesions. The authors advocate early evaluation of all children with imperforate anus for a tethered cord.
    MeSH term(s) Abnormalities, Multiple/diagnosis ; Abnormalities, Multiple/epidemiology ; Anus, Imperforate/diagnosis ; Anus, Imperforate/epidemiology ; Child ; Comorbidity ; Female ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Mass Screening/methods ; Neural Tube Defects/diagnosis ; Neural Tube Defects/epidemiology ; Retrospective Studies ; Spina Bifida Occulta/diagnosis ; Spina Bifida Occulta/epidemiology ; Spine/abnormalities
    Language English
    Publishing date 2002-07
    Publishing country United States
    Document type Evaluation Studies ; Journal Article
    ZDB-ID 80165-3
    ISSN 1531-5037 ; 0022-3468
    ISSN (online) 1531-5037
    ISSN 0022-3468
    DOI 10.1053/jpsu.2002.33817
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