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  1. AU="Mark I Neuman"
  2. AU="Paul Trayhurn"
  3. AU="Wendy W. Lam"
  4. AU="King, Pamela"
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  1. Artikel ; Online: PEMCRC anaphylaxis study protocol

    Rakesh D Mistry / Kenneth A Michelson / Stephanie Boyd / Mark I Neuman / Timothy E Dribin / David Vyles / David C Brousseau / Peter S Dayan / Nanhua Zhang / Shiv Viswanathan / John Witry / David Schnadower

    BMJ Open, Vol 11, Iss

    a multicentre cohort study to derive and validate clinical decision models for the emergency department management of children with anaphylaxis

    2021  Band 1

    Abstract: Introduction There remain significant knowledge gaps about the management and outcomes of children with anaphylaxis. These gaps have led to practice variation regarding decisions to hospitalise children and length of observation periods following ... ...

    Abstract Introduction There remain significant knowledge gaps about the management and outcomes of children with anaphylaxis. These gaps have led to practice variation regarding decisions to hospitalise children and length of observation periods following treatment with epinephrine. The objectives of this multicentre study are to (1) determine the prevalence of and risk factors for severe, persistent, refractory and biphasic anaphylaxis, as well as persistent and biphasic non-anaphylactic reactions; (2) derive and validate prediction models for emergency department (ED) discharge; and (3) determine data-driven lengths of ED and inpatient observation prior to discharge to home based on initial reaction severity.Methods and analysis The study is being conducted through the Pediatric Emergency Medicine Collaborative Research Committee (PEMCRC). Children 6 months to less than 18 years of age presenting to 30 participating EDs for anaphylaxis from October 2015 to December 2019 will be eligible. The primary outcomes for each objective are (1) severe, persistent, refractory or biphasic anaphylaxis, as well as persistent or biphasic non-anaphylactic reactions; (2) safe ED discharge, defined as no receipt of acute anaphylaxis medications or hypotension beyond 4 hours from first administered dose of epinephrine; and (3) time from first to last administered dose of epinephrine and vasopressor cessation. Analyses for each objective include (1) descriptive statistics to estimate prevalence and generalised estimating equations that will be used to investigate risk factors for anaphylaxis outcomes, (2) least absolute shrinkage and selection operator regression and binary recursive partitioning to derive and validate prediction models of children who may be candidates for safe ED discharge, and (3) Kaplan-Meier analyses to assess timing from first to last epinephrine doses and vasopressor cessation based on initial reaction severity.Ethics and dissemination All sites will obtain institutional review board approval; results will be published in peer-reviewed journals and disseminated via traditional and social media, blogs and online education platforms.
    Schlagwörter Medicine ; R
    Thema/Rubrik (Code) 360
    Sprache Englisch
    Erscheinungsdatum 2021-01-01T00:00:00Z
    Verlag BMJ Publishing Group
    Dokumenttyp Artikel ; Online
    Datenquelle BASE - Bielefeld Academic Search Engine (Lebenswissenschaftliche Auswahl)

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  2. Artikel ; Online: Intracranial Traumatic Hematoma Detection in Children Using a Portable Near-infrared Spectroscopy Device

    Matthew P. Kirschen / Sage R. Myers / Mark I. Neuman / Joseph A. Grubenhoff / Rebekah Mannix / Nicholas Stence / Edward Yang / Ashley L. Woodford / Tyson Rogers / Anna Nordell / Arastoo Vossough / Mark R. Zonfrillo

    Western Journal of Emergency Medicine, Vol 22, Iss

    2021  Band 3

    Abstract: Introduction: We sought to validate a handheld, near-infrared spectroscopy (NIRS) device for detecting intracranial hematomas in children with head injury. Methods: Eligible patients were those <18 years old who were admitted to the emergency department ... ...

    Abstract Introduction: We sought to validate a handheld, near-infrared spectroscopy (NIRS) device for detecting intracranial hematomas in children with head injury. Methods: Eligible patients were those <18 years old who were admitted to the emergency department at three academic children’s hospitals with head trauma and who received a clinically indicated head computed tomography (HCT). Measurements were obtained by a blinded operator in bilateral frontal, temporal, parietal, and occipital regions. Qualifying hematomas were a priori determined to be within the brain scanner’s detection limits of >3.5 milliliters in volume and <2.5 centimeters from the surface of the brain. The device’s measurements were positive if the difference in optical density between hemispheres was >0.2 on three successive scans. We calculated diagnostic performance measures with corresponding exact two-sided 95% Clopper-Pearson confidence intervals (CI). Hypothesis test evaluated whether predictive performance exceeded chance agreement (predictive Youden’s index > 0). Results: A total of 464 patients were enrolled and 344 met inclusion for primary data analysis: 10.5% (36/344) had evidence of a hematoma on HCT, and 4.7% (16/344) had qualifying hematomas. The handheld brain scanner demonstrated a sensitivity of 58.3% (21/36) and specificity of 67.9% (209/308) for hematomas of any size. For qualifying hematomas the scanner was designed to detect, sensitivity was 81% (13/16) and specificity was 67.4% (221/328). Predictive performance exceeded chance agreement with a predictive Youden’s index of 0.11 (95% CI, 0.10 – 0.15; P < 0.001) for all hematomas, and 0.09 (95% CI, 0.08 – 0.12; P < 0.001) for qualifying hematomas. Conclusion: The handheld brain scanner can non-invasively detect a subset of intracranial hematomas in children and may serve an adjunctive role to head-injury neuroimaging decision rules that predict the risk of clinically significant intracranial pathology after head trauma.
    Schlagwörter Medicine ; R ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9
    Thema/Rubrik (Code) 610
    Sprache Englisch
    Erscheinungsdatum 2021-05-01T00:00:00Z
    Verlag eScholarship Publishing, University of California
    Dokumenttyp Artikel ; Online
    Datenquelle BASE - Bielefeld Academic Search Engine (Lebenswissenschaftliche Auswahl)

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  3. Artikel ; Online: Prospective cohort study of children with suspected SARS-CoV-2 infection presenting to paediatric emergency departments

    Nathan Kuppermann / Daniel Joseph Tancredi / Lilliam Ambroggio / Anna L. Funk / Todd A. Florin / Stuart R. Dalziel / Marina I. Salvadori / Mark I. Neuman / Daniel C. Payne / Amy C. Plint / Terry P. Klassen / Richard Malley / Kelly Kim / Stephen B. Freedman

    BMJ Open, Vol 11, Iss

    a Paediatric Emergency Research Networks (PERN) Study Protocol

    2021  Band 1

    Abstract: Introduction Relatively limited data are available regarding paediatric COVID-19. Although most children appear to have mild or asymptomatic infections, infants and those with comorbidities are at increased risk of experiencing more severe illness and ... ...

    Abstract Introduction Relatively limited data are available regarding paediatric COVID-19. Although most children appear to have mild or asymptomatic infections, infants and those with comorbidities are at increased risk of experiencing more severe illness and requiring hospitalisation due to COVID-19. The recent but uncommon association of SARS-CoV-2 infection with development of a multisystem inflammatory syndrome has heightened the importance of understanding paediatric SARS-CoV-2 infection.Methods and analysis The Paediatric Emergency Research Network-COVID-19 cohort study is a rapid, global, prospective cohort study enrolling 12 500 children who are tested for acute SARS-CoV-2 infection. 47 emergency departments across 12 countries on four continents will participate. At enrolment, regardless of SARS-CoV-2 test results, all children will have the same information collected, including clinical, epidemiological, laboratory, imaging and outcome data. Interventions and outcome data will be collected for hospitalised children. For all children, follow-up at 14 and 90 days will collect information on further medical care received, and long-term sequelae, respectively. Statistical models will be designed to identify risk factors for infection and severe outcomes.Ethics and dissemination Sites will seek ethical approval locally, and informed consent will be obtained. There is no direct risk or benefit of study participation. Weekly interim analysis will allow for real-time data sharing with regional, national, and international policy makers. Harmonisation and sharing of investigation materials with WHO, will contribute to synergising global efforts for the clinical characterisation of paediatric COVID-19. Our findings will enable the implementation of countermeasures to reduce viral transmission and severe COVID-19 outcomes in children.Trial registration number NCT04330261
    Schlagwörter Medicine ; R
    Thema/Rubrik (Code) 170
    Sprache Englisch
    Erscheinungsdatum 2021-01-01T00:00:00Z
    Verlag BMJ Publishing Group
    Dokumenttyp Artikel ; Online
    Datenquelle BASE - Bielefeld Academic Search Engine (Lebenswissenschaftliche Auswahl)

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  4. Artikel ; Online: Identification of children with anaphylaxis at low risk of receiving acute inpatient therapies.

    Timothy E Dribin / Kenneth A Michelson / Michael C Monuteaux / Anne M Stack / Karen S Farbman / Lynda C Schneider / Mark I Neuman

    PLoS ONE, Vol 14, Iss 2, p e

    2019  Band 0211949

    Abstract: Objective Opportunity exists to reduce unnecessary hospitalizations for children with anaphylaxis given wide variation in admission rates across U.S. emergency departments (EDs). We sought to identify children hospitalized with anaphylaxis at low risk of ...

    Abstract Objective Opportunity exists to reduce unnecessary hospitalizations for children with anaphylaxis given wide variation in admission rates across U.S. emergency departments (EDs). We sought to identify children hospitalized with anaphylaxis at low risk of receiving epinephrine and other acute inpatient therapies, as these patients may be candidates for ED discharge rather than inpatient hospitalization. Methods We conducted a single-center retrospective cohort study of children 1-21 years of age hospitalized with anaphylaxis from 2009 to 2016. Acute inpatient therapies included intramuscular (IM) or racemic epinephrine, bronchodilators, fluid boluses, vasopressors, non-invasive ventilation, or intubation. We derived age-specific (pre-verbal [<36 months] vs. verbal [≥ 36 months]) prediction rules using recursive partitioning to identify children at low risk of receiving acute inpatient therapies. Results During the study period 665 children were hospitalized for anaphylaxis, of whom 108 (16.2%) received acute inpatient therapies. The prediction rule for patients < 36 months (no wheezing, no cardiac involvement [hypotension or wide pulse pressure]) had a sensitivity of 90.5% (CI 69.6-98.8%) and a negative predictive value of 98.3% (CI 94.1-99.8%) for identifying children at low risk of receipt of acute inpatient therapies during hospitalization. For children ≥ 36 months, the prediction rule (no wheezing, no cardiac involvement, presence of gastrointestinal symptoms) had a sensitivity of 90.8% (CI 82.7-96.0%) and a negative predictive value of 92.4% (CI 85.6-96.7%). Conclusions We derived age specific prediction rules for children hospitalized with anaphylaxis at low risk of receiving epinephrine and other acute inpatient therapies. These children may be candidates for ED discharge rather than inpatient hospitalization.
    Schlagwörter Medicine ; R ; Science ; Q
    Sprache Englisch
    Erscheinungsdatum 2019-01-01T00:00:00Z
    Verlag Public Library of Science (PLoS)
    Dokumenttyp Artikel ; Online
    Datenquelle BASE - Bielefeld Academic Search Engine (Lebenswissenschaftliche Auswahl)

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  5. Artikel ; Online: Derivation and validation of a novel risk assessment tool to identify children aged 2–59 months at risk of hospitalised pneumonia-related mortality in 20 countries

    Norman Lufesi / Philippe Vanhems / Tim Colbourn / Charles Mwansambo / Eric D McCollum / Samir K Saha / Mathuram Santosham / Shally Awasthi / Harish Nair / Archana Patel / Patricia L Hibberd / Shabir Ahmed Madhi / Tor A Strand / Harry Campbell / Carina King / Rakesh Lodha / Shubhada Hooli / Mark I Neuman / Vanessa Rouzier /
    Ashish Bavdekar / Nitya Wadhwa / William B MacLeod / Donald M Thea / Emmanuel Addo-Yobo / Chris A Rees / Shamim A Qazi / Rai Asghar / Imran Iqbal / Shinjini Bhatnagar / Sunit Singhi / Sudha Basnet / Valentina S Picot / Pagbajabyn Nymadawa / Cissy B Kartasasmita / Marilla Lucero / Jennifer Falconer / Yasir B Nisar / Glaucia Paranhos-Baccalà / Juan M Lozano / Salem Banajeh / Irene Maulen-Radovan / Prakash M Jeena / Clare Cutland / Marta Nunes / Joseph L Matthew / Noel Chisaka / Mumtaz Hassan / Ngoc Tuong Vy Nguyen / Monidarin Chou / Jean-William Pape

    BMJ Global Health, Vol 7, Iss

    2022  Band 4

    Schlagwörter Medicine (General) ; R5-920 ; Infectious and parasitic diseases ; RC109-216
    Sprache Englisch
    Erscheinungsdatum 2022-04-01T00:00:00Z
    Verlag BMJ Publishing Group
    Dokumenttyp Artikel ; Online
    Datenquelle BASE - Bielefeld Academic Search Engine (Lebenswissenschaftliche Auswahl)

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  6. Artikel ; Online: Predicting severe pneumonia in the emergency department

    Nicholas Watkins / Mark I Neuman / Todd Adam Florin / Daniel Joseph Tancredi / Lilliam Ambroggio / Fahd A Ahmad / Andrea Álvarez-Álvarez / Alberto Arrighini / Usha Avva / Elena Aquino Olivia / Uchechi Azubuine / Luisa Baron Gonzalez de Suso / Kelly R Bergmann / Stuart A Bradin / Kristen Breslin / Rosa María Calderón Checa / Maria Natali Campo Fernández / Carmen Campos-Calleja / Kerry Caperell /
    Pradip P Chaudhari / Jonathan Cherry / Wee-Jhong Chua / Ida Concha Murray / Thosar Deepali / Pinky-Rose Espina / Susan Fairbrother / Alexandria Farish / Daniel M Fein / Ramón Fernández Álvarez / Todd A Florin / Karen Forward / Jara Gaitero Tristán / Iker Gangoiti / Michael A Gardiner / Virginia Gómez-Barrena / Tamara Hirsch Birn / Adam Isacoff / April J Kam / Nirupama Kannikeswaran / Maria Y Kwok / Maren M Lunoe / Ryan McKee / Son H McLaren / Lianne McLean / Garth D Meckler / Erin Mills / Diana Aniela Moldovan / Andrea Mora-Capín / Viera Morales / Claudia R Morris

    BMJ Open, Vol 10, Iss

    a global study of the Pediatric Emergency Research Networks (PERN)—study protocol

    2020  Band 12

    Abstract: Introduction Pneumonia is a frequent and costly cause of emergency department (ED) visits and hospitalisations in children. There are no evidence-based, validated tools to assist physicians in management and disposition decisions for children presenting ... ...

    Abstract Introduction Pneumonia is a frequent and costly cause of emergency department (ED) visits and hospitalisations in children. There are no evidence-based, validated tools to assist physicians in management and disposition decisions for children presenting to the ED with community-acquired pneumonia (CAP). The objective of this study is to develop a clinical prediction model to accurately stratify children with CAP who are at risk for low, moderate and severe disease across a global network of EDs.Methods and analysis This study is a prospective cohort study enrolling up to 4700 children with CAP at EDs at ~80 member sites of the Pediatric Emergency Research Networks (PERN; https://pern-global.com/). We will include children aged 3 months to <14 years with a clinical diagnosis of CAP. We will exclude children with hospital admissions within 7 days prior to the study visit, hospital-acquired pneumonias or chronic complex conditions. Clinical, laboratory and imaging data from the ED visit and hospitalisations within 7 days will be collected. A follow-up telephone or text survey will be completed 7–14 days after the visit. The primary outcome is a three-tier composite of disease severity. Ordinal logistic regression, assuming a partial proportional odds specification, and recursive partitioning will be used to develop the risk stratification models.Ethics and dissemination This study will result in a clinical prediction model to accurately identify risk of severe disease on presentation to the ED. Ethics approval was obtained for all sites included in the study. Cincinnati Children’s Hospital Institutional Review Board (IRB) serves as the central IRB for most US sites. Informed consent will be obtained from all participants. Results will be disseminated through international conferences and peer-reviewed publications. This study overcomes limitations of prior pneumonia severity scores by allowing for broad generalisability of findings, which can be actively implemented after model development and validation.
    Schlagwörter Medicine ; R
    Sprache Englisch
    Erscheinungsdatum 2020-12-01T00:00:00Z
    Verlag BMJ Publishing Group
    Dokumenttyp Artikel ; Online
    Datenquelle BASE - Bielefeld Academic Search Engine (Lebenswissenschaftliche Auswahl)

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