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  1. Article ; Online: Rehabilitation in critically ill children

    Joongbum Cho / Hyejeong Park / Danbee Kang / Esther Park / Chi Ryang Chung / Juhee Cho / Sapna R Kudchadkar

    PLoS ONE, Vol 17, Iss 3, p e

    Findings from the Korean National Health Insurance database.

    2022  Volume 0266360

    Abstract: Purpose Intensive care unit (ICU) survivors suffer from physical weakness and challenges returning to daily life. With the importance of rehabilitating patients in the pediatric intensive care unit being increasingly recognized, we evaluated the ... ...

    Abstract Purpose Intensive care unit (ICU) survivors suffer from physical weakness and challenges returning to daily life. With the importance of rehabilitating patients in the pediatric intensive care unit being increasingly recognized, we evaluated the prevalence of physical and occupational therapy (PT/OT)-provided rehabilitation and factors affecting its use. Methods We conducted a retrospective cohort analysis of rehabilitation between 2013 and 2019 using the Korean National Health Insurance database. All patients aged 28 days to 18 years who had been admitted to 245 ICUs for more than 2 days were included. Neonatal ICUs were excluded. Results Of 13,276 patients, 2,447 (18%) received PT/OT-provided rehabilitation during their hospitalization; prevalence was lowest for patients younger than 3 years (11%). Neurologic patients were most likely to receive rehabilitation (adjusted odds ratio [aOR], 6.47; 95% confidence interval [CI], 5.11-8.20). Longer ICU stay (versus ≤ 1 week) was associated with rehabilitation (aOR for 1-2 weeks, 3.50 [95% CI, 3.04-4.03]; 2-3 weeks, 6.60 [95% CI, 5.45-8.00]; >3 weeks, 13.69 [95% CI, 11.46-16.35]). Mechanical ventilation >2 days (aOR, 0.78; 95% CI, 0.67-0.91) and hemodialysis (aOR, 0.50; 95% CI, 0.41-0.52) were negatively affecting factors. Conclusion Prevalence of rehabilitation for critically ill children was low and concentrated on patients with a prolonged ICU stay. The finding that mechanical ventilation, a risk factor for ICU-acquired weakness, was an obstacle to rehabilitation highlights the need for studies on early preventive rehabilitation based on individual patient needs.
    Keywords Medicine ; R ; Science ; Q
    Language English
    Publishing date 2022-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: The association of a scholarly concentrations program with medical students’ matched residencies

    Hosam H. Alkhatib / Mary Catherine Beach / Kelly A. Gebo / Eric B. Bass / Jenny R. Park / Meredith A. Atkinson / Sapna R. Kudchadkar / Stephen M. Sozio

    Medical Education Online, Vol 28, Iss

    2023  Volume 1

    Abstract: ABSTRACTPurpose Many medical school curricula include Scholarly Concentrations (SC) programs. While studies have examined how these programs affect students’ future research involvement, the association of SC programs with students’ specialty choices is ... ...

    Abstract ABSTRACTPurpose Many medical school curricula include Scholarly Concentrations (SC) programs. While studies have examined how these programs affect students’ future research involvement, the association of SC programs with students’ specialty choices is uncertain. This study examines the SC program factors associated with congruence between the specialty focus of students’ SC projects and the clinical specialty they matched into for residency.Methods The authors conducted a retrospective cohort study of all students participating in the SC program at Johns Hopkins University School of Medicine for graduating classes 2013–2020. They used data from program questionnaires to categorize students’ specialty interests (baseline) and SC program experiences (post-program). The authors categorized each student’s project into specialties according to their faculty mentors’ primary appointments, abstracted student publications from SCOPUS, and abstracted residency program rankings from Doximity Residency Navigator. The authors used multivariable logistic regression to calculate adjusted odds ratios (aOR) for specialty-congruent matching (same specialty as SC project) and for matching into a Doximity-ranked top 20 or top 10 program.Results Overall, 35.3% of the 771 students matched into the same specialty as their SC projects. Increased odds of specialty-congruent matching occurred with ‘definite’ interest in the specialty at baseline [aOR (95% CI): 1.76 (0.98–3.15)] (P = 0.06) and with increasing publications with SC mentors [aOR (95% CI): 1.16 (1.03–1.30)] (P = 0.01). Congruence between SC specialty focus and matched specialty conferred no significant difference in odds of matching to a Doximity-ranked top 20 or top 10 program.Conclusions Baseline certainty of specialty interest and research productivity were associated with specialty congruence. However, as completing an SC project in a given specialty was not associated with increased odds of matching into that specialty nor into a higher Doximity-ranked program, SC ...
    Keywords Scholarly concentrations ; medical student research ; specialty choice ; career choice ; curricular design ; Special aspects of education ; LC8-6691 ; Medicine (General) ; R5-920
    Subject code 005 ; 020
    Language English
    Publishing date 2023-12-01T00:00:00Z
    Publisher Taylor & Francis Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article: Effect of anesthetics on microglial activation and nanoparticle uptake: Implications for drug delivery in traumatic brain injury

    Kannan, Gokul / Sapna R. Kudchadkar / Siva P. Kambhampati

    Journal of Controlled Release. 2017,

    2017  

    Abstract: Traumatic brain injury (TBI) is a serious public health problem, often with devastating consequences for patients and their families. Affordable and timely therapies can have a substantial impact on outcomes in severe TBI. Despite the common use of ... ...

    Abstract Traumatic brain injury (TBI) is a serious public health problem, often with devastating consequences for patients and their families. Affordable and timely therapies can have a substantial impact on outcomes in severe TBI. Despite the common use of sedatives and anesthetics in the acute phase of TBI management, their effect on glial cells is not well understood. We investigated the effect of a commonly used sedative, pentobarbital, on glial cells and their uptake of nanoparticles. First, we studied how pentobarbital affects BV2 mouse microglial cells in culture. The cell morphology was imaged by confocal microscopy and analyzed. Our results suggest that microglia change to a more swollen, ‘activated’ shape with pentobarbital (cell area increased by approximately 20%, p<0.001). Such glial activation may have negative implications for the ability of the injured brain to clear edema. Second, we investigated how pentobarbital treatment affected nanoparticle uptake. BV-2 mouse microglial cells in the presence and absence of pentobarbital were treated with fluorescently-labeled, hydroxyl-functionalized poly(amidoamine) dendrimer nanoparticles (Dendrimer-Cy5). We demonstrated that the presence of pentobarbital increased the dendrimer nanoparticle uptake significantly (~2-fold both 2 and 6h following treatment). This semi-quantitative fluorescence assessment was broadly consistent among confocal image analysis, flow cytometry, and fluorescence quantification of cell-extracted dendrimer-Cy5. Although anesthetics appear to activate microglia, the increased uptake of dendrimer nanoparticles in their presence can be exploited to deliver drug-loaded nanoparticles directly to microglia after TBI. These drugs could restore glial and glymphatic function, enabling efficient drainage of waste and fluid from the brain and effectively improving recovery after TBI. A key future direction is to validate these findings in TBI models.
    Keywords anesthetics ; brain ; cell biology ; confocal microscopy ; drainage ; edema ; flow cytometry ; fluorescence ; image analysis ; mice ; models ; nanoparticles ; neuroglia ; patients ; pentobarbital ; public health ; sedatives ; wastes
    Language English
    Size p. .
    Publishing place Elsevier B.V.
    Document type Article
    Note Pre-press version
    ZDB-ID 632533-6
    ISSN 1873-4995 ; 0168-3659
    ISSN (online) 1873-4995
    ISSN 0168-3659
    DOI 10.1016/j.jconrel.2017.03.032
    Database NAL-Catalogue (AGRICOLA)

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  4. Article ; Online: Librarian integration into health care conferences

    Carrie Price / Sapna R. Kudchadkar / Pragyashree Sharma Basyal / Archana Nelliot / Madison Smith / Michael Friedman / Dale M. Needham

    Journal of the Medical Library Association, Vol 108, Iss

    a case report

    2020  Volume 2

    Abstract: Background: Health care continuing education conferences are important educational events that present opportunities for structured learning, interactive sharing, and professional networking. Conference presenters frequently cite published literature, ... ...

    Abstract Background: Health care continuing education conferences are important educational events that present opportunities for structured learning, interactive sharing, and professional networking. Conference presenters frequently cite published literature, such as clinical trials, to supply an evidence-based foundation, with presenters’ slides often shared with conference attendees. By using social media, these conferences can have greater impact, assist in supporting evidence-based clinical practice, and increase stakeholder engagement. Case Presentation: The authors present a case of embedding a health sciences librarian into the Annual Johns Hopkins Critical Care Rehabilitation Conference. The librarian served multiple roles, including social media ambassador, conference exhibitor, and presenter. We explore how these roles contributed to the field of early rehabilitation research through information dissemination and education. We also address best practices for librarian support of the conference, with a discussion of tools, platforms, and work flows that were beneficial. Conclusions: Librarian integration facilitated education about bibliographic literature database content, database searching, critical appraisal, and reporting of search methodology. Additionally, the librarian contributed to real-time distribution of scholarly literature through proficiency with web platforms, citation management programs, and social media. Librarians’ expertise in information organization and dissemination, as well as various technology platforms, make them a valuable addition to health care conferences. This article has been approved for the Medical Library Association’s Independent Reading Program.
    Keywords health care conferences ; librarians ; social media ; Bibliography. Library science. Information resources ; Z ; Medicine ; R
    Subject code 028
    Language English
    Publishing date 2020-04-01T00:00:00Z
    Publisher University Library System, University of Pittsburgh
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Study protocol for a two-center test of a nurse-implemented chronotherapeutic restoring bundle in critically ill children

    Mallory A. Perry, PhD, RN / Onella S. Dawkins-Henry, MS / Ronke E. Awojoodu, RN, MPH / Jennifer Blumenthal, MSN / Lisa A. Asaro, MS / David Wypij, PhD / Sapna R. Kudchadkar, MD, PhD / Athena F. Zuppa, MD, MSCE / Martha A.Q. Curley, PhD, RN

    Contemporary Clinical Trials Communications, Vol 23, Iss , Pp 100840- (2021)

    RESTORE Resilience (R2)

    2021  

    Abstract: Often, pediatric intensive care environments are not conducive to healing the sick. Critically ill children experience disruptions in their circadian rhythms, which can contribute to delayed recovery and poor outcomes. We aim to test the hypothesis that ... ...

    Abstract Often, pediatric intensive care environments are not conducive to healing the sick. Critically ill children experience disruptions in their circadian rhythms, which can contribute to delayed recovery and poor outcomes. We aim to test the hypothesis that children managed via RESTORE Resilience (R2), a nurse-implemented chronotherapeutic bundle, will experience restorative circadian rhythms compared to children receiving usual care. In this two-phased, prospective cohort study, two separate pediatric intensive care units in the United Sates will enroll a total of 20 baseline subjects followed by 40 intervention subjects, 6 months to less than 18 years of age, requiring invasive mechanical ventilation. During the intervention phase, we will implement the R2 bundle, which includes: (1) a focused effort to replicate the child's pre-hospitalization daily routine, (2) cycled day-night lighting and sound modulation, (3) minimal yet effective sedation (RESTORE), (4) nighttime fasting with bolus enteral daytime feedings, (5) early progressive mobility (PICU Up!), (6) continuity in nursing care, and (7) parent diaries. Our primary outcome is circadian activity ratio post-extubation. We hypothesize that children receiving R2 will experience restored circadian rhythms as evidenced by decreased nighttime activity while in the PICU. Our exploratory outcomes include salivary melatonin levels; electroencephalogram (EEG) slow-wave activity; R2 feasibility, adherence, and system barriers; levels of patient comfort; exposure to sedative medications; time to physiological stability; and parent perception of being well cared for. This paper describes the design, rationale, and implementation of R2. Clinicaltrials.gov identifier: NCT04695392.
    Keywords Pediatric critical care ; Circadian rhythm ; Mechanical ventilation ; Nurse-implemented interventions ; Medicine (General) ; R5-920
    Subject code 360
    Language English
    Publishing date 2021-09-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Implementation of the ABCDEF Bundle for Critically Ill ICU Patients During the COVID-19 Pandemic

    Keibun Liu / Kensuke Nakamura / Hajime Katsukawa / Peter Nydahl / Eugene Wesley Ely / Sapna R. Kudchadkar / Kunihiko Takahashi / Muhammed Elhadi / Mohan Gurjar / Be Kim Leong / Chi Ryang Chung / Jayachandran Balachandran / Shigeaki Inoue / Alan Kawarai Lefor / Osamu Nishida

    Frontiers in Medicine, Vol

    A Multi-National 1-Day Point Prevalence Study

    2021  Volume 8

    Abstract: Background: Data regarding delivery of evidence-based care to critically ill patients in Intensive Care Units (ICU) during the COVID-19 pandemic is crucial but lacking. This study aimed to evaluate the implementation rate of the ABCDEF bundle, which is a ...

    Abstract Background: Data regarding delivery of evidence-based care to critically ill patients in Intensive Care Units (ICU) during the COVID-19 pandemic is crucial but lacking. This study aimed to evaluate the implementation rate of the ABCDEF bundle, which is a collection of six evidence-based ICU care initiatives which are strongly recommended to be incorporated into clinical practice, and ICU diaries for patients with and without COVID-19 infections in ICUs, and to analyze the impact of COVID-19 on implementation of each element of the bundle and independent associated factors.Methods: A world-wide 1-day point prevalence study investigated the delivery of the ABCDEF bundle and ICU diary to patients without or with COVID-19 infections on 27 January 2021 via an online questionnaire. Multivariable logistic regression analysis with adjustment for patient demographics evaluated the impact of COVID-19 and identified factors in ICU administrative structures and policies independently associated with delivery.Results: From 54 countries and 135 ICUs, 1,229 patients were eligible, and 607 (49%) had COVID-19 infections. Implementation rates were: entire bundle (without COVID-19: 0% and with COVID-19: 1%), Element A (regular pain assessment: 64 and 55%), Element B (both spontaneous awakening and breathing trials: 17 and 10%), Element C (regular sedation assessment: 45 and 61%), Element D (regular delirium assessment: 39 and 35%), Element E (exercise: 22 and 25%), Element F (family engagement/empowerment: 16 and 30%), and ICU diary (17 and 21%). The presence of COVID-19 was not associated with failure to implement individual elements. Independently associated factors for each element in common between the two groups included presence of a specific written protocol, application of a target/goal, and tele-ICU management. A lower income status country and a 3:1 nurse-patient ratio were significantly associated with non-implementation of elements A, C, and D, while a lower income status country was also associated with implementation ...
    Keywords ABCDEF bundle ; COVID-19 ; ICU diary ; ICU liberation bundle ; pandemic (COVID-19) ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2021-10-01T00:00:00Z
    Publisher Frontiers Media S.A.
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: Dexmedetomidine Infusion Associated with Transient Adrenal Insufficiency in a Pediatric Patient

    Elizabeth W. Tucker / David W. Cooke / Sapna R. Kudchadkar / Sybil Ann Klaus

    Case Reports in Pediatrics, Vol

    A Case Report

    2013  Volume 2013

    Keywords Pediatrics ; RJ1-570 ; Medicine ; R ; DOAJ:Pediatrics ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
    Language English
    Publishing date 2013-01-01T00:00:00Z
    Publisher Hindawi Publishing Corporation
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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