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Article: Culturally competent care for Canadian children with 'low' neutrophil counts.

Yan, Adam P / Gruda-Sussman, Raizl

2022 Volume 28, Issue 6, Page(s) 336–337

Language	English
Publishing date	2022-12-16
Publishing country	England
Document type	Journal Article
ZDB-ID	2106767-3
ISSN	1918-1485 ; 1205-7088
ISSN (online)	1918-1485
ISSN	1205-7088
DOI	10.1093/pch/pxac114
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Article ; Online: An Algorithm to Assess Guideline Concordance of Antibiotic Choice in Community-Acquired Pneumonia.

Yarahuan, Julia K W / Kisvarday, Susannah / Kim, Eugene / Yan, Adam P / Nakamura, Mari M / Jones, Sarah B / Hron, Jonathan D

Hospital pediatrics

2024 Volume 14, Issue 2, Page(s) 137–145

Abstract: Background and objective: This study aimed to develop and evaluate an algorithm to reduce the chart review burden of improvement efforts by automatically labeling antibiotic selection as either guideline-concordant or -discordant based on electronic ... ...

Abstract	Background and objective: This study aimed to develop and evaluate an algorithm to reduce the chart review burden of improvement efforts by automatically labeling antibiotic selection as either guideline-concordant or -discordant based on electronic health record data for patients with community-acquired pneumonia (CAP). Methods: We developed a 3-part algorithm using structured and unstructured data to assess adherence to an institutional CAP clinical practice guideline. The algorithm was applied to retrospective data for patients seen with CAP from 2017 to 2019 at a tertiary children's hospital. Performance metrics included positive predictive value (precision), sensitivity (recall), and F1 score (harmonized mean), with macro-weighted averages. Two physician reviewers independently assigned "actual" labels based on manual chart review. Results: Of 1345 patients with CAP, 893 were included in the training cohort and 452 in the validation cohort. Overall, the model correctly labeled 435 of 452 (96%) patients. Of the 286 patients who met guideline inclusion criteria, 193 (68%) were labeled as having received guideline-concordant antibiotics, 48 (17%) were labeled as likely in a scenario in which deviation from the clinical practice guideline was appropriate, and 45 (16%) were given the final label of "possibly discordant, needs review." The sensitivity was 0.96, the positive predictive value was 0.97, and the F1 was 0.96. Conclusions: An automated algorithm that uses structured and unstructured electronic health record data can accurately assess the guideline concordance of antibiotic selection for CAP. This tool has the potential to improve the efficiency of improvement efforts by reducing the manual chart review needed for quality measurement.
MeSH term(s)	Child ; Humans ; Anti-Bacterial Agents/therapeutic use ; Retrospective Studies ; Guideline Adherence ; Pneumonia/drug therapy ; Community-Acquired Infections/drug therapy
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2024-01-29
Publishing country	United States
Document type	Journal Article
ISSN	2154-1671
ISSN (online)	2154-1671
DOI	10.1542/hpeds.2023-007418
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Article ; Online: Pediatric Emergency Department Sepsis Screening Tool Accuracy During the COVID-19 Pandemic.

Yan, Adam P / Zipursky, Amy R / Capraro, Andrew / Harper, Marvin / Eisenberg, Matthew

Pediatrics

2022 Volume 150, Issue 1

Abstract: Background: Automated sepsis alerts in pediatric emergency departments (EDs) can identify patients at risk for sepsis, allowing for earlier intervention with appropriate therapies. The impact of the COVID-19 pandemic on the performance of pediatric ... ...

Abstract	Background: Automated sepsis alerts in pediatric emergency departments (EDs) can identify patients at risk for sepsis, allowing for earlier intervention with appropriate therapies. The impact of the COVID-19 pandemic on the performance of pediatric sepsis alerts is unknown. Methods: We performed a retrospective cohort study of 59 335 ED visits before the pandemic and 51 990 ED visits during the pandemic in an ED with an automated sepsis alert based on systemic inflammatory response syndrome criteria. The sensitivity, specificity, negative predictive value, and positive predictive value of the sepsis algorithm were compared between the prepandemic and pandemic phases and between COVID-19-negative and COVID-19-positive patients during the pandemic phase. Results: The proportion of ED visits triggering a sepsis alert was 7.0% (n = 4180) before and 6.1% (n = 3199) during the pandemic. The number of sepsis alerts triggered per diagnosed case of hypotensive septic shock was 24 in both periods. There was no difference in the sensitivity (74.1% vs 72.5%), specificity (93.2% vs 94.0%), positive predictive value (4.1% vs 4.1%), or negative predictive value (99.9% vs 99.9%) of the sepsis alerts between these periods. The alerts had a lower sensitivity (60% vs 73.3%) and specificity (87.3% vs 94.2%) for COVID-19-positive versus COVID-19-negative patients. Conclusions: The sepsis alert algorithm evaluated in this study did not result in excess notifications and maintained adequate performance during the COVID-19 pandemic in the pediatric ED setting.
MeSH term(s)	COVID-19/diagnosis ; COVID-19/epidemiology ; Child ; Emergency Service, Hospital ; Humans ; Pandemics ; Retrospective Studies ; Sepsis/diagnosis ; Sepsis/epidemiology
Language	English
Publishing date	2022-05-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	207677-9
ISSN	1098-4275 ; 0031-4005
ISSN (online)	1098-4275
ISSN	0031-4005
DOI	10.1542/peds.2022-057492
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Article ; Online: Gender differences in adherence to COVID-19 preventative measures and preferred sources of COVID-19 information among adolescents and young adults with cancer.

Yan, Adam P / Howden, Kaitlyn / Mahar, Alyson L / Glidden, Camille / Garland, Sheila N / Oberoi, Sapna

Cancer epidemiology

2022 Volume 77, Page(s) 102098

Abstract: Background: The COVID-19 pandemic has greatly altered the behavior of adolescents and young adults (AYAs) with cancer. No data exists on how gender influences the adherence of individuals with cancer to COVID-19 related public health guidelines and ... ...

Abstract	Background: The COVID-19 pandemic has greatly altered the behavior of adolescents and young adults (AYAs) with cancer. No data exists on how gender influences the adherence of individuals with cancer to COVID-19 related public health guidelines and their preferred methods of receiving COVID-19 related information. Methods: We conducted a cross-sectional survey of adolescents and young adults with cancer. Data were summarized using descriptive statistics. Multiple logistic regression was used to assess differences in adherence to COVID-19 preventative behaviors, and differences in preferred information sources of COVID-19 related information between men and women. Results: Among 633 participants, adherence to key COVID-19 preventative measures was 44.9-58.8% for males and 53.4-68.1% for females. After adjusting for key confounding variables in multivariable analysis, males were less likely to adhere to frequent hand washing (AOR [adjusted odds ratio] 1.45, 95% CI [confidence interval] 1.03-2.03), not touching face (AOR 1.82, 95% CI 1.29-2.56) and social distancing (AOR 1.93, 95% CI 1.37-2.71) than females. Both genders preferred to receive information from their cancer institutes and social media. Discussion: Gender-specific interventions are needed to improve the adherence of males to COVID-19 precautionary measures. Information should be disseminated via cancer institutes and social media as these are the preferred sources of COVID-19 related information among AYAs with cancer.
MeSH term(s)	Adolescent ; COVID-19/epidemiology ; COVID-19/prevention & control ; Cross-Sectional Studies ; Female ; Humans ; Male ; Neoplasms/epidemiology ; Neoplasms/prevention & control ; Pandemics ; SARS-CoV-2 ; Sex Factors ; Surveys and Questionnaires ; Young Adult
Language	English
Publishing date	2022-01-06
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2508729-0
ISSN	1877-783X ; 1877-7821
ISSN (online)	1877-783X
ISSN	1877-7821
DOI	10.1016/j.canep.2022.102098
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Article: Clinical Characteristics, Treatment Considerations, and Outcomes of Infants with Rhabdomyosarcoma.

Yan, Adam P / Venkatramani, Rajkumar / Bradley, Julie A / Lautz, Timothy B / Urla, Cristian I / Merks, Johannes H M / Oberoi, Sapna

Cancers

2023 Volume 15, Issue 8

Abstract: RMS most commonly presents in children and adolescents, however a subset of tumors are diagnosed in infants under one year of age. Due to the rarity of infant RMS, utilization of different treatment approaches and goals, and small sample sizes, the ... ...

Abstract	RMS most commonly presents in children and adolescents, however a subset of tumors are diagnosed in infants under one year of age. Due to the rarity of infant RMS, utilization of different treatment approaches and goals, and small sample sizes, the published studies of infants with RMS have yielded heterogeneous results. In this review, we discuss the outcomes of infants with RMS treated in various clinical trials and the strategies that various international cooperative groups have employed to reduce the morbidity and mortality related to treatment without compromising the overall survival of this population. This review discusses the unique scenarios of diagnosing and managing congenitals or neonatal RMS, spindle cell RMS and relapsed RMS. This review concludes by exploring novel approaches to diagnosis and management of infants with RMS that are currently being studied by various international cooperative groups.
Language	English
Publishing date	2023-04-14
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15082296
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Article ; Online: Mental Disorders Among Adolescents and Young Adults With Cancer: A Canadian Population-Based and Sibling Cohort Study.

Oberoi, Sapna / Garland, Allan / Yan, Adam P / Lambert, Pascal / Xue, Lin / Decker, Kathleen / Israels, Sara J / Banerji, Shantanu / Bolton, James M / Deleemans, Julie M / Garand-Sheridan, Bronwen / Louis, Deepak / Lix, Lisa M / Mahar, Alyson L

Journal of clinical oncology : official journal of the American Society of Clinical Oncology

2024 Volume 42, Issue 13, Page(s) 1509–1519

Abstract: Purpose: To compare the cumulative incidence of mental disorders among adolescents and young adults (AYAs) diagnosed with cancer with the general population and their unaffected siblings.: Methods: A retrospective, population-based, matched cohort ... ...

Abstract	Purpose: To compare the cumulative incidence of mental disorders among adolescents and young adults (AYAs) diagnosed with cancer with the general population and their unaffected siblings. Methods: A retrospective, population-based, matched cohort design was used to investigate the impact of cancer diagnosis on mental disorders among individuals age 15-39 diagnosed between 1989 and 2019. Two cancer-free cohorts were identified: matched population-based and sibling cohorts. Outcomes included incidence of mood and anxiety disorders, substance use disorders, suicide outcomes, psychotic disorders, and any of the preceding four categories within 5 years of cancer diagnosis. Competing risk regression was used to estimate adjusted subhazard ratios (aSHR) and 95% CIs. Results: Among 3,818 AYAs with cancer matched to the population-based cancer-free cohort, individuals with cancer were more likely to be diagnosed with incident mental disorders than those without cancer; the risk was highest immediately after a cancer diagnosis and decreased over time with aSHR [95% CI] for mood and anxiety disorders at 0-6 months (11.27 [95% CI, 6.69 to 18.97]), 6-12 months (2.35 [95% CI, 1.54 to 3.58]), and 12-24 months (2.06 [95% CI, 1.55 to 2.75]); for substance use disorders at 0-6 months (2.73 [95% CI, 1.90 to 3.92]); for psychotic disorders at 0-6 months (4.69 [95% CI, 2.07 to 10.65]); and for any mental disorder at 0-6 months (4.46 [95% CI, 3.41 to 5.85]), 6-12 months (1.56 [95% CI, 1.14 to 2.14]), and 12-24 months (1.7 [95% CI, 1.36 to 2.13]) postcancer diagnosis. In sibling comparison, cancer diagnosis was associated with a higher incidence of mood and anxiety and any mental disorder during first 6 months of cancer diagnosis. Conclusion: AYAs with cancer experience a greater incidence of mental disorders after cancer diagnosis relative to population-based and sibling cohorts without cancer, primarily within first 2 years, underscoring the need to address mental health concerns during this period.
MeSH term(s)	Humans ; Neoplasms/psychology ; Neoplasms/epidemiology ; Adolescent ; Male ; Female ; Young Adult ; Siblings/psychology ; Adult ; Mental Disorders/epidemiology ; Retrospective Studies ; Canada/epidemiology ; Incidence ; Cohort Studies
Language	English
Publishing date	2024-02-09
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	604914-x
ISSN	1527-7755 ; 0732-183X
ISSN (online)	1527-7755
ISSN	0732-183X
DOI	10.1200/JCO.23.01615
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Article ; Online: Increasing COVID-19 Vaccination Rates for Children With Sickle Cell Disease.

Yan, Adam P / Archer, Natasha M / Arnold, Dianne / Hansbury, Eileen / Heeney, Matthew M / Johnson, David / Lichtman, Erica / McMullan, Heather / Morrissey, Lisa / Ilowite, Maya

Pediatrics

2023 Volume 152, Issue 4

Abstract: Background: The COVID-19 vaccine is important for children with sickle cell disease (SCD). This quality improvement project's objective was to increase the proportion of children with SCD receiving ≥2 COVID-19 vaccine doses to ≥70% by June 2022.: ... ...

Abstract	Background: The COVID-19 vaccine is important for children with sickle cell disease (SCD). This quality improvement project's objective was to increase the proportion of children with SCD receiving ≥2 COVID-19 vaccine doses to ≥70% by June 2022. Methods: We used the Model for Improvement framework. We assessed COVID-19 vaccination rates biweekly. Three plan-do-study-act cycles focusing on patient education, provider awareness, and access were performed. Process measures included the outcome of outreach calls and educational video views. Missed clinic appointments was our balancing measure. Line graphs and statistical process control charts were used to track changes. Interrupted time series was used to model implementation rates while accounting for preexisting trends. Results: A total of 243 patients were included. During the preintervention (September 2021-January 2022) and intervention periods (February 2022-June 2022), overall vaccination rates increased from 33% to 41% and 41% to 64%, respectively. Mean vaccination rate in eligible children in each 2-week period increased from 2.1% to 7.2%. The achieved vaccination rate was 11% greater than predicted for patients with SCD. For the general population the achieved vaccination rate was 23% lower than predicted. The proportion of missed visits did not change (9.0% vs. 9.6%). During outreach calls, 10 patients (13.5%) booked a vaccine. Forty percent of patients watched the promotional video. Conclusions: A significant number of patients with SCD are not vaccinated against COVID-19. Targeting misinformation and improving vaccine access aided in increasing vaccination. Additional interventions are needed as a large number of patients remain unvaccinated.
Language	English
Publishing date	2023-09-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	207677-9
ISSN	1098-4275 ; 0031-4005
ISSN (online)	1098-4275
ISSN	0031-4005
DOI	10.1542/peds.2022-061011
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Article ; Online: Loneliness among adolescents and young adults with cancer during the COVID-19 pandemic: a cross-sectional survey.

Howden, Kaitlyn / Yan, Adam P / Glidden, Camille / Romanescu, Razvan G / Scott, Ian / Deleemans, Julie M / Chalifour, Karine / Eaton, Geoff / Gupta, Abha A / Bolton, James M / Garland, Sheila N / Mahar, Alyson L / Oberoi, Sapna

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

2021 Volume 30, Issue 3, Page(s) 2215–2224

Abstract: Background: Adolescents and young adults (AYAs) diagnosed with cancer are at an increased risk of experiencing social isolation and loneliness secondary to their cancer and its treatment. The physical distancing measures implemented during the COVID-19 ... ...

Abstract	Background: Adolescents and young adults (AYAs) diagnosed with cancer are at an increased risk of experiencing social isolation and loneliness secondary to their cancer and its treatment. The physical distancing measures implemented during the COVID-19 pandemic may have further increased loneliness among this group. This study examined the prevalence of loneliness and factors associated with loneliness among AYAs with cancer during this pandemic. Methods: We conducted a self-administered, online, cross-sectional survey of Canadian AYAs diagnosed with cancer between 15 and 39 between January and February 2021. Loneliness was measured using the 3-item UCLA Loneliness Scale. Factors associated with higher levels of loneliness were identified using multiple logistic regression. Results: The analysis included 805 AYAs. The prevalence of loneliness was 52.2% [N = 419, 95% CI (confidence interval) 48.7 to 55.6%]. Individuals who were 18-25 years old [AOR (adjusted odds ratio)1.60, CI 1.03-2.47, p = 0.035], currently undergoing cancer therapy (AOR 1.46, 95% CI 1.03-2.07, p = 0.035), who self-disclosed the presence of a pre-pandemic mental health condition (AOR 2.09, 95% CI = 1.22-3.58, p = 0.007), or were not in a relationship (AOR 2.22, 95% CI 1.57-3.14, p < 0.001) were more likely to report loneliness than others. Participants that lived in rural or remote locations were less likely to experience loneliness (AOR 0.59, 95%CI 0.40-0.87, p = 0.008). Conclusion: One in two AYAs with cancer are feeling lonely during the COVID-19 pandemic. Future studies for developing interventions to target loneliness, particularly for those at greater risk, are necessary to improve the health and quality of life of AYAs with cancer.
MeSH term(s)	Adolescent ; Adult ; COVID-19 ; Canada/epidemiology ; Cross-Sectional Studies ; Humans ; Loneliness ; Neoplasms/epidemiology ; Pandemics ; Quality of Life ; SARS-CoV-2 ; Young Adult
Language	English
Publishing date	2021-10-27
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1134446-5
ISSN	1433-7339 ; 0941-4355
ISSN (online)	1433-7339
ISSN	0941-4355
DOI	10.1007/s00520-021-06628-5
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Article ; Online: COVID-19-Related Information Sources, Behavioral Changes, and Adherence to Social Distancing Among Adolescents and Young Adults with Cancer.

Yan, Adam P / Howden, Kaitlyn / Glidden, Camille / Romanescu, Razvan G / Scott, Ian / Deleemans, Julie M / Chalifour, Karine / Eaton, Geoff / Gupta, Abha A / Bolton, James M / Garland, Sheila N / Mahar, Alyson L / Oberoi, Sapna

Journal of adolescent and young adult oncology

2021 Volume 11, Issue 4, Page(s) 352–359

Abstract: Purpose: ...

Abstract	Purpose:
MeSH term(s)	Adolescent ; COVID-19/epidemiology ; COVID-19/prevention & control ; Cross-Sectional Studies ; Female ; Humans ; Male ; Neoplasms ; Pandemics ; Physical Distancing ; SARS-CoV-2 ; Surveys and Questionnaires ; Young Adult
Language	English
Publishing date	2021-10-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2607978-1
ISSN	2156-535X ; 2156-5333
ISSN (online)	2156-535X
ISSN	2156-5333
DOI	10.1089/jayao.2021.0126
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Article ; Online: Adherence to Surveillance for Second Malignant Neoplasms and Cardiac Dysfunction in Childhood Cancer Survivors: A Childhood Cancer Survivor Study.

Yan, Adam P / Chen, Yan / Henderson, Tara O / Oeffinger, Kevin C / Hudson, Melissa M / Gibson, Todd M / Neglia, Joseph P / Leisenring, Wendy M / Ness, Kirsten K / Ford, Jennifer S / Robison, Leslie L / Armstrong, Gregory T / Yasui, Yutaka / Nathan, Paul C

Journal of clinical oncology : official journal of the American Society of Clinical Oncology

2020 Volume 38, Issue 15, Page(s) 1711–1722

Abstract: Purpose: To evaluate childhood cancer survivors' adherence to surveillance protocols for late effects of treatment and to determine the factors affecting adherence.: Methods: Between 2014 and 2016, 11,337 survivors and 2,146 siblings in the Childhood ...

Abstract	Purpose: To evaluate childhood cancer survivors' adherence to surveillance protocols for late effects of treatment and to determine the factors affecting adherence. Methods: Between 2014 and 2016, 11,337 survivors and 2,146 siblings in the Childhood Cancer Survivor Study completed a survey ascertaining adherence to Children's Oncology Group (COG) guidelines for survivors at high risk for second malignant neoplasms or cardiac dysfunction and to the American Cancer Society (ACS) cancer screening guidelines for average-risk populations. Adherence rates and factors affecting adherence were analyzed. Results: Median age at diagnosis was 7 years (range, 0-20.9 years), and median time from diagnosis was 29 years (range, 15-47 years). Among high-risk survivors, adherence to COG breast, colorectal, skin, and cardiac surveillance was 12.6% (95% CI, 10.0% to 15.3%), 37.0% (34.1% to 39.9%), 22.3% (21.2% to 23.4%), and 41.4% (40.1% to 42.7%), respectively. Among average-risk survivors, adherence to ACS breast, cervical, and colorectal screening was 57.1% (53.2% to 61.0%), 83.6% (82.7% to 84.5%), and 68.5% (64.7% to 72.2%), respectively. Twenty-seven percent of survivors and 20.0% of primary care providers (PCPs) had a survivorship care plan (SCP). For high-risk survivors, SCP possession was associated with increased adherence to COG breast (22.3% Conclusion: Guideline adherence is suboptimal. Although survivor SCP possession is associated with better adherence, few survivors and PCPs have one. New strategies to improve adherence are needed.
MeSH term(s)	Adolescent ; Adult ; Cancer Survivors ; Child ; Child, Preschool ; Cohort Studies ; Female ; Heart Diseases/etiology ; Heart Diseases/pathology ; Humans ; Infant ; Infant, Newborn ; Male ; Neoplasms/complications ; Neoplasms/mortality ; Neoplasms/pathology ; Neoplasms, Second Primary/etiology ; Neoplasms, Second Primary/pathology ; Retrospective Studies ; Young Adult
Language	English
Publishing date	2020-03-06
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	604914-x
ISSN	1527-7755 ; 0732-183X
ISSN (online)	1527-7755
ISSN	0732-183X
DOI	10.1200/JCO.19.01825
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