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Article ; Online: Marijuana Lollipop-Induced Myocardial Infarction.

Saunders, Alexandra / Stevenson, Robert S

2018 Volume 35, Issue 2, Page(s) 229.e1–229.e3

Abstract: A 70-year-old man with known coronary artery disease presented with crushing chest pain, diaphoresis, and pallor after consuming a marijuana lollipop; the pain began within 30 minutes of consumption. His troponin T increased from 94 ng/L to 216 ng/L, ... ...

Abstract	A 70-year-old man with known coronary artery disease presented with crushing chest pain, diaphoresis, and pallor after consuming a marijuana lollipop; the pain began within 30 minutes of consumption. His troponin T increased from 94 ng/L to 216 ng/L, with slight ST changes but no gross ST elevations. Discharge diagnosis was non-ST-elevation myocardial infarction, and subsequent nuclear medicine wall motion studies showed worsening ejection fraction (40% to 31%). He also described worsening functional status and exercise capacity after the event. The outcome of this case is important with new marijuana legalization-hopefully with marijuana use no longer criminalized, more research into the cardiovascular side effects will emerge.
MeSH term(s)	Aged ; Cannabis/adverse effects ; Electrocardiography ; Humans ; Male ; Marijuana Abuse/complications ; Non-ST Elevated Myocardial Infarction/chemically induced ; Non-ST Elevated Myocardial Infarction/diagnosis ; Troponin T/blood
Chemical Substances	Troponin T
Language	English
Publishing date	2018-12-04
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	632813-1
ISSN	1916-7075 ; 0828-282X
ISSN (online)	1916-7075
ISSN	0828-282X
DOI	10.1016/j.cjca.2018.11.033
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Article ; Online: Impairment of wound healing by reactive skin decontamination lotion (RSDL

Connolly, Jessica M / Stevenson, Robert S / Railer, Roy F / Clark, Offie E / Whitten, Kimberly A / Lee-Stubbs, Robyn B / Anderson, Dana R

Cutaneous and ocular toxicology

2020 Volume 39, Issue 2, Page(s) 143–157

Abstract: Reactive Skin Decontamination Lotion ( ... ...

Abstract	Reactive Skin Decontamination Lotion (RSDL
MeSH term(s)	Animals ; Bandages ; Chemical Warfare Agents ; Decontamination/methods ; Female ; Models, Animal ; Skin/pathology ; Skin Cream/therapeutic use ; Swine ; Swine, Miniature ; Wound Healing/drug effects
Chemical Substances	Chemical Warfare Agents
Language	English
Publishing date	2020-04-22
Publishing country	England
Document type	Journal Article
ZDB-ID	605635-0
ISSN	1556-9535 ; 1556-9527 ; 0731-3829
ISSN (online)	1556-9535
ISSN	1556-9527 ; 0731-3829
DOI	10.1080/15569527.2020.1751183
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Article ; Online: A randomized trial examining preoperative sedative medication and postoperative sleep in children.

Min, Christopher B / Kain, Zeev N / Stevenson, Robert S / Jenkins, Brooke / Fortier, Michelle A

Journal of clinical anesthesia

2016 Volume 30, Page(s) 15–20

Abstract: Study objective: Midazolam has been found to have beneficial effects on anxiety in children in the preoperative setting. Prior studies have examined various postoperative behaviors of children, but little research has examined the effects of ... ...

Abstract	Study objective: Midazolam has been found to have beneficial effects on anxiety in children in the preoperative setting. Prior studies have examined various postoperative behaviors of children, but little research has examined the effects of preoperative use of midazolam with postoperative sleep. The purpose of this investigation was to compare postoperative sleep in children as a function of preoperative sedative medication use. Design: This study was a 2-group randomized controlled trial. Setting: Participants were recruited from Yale-New Haven Children's Hospital. Patients: Participants included a convenience sample of 70 children between the ages of 3 to 12 years undergoing ambulatory tonsillectomy and adenoidectomy. Interventions: Children were randomly assigned to 1 of 2 groups: a control group who received preoperative acetaminophen only (n = 32) and an experimental group who received both acetaminophen and midazolam preoperatively (n = 38). Measurements: Parents completed measures of postoperative behavioral recovery and a subset of children wore actigraphs to examine objective sleep data. Main results: Children who received midazolam experienced similar sleep changes compared to children in the control group. The actigraph data revealed that children who received midazolam were awake significantly less during the night compared to the control group (P= .01). Conclusion: Children who received midazolam before surgery had similar postoperative sleep changes compared to children who did not receive midazolam. Further understanding of the postoperative behavioral effects of midazolam on children will help guide healthcare providers in their practice.
MeSH term(s)	Acetaminophen/administration & dosage ; Actigraphy ; Adenoidectomy/methods ; Child ; Child, Preschool ; Female ; Humans ; Hypnotics and Sedatives/administration & dosage ; Male ; Midazolam/administration & dosage ; Postoperative Period ; Preoperative Care/methods ; Sleep/drug effects ; Tonsillectomy/methods
Chemical Substances	Hypnotics and Sedatives ; Acetaminophen (362O9ITL9D) ; Midazolam (R60L0SM5BC)
Language	English
Publishing date	2016-05
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	1011618-7
ISSN	1873-4529 ; 0952-8180
ISSN (online)	1873-4529
ISSN	0952-8180
DOI	10.1016/j.jclinane.2015.11.011
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Article ; Online: An evaluation of preoperative anxiety in Spanish-speaking and Latino children in the United States.

Mamtora, Pragati H / Kain, Zeev N / Stevenson, Robert S / Golianu, Brenda / Zuk, Jeannie / Gold, Jeffrey I / Fortier, Michelle A

Paediatric anaesthesia

2018 Volume 28, Issue 8, Page(s) 719–725

Abstract: Background: There is a large body of literature examining factors associated with children's preoperative anxiety; however, cultural variables such as ethnicity and language have not been included.: Aims: The purpose of this investigation was to ... ...

Abstract	Background: There is a large body of literature examining factors associated with children's preoperative anxiety; however, cultural variables such as ethnicity and language have not been included. Aims: The purpose of this investigation was to examine the role of Latino ethnicity and Spanish-speaking families in pediatric preoperative anxiety. Methods: Participants were 294 children aged 2-15 years of age undergoing outpatient, elective tonsillectomy and/or adenoidectomy surgery and general anesthesia. Participants were recruited and categorized into 3 groups: English-speaking non-Latino White (n = 139), English-speaking Latino (n = 88), and Spanish-speaking Latino (n = 67). Children's anxiety was rated at 2 time points before surgery: the time the child entered the threshold of the operating room (Induction 1) and the time when the anesthesia mask was placed (Induction 2). Results: Results from separate linear regression models at Induction 1 and Induction 2, respectively, showed that being from a Spanish-speaking Latino family was associated with higher levels of preoperative anxiety compared with being from an English-speaking family. In addition, young age and low sociability was associated with higher preoperative anxiety in children. Conclusion: Clinicians should be aware that younger, less sociable children of Spanish-speaking Latino parents are at higher risk of developing preoperative anxiety and manage these children based on this increased risk.
MeSH term(s)	Adenoidectomy ; Adolescent ; Anesthesia, General/psychology ; Anxiety/ethnology ; Anxiety/psychology ; Child ; Child, Preschool ; Communication Barriers ; Female ; Hispanic Americans/psychology ; Humans ; Male ; Preoperative Period ; Tonsillectomy/psychology ; United States
Language	English
Publishing date	2018-07-01
Publishing country	France
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1086049-6
ISSN	1460-9592 ; 1155-5645
ISSN (online)	1460-9592
ISSN	1155-5645
DOI	10.1111/pan.13425
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Article ; Online: A comprehensive examination of the immediate recovery of children following tonsillectomy and adenoidectomy.

Lao, Bryan K / Kain, Zeev N / Khoury, Dina / Jenkins, Brooke N / Prager, Jeremy / Stevenson, Robert S / Golianu, Brenda / Zuk, Jeannie / Gold, Jeffrey I / Zhong, Qiu / Fortier, Michelle A

International journal of pediatric otorhinolaryngology

2020 Volume 135, Page(s) 110106

Abstract: Objectives: Using multiple well-validated measures and a large sample size, the goal of this paper was to describe the immediate clinical and behavioral recovery of children following tonsillectomy with or without an adenoidectomy (T&A) during the first ...

Abstract	Objectives: Using multiple well-validated measures and a large sample size, the goal of this paper was to describe the immediate clinical and behavioral recovery of children following tonsillectomy with or without an adenoidectomy (T&A) during the first two weeks following surgery. Study design: Observational, longitudinal study. Setting: Four major pediatric hospitals in the U.S. consisting of Children's Hospital of Orange County, Children's Hospital of Los Angeles, Lucile Packard Children's Hospital, and Children's Hospital Colorado. Subjects: and Methods: Participants included 827 patients between 2 and 15 years of age who underwent tonsillectomy with or without adenoidectomy surgery. Baseline and demographic information were gathered prior to surgery, and measures of clinical, behavioral, and physical recovery were recorded immediately following and up through two weeks after surgery. Results: Pain following T&A was clinically significant through the first post-operative week and nearly resolved by the end of the second week. Negative behavioral changes were highly prevalent after surgery (75.6% of children at Day 0) through the first week (63.9% at Week 1), and over 20% of children continued to evidence new onset negative behavioral changes at two weeks post-operatively. Children were rated as experiencing significant functional impairment in the immediate three days following surgery and most children returned to baseline functioning by the end of the second week. Conclusions: Results of this study suggest that children show immediate impairment in functioning and experience clinically significant pain throughout the first week following T&A, and new onset maladaptive behavioral changes persisting even up to the two-week assessment period.
MeSH term(s)	Adenoidectomy/adverse effects ; Adolescent ; Adolescent Behavior ; California ; Child ; Child Behavior ; Child, Preschool ; Colorado ; Female ; Hospitals, Pediatric ; Humans ; Longitudinal Studies ; Male ; Pain, Postoperative/epidemiology ; Postoperative Complications/epidemiology ; Postoperative Complications/psychology ; Prevalence ; Surveys and Questionnaires ; Tonsillectomy/adverse effects
Language	English
Publishing date	2020-05-11
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	754501-0
ISSN	1872-8464 ; 0165-5876
ISSN (online)	1872-8464
ISSN	0165-5876
DOI	10.1016/j.ijporl.2020.110106
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Article ; Online: The Role of Ethnicity and Acculturation in Preoperative Distress in Parents of Children Undergoing Surgery.

Stevenson, Robert S / Rosales, Alvina / Fortier, Michelle A / Campos, Belinda / Golianu, Brenda / Zuk, Jeannie / Gold, Jeffrey / Kain, Zeev N

Journal of immigrant and minority health

2017 Volume 19, Issue 3, Page(s) 738–744

Abstract: This study examined the effects of acculturation on anxiety and stress in Latino and non-Latino white parents of children undergoing outpatient surgery. Participants included 686 parent-child dyads from four major children's hospitals in the United ... ...

Abstract	This study examined the effects of acculturation on anxiety and stress in Latino and non-Latino white parents of children undergoing outpatient surgery. Participants included 686 parent-child dyads from four major children's hospitals in the United States. Latino parents who grew up in the U.S. reported higher levels of anxiety (p = 0.009) and stress (p < 0.001) compared to parents who grew up in a Latin American country. Additionally, English-speaking Latino parents reported higher anxiety and stress compared to both Spanish-speaking Latino and non-Latino white parents (p's < 0.05), whereas Spanish-speaking Latino and non-Latino white parents reported similar levels of stress and anxiety. Results of the current study were consistent with the immigrant health paradox in that more acculturated Latino parents reported higher levels of anxiety and stress than less acculturated Latino and non-Latino white parents, supporting the need for culturally tailored interventions in the perioperative environment.
Language	English
Publishing date	2017-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2220162-2
ISSN	1557-1920 ; 1557-1912
ISSN (online)	1557-1920
ISSN	1557-1912
DOI	10.1007/s10903-016-0357-7
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Article: Therapeutic hypothermia for out-of-hospital cardiac arrest: An analysis comparing cooled and not cooled groups at a Canadian center.

Maclean, D Alex / Stevenson, Robert S / Bata, Iqbal / Green, Robert S

Journal of emergencies, trauma, and shock

2012 Volume 5, Issue 4, Page(s) 328–332

Abstract: Background: Out of hospital cardiac arrest is a devastating event and is associated with poor outcomes; however, therapeutic hypothermia (TH) is a novel treatment which may improve neurological outcome and decrease mortality. Despite this, TH is not ... ...

Abstract	Background: Out of hospital cardiac arrest is a devastating event and is associated with poor outcomes; however, therapeutic hypothermia (TH) is a novel treatment which may improve neurological outcome and decrease mortality. Despite this, TH is not uniformly implemented across Coronary Care and Intensive Care Units in Canada. Objective: The purpose of this study was to compare cerebral recovery and mortality rates between patients in our Coronary Care Unit who received TH with a historical control group. Materials and methods: A retrospective chart review was performed of patients admitted to a tertiary care center with out-of-hospital cardiac arrest. Twenty patients who were admitted and cooled after December 2006 were compared with 29 noncooled patients admitted in the 5 years prior as a historical control group. The primary outcomes of interest were in-hospital mortality and neurological outcome. Results: Eleven of 20 (11/20, 55%) patients who were cooled as per protocol survived to hospital discharge, all having a good neurological outcome. Eleven of 29 (11/29, 38%) noncooled patients survived to hospital discharge (Odds Ratio: 0.50, 95% CI: 0.16- 1.60, P=0.26). Eleven of 20 patients who were cooled had a good neurological outcome (CPS I-II, 11/20, 55%), versus 7 of 29 (7/29, 24%) of noncooled patients (Odds ratio: 3.84, 95% CI: 1.13- 13.1, P=0.03). One hundred percent (11/11) of survivors in the cooled group had a good neurological outcome. Conclusion: In our center, the use of TH in out-of-hospital cardiac arrest survivors was associated with improved neurological outcome.
Language	English
Publishing date	2012-12-16
Publishing country	India
Document type	Journal Article
ZDB-ID	2461111-6
ISSN	0974-519X ; 0974-2700
ISSN (online)	0974-519X
ISSN	0974-2700
DOI	10.4103/0974-2700.102403
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Article ; Online: Children and their parents' assessment of postoperative surgical pain: Agree or disagree?

Kaminsky, Olivia / Fortier, Michelle A / Jenkins, Brooke N / Stevenson, Robert S / Gold, Jeffrey I / Zuk, Jeannie / Golianu, Brenda / Kaplan, Sherrie H / Kain, Zeev N

International journal of pediatric otorhinolaryngology

2019 Volume 123, Page(s) 84–92

Abstract: Objective: The purpose of this study is to compare postoperative pain scores between children undergoing tonsillectomy and adenoidectomy (T&A) surgery and their parents, identify potential predictors for this disagreement, and determine possible impact ... ...

Abstract	Objective: The purpose of this study is to compare postoperative pain scores between children undergoing tonsillectomy and adenoidectomy (T&A) surgery and their parents, identify potential predictors for this disagreement, and determine possible impact on analgesic administration. Methods: This is a prospective longitudinal study conducted with children undergoing outpatient T&A in 4 major tertiary hospitals and their parents. Children and their parents were enrolled prior to surgery and completed baseline psychological instruments assessing parental anxiety (STAI), parental coping style (MBSS), child temperament (EAS) and parental medication administration attitude questionnaire (MAQ). Postoperatively, parents and children completed at-home pain severity ratings (Faces Pain Scale-Revised, children; Numeric Rating Scale, parents) on postoperative recovery days 1, 2, and 3, reflecting an overall pain level for the past 24 h. Parents also completed a log of analgesic administration. Based on postoperative pain scores, parent-child dyads were classified as overestimators (i.e., parents rated their child's pain higher than children rated their own pain), in agreement (i.e., rating in agreement), or underestimators (i.e., parents rated their child's pain lower than children rated their own pain). Results: A significant proportion of parent-child pairs disagreed on pain ratings on postoperative days 1-3 (30.05%-35.95%). Of those pairs in disagreement, the majority of parents overestimated their child's pain on all three postoperative days, specifically such that a total of 24-26% parents overestimated their child's pain on postoperative days 1, 2, and 3. Repeated measures ANOVA demonstrated that parents in the overestimator group administered higher, though still within safe limits, amounts of ibuprofen and oxycodone (mg/day) than did the underestimator or agreement groups. Multiple regression models showed hospital site as the only independent predictor for postoperative pain rating disagreement between children and parents. Conclusions: Since parents overestimate their child's postoperative pain and may administer more analgesics to their child, it is essential to develop a standardized method of child pain assessment and a tailored recommended postoperative analgesic regimen amongst medical providers for children undergoing T&A.
MeSH term(s)	Acetaminophen/administration & dosage ; Adenoidectomy/adverse effects ; Adolescent ; Analgesics/administration & dosage ; Child ; Child, Preschool ; Female ; Humans ; Longitudinal Studies ; Male ; Pain Measurement ; Pain, Postoperative/drug therapy ; Pain, Postoperative/etiology ; Parents/psychology ; Prospective Studies ; Surveys and Questionnaires ; Tonsillectomy/adverse effects
Chemical Substances	Analgesics ; Acetaminophen (362O9ITL9D)
Language	English
Publishing date	2019-05-02
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	754501-0
ISSN	1872-8464 ; 0165-5876
ISSN (online)	1872-8464
ISSN	0165-5876
DOI	10.1016/j.ijporl.2019.04.005
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Article ; Online: Parental satisfaction of child's perioperative care.

Shafer, Jonathan S / Jenkins, Brooke N / Fortier, Michelle A / Stevenson, Robert S / Hikita, Natasha / Zuk, Jeannie / Gold, Jeffrey I / Golianu, Brenda / Kaplan, Sherrie H / Mayes, Linda / Kain, Zeev N

Paediatric anaesthesia

2018 Volume 28, Issue 11, Page(s) 955–962

Abstract: Background: Satisfaction in the hospital setting is an important component of both hospital funding and patient experience. When it comes to a child's hospital experience, parent satisfaction of their child's perioperative care is also necessary to ... ...

Abstract	Background: Satisfaction in the hospital setting is an important component of both hospital funding and patient experience. When it comes to a child's hospital experience, parent satisfaction of their child's perioperative care is also necessary to understand. However, little research has been conducted on the predictors of this outcome. Therefore, the purpose of this current study was to validate a priori selected predictors for parental satisfaction in their child's perioperative process. Methods: Eight hundred and ten pediatric patients who underwent tonsillectomy and adenoidectomy surgery and their parents were included in this study. The primary outcome was assessed using a 21-item parent satisfaction questionnaire resulting in three satisfaction scores: overall care satisfaction, OR/induction satisfaction, and total satisfaction. Results: Descriptive statistics and correlational analysis found that sedative-premedication, parental presence at anesthesia induction, child social functioning, parental anxiety, and language were all significant predictors of various components of the satisfaction score. Regression models, however, revealed that only parent anxiety and child social functioning remained significant predictors such that parents who reported lower state anxiety (OR/induction satisfaction: OR = 0.975, 95% CI [0.957, 0.994]; total satisfaction: OR = 0.968, 95% CI [0.943, 0.993]) and who had higher socially functioning children (overall care satisfaction: OR = 1.019, 95% CI [1.005, 1.033]; OR/induction satisfaction: OR = 1.011, 95% CI [1.000, 1.022]) were significantly more satisfied with the perioperative care they received. Conclusion: Lower parent anxiety and higher child social functioning were predictive of higher parental satisfaction scores.
MeSH term(s)	Anxiety/psychology ; Child ; Child, Preschool ; Female ; Humans ; Hypnosis, Anesthetic/psychology ; Male ; Parents/psychology ; Patient Satisfaction ; Perioperative Care/psychology
Language	English
Publishing date	2018-10-30
Publishing country	France
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1086049-6
ISSN	1460-9592 ; 1155-5645
ISSN (online)	1460-9592
ISSN	1155-5645
DOI	10.1111/pan.13496
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Article ; Online: Revisiting a measure of child postoperative recovery: development of the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery.

Jenkins, Brooke N / Kain, Zeev N / Kaplan, Sherrie H / Stevenson, Robert S / Mayes, Linda C / Guadarrama, Josue / Fortier, Michelle A

Paediatric anaesthesia

2015 Volume 25, Issue 7, Page(s) 738–745

Abstract: Background: The Post Hospitalization Behavior Questionnaire (PHBQ) was designed for assessing children's posthospitalization and postoperative new-onset behavioral changes. However, the psychometric properties of the scale have not been re-evaluated in ... ...

Abstract	Background: The Post Hospitalization Behavior Questionnaire (PHBQ) was designed for assessing children's posthospitalization and postoperative new-onset behavioral changes. However, the psychometric properties of the scale have not been re-evaluated in the past five decades despite substantial changes in the practice of surgery and anesthesia. In this investigation, we examined the psychometric properties of the PHBQ to potentially increase the efficacy and relevance of the instrument in current perioperative settings. Method: This study used principal components analysis, a panel of experts, Cronbach's alpha, and correlations to examine the current subscale structure of the PHBQ and eliminate items to create the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS). Data from previous investigations (N = 1064, Mage = 5.88) which utilized the PHBQ were combined for the purposes of this paper. Results: A principal components analysis revealed that the original subscale structure of the PHBQ could not be replicated. Subsequently, a battery reduction, which utilized principal components analysis and a panel of experts, was used to eliminate the subscale structure of the scale and reduce the number of items from 27 to 11, creating the PHBQ-AS. The PHBQ-AS demonstrated good internal consistency reliability and concurrent validity with another measure of children's psychosocial and physical functioning. Conclusion: Revising the former subscale structure and reducing the number of items in the PHBQ to create the PHBQ-AS may provide a means for reducing the burden of postoperative behavioral assessment through decreasing time of administration and eliminating redundancy of items and allow for more accurate measurement of child postoperative behavioral changes.
MeSH term(s)	Ambulatory Surgical Procedures/psychology ; Ambulatory Surgical Procedures/statistics & numerical data ; Anesthesia/psychology ; Anesthesia/statistics & numerical data ; Child Behavior/psychology ; Child, Preschool ; Female ; Hospitalization/statistics & numerical data ; Humans ; Male ; Postoperative Period ; Principal Component Analysis ; Psychometrics ; Reproducibility of Results ; Surveys and Questionnaires/standards
Language	English
Publishing date	2015-07
Publishing country	France
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1086049-6
ISSN	1460-9592 ; 1155-5645
ISSN (online)	1460-9592
ISSN	1155-5645
DOI	10.1111/pan.12678
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