Evaluating Epidemiologic Trends and Variations in NICU Admissions in California, 2008 to 2018.
2023; 13 (11): 976-83
Previous research suggests increasing numbers of and variation in NICU admissions. We explored whether these trends were reflected in California by examining NICU admissions and birth data in aggregate and among patient and hospital subpopulations more susceptible to variations in care.In this retrospective cohort study, we evaluated NICU utilization between 2008 and 2018 for all live births at hospitals that provide data to the California Perinatal Quality Care Collaborative. We compared hospital- and admission-level data across birth weight (BW), gestational age (GA), and illness acuity categories. Trends were analyzed by using linear regression models.We identified 472 402 inborn NICU admissions and 3 960 441 live births across 144 hospitals. Yearly trends in NICU admissions remained stable among all births and higher acuity births (mean admission rates 11.9% and 4.1%, respectively). However, analysis of the higher acuity births revealed significant increases in NICU admission rates for neonates with higher BW and GA (BW ≥ 2500g: 1.8% in 2008, 2.1% in 2018; GA ≥ 37 weeks: 1.5% in 2010, 1.8% in 2018). Kaiser hospitals had a decreasing trend of NICU admissions compared to non-Kaiser hospitals (Kaiser: 13.9% in 2008, 10.1% in 2018; non-Kaiser: 11.3% in 2008, 12.3% in 2018).Overall NICU admission rates in California were stable from 2008-2018. However, trends similar to national patterns emerged when stratified by infant GA, BW, and illness acuity as well as Kaiser or non-Kaiser hospitals, with increasing admission rates for infants born at higher BW and GA and within non-Kaiser hospitals.
View details for DOI 10.1542/hpeds.2023-007190
View details for PubMedID 37867440
View details for PubMedCentralID PMC10593864
"My Home Away From Home": Community Support for International Pediatric and Young Adult Patients and Their Families in End-of-Life Care and Bereavement.
Journal of palliative medicine
Background: Foreign national patients and families can face life-limiting illness and end-of-life care far from home; this palliative need has not been well described. Case Description: We present a case of a 20-year-old Ugandan patient diagnosed with metastatic alveolar rhabdomyosarcoma who presented to a pediatric academic medical center in California. Despite treatment, her disease progressed and she was unable to return to Uganda due to symptom burden. The patient and her family met regularly with palliative care during their hospital stay; the palliative approach included cross-cultural sharing, connecting across differences, and fostering community. The family additionally cultivated a support system within the hospital and local African communities. This was illustrated in the memory album the patient created, and in her family's extensive bereavement support. Conclusions: This case explores opportunities for individualized psychosocial care and community-based support to enhance palliative care for foreign national patients and families.
View details for DOI 10.1089/jpm.2023.0370
View details for PubMedID 37856163
- Commentary on Hippocrates: An Oath in Entering Medicine and Milestones: A Meditation on Growth. Academic medicine : journal of the Association of American Medical Colleges 2023
Cancer center-based follow-up among pediatric and adolescent/young adult cancer survivors: the role of a community-based organization and the social determinants of health.
Journal of cancer survivorship : research and practice
Adherence to survivorship care is suboptimal among pediatric and adolescent/young adult (AYA) cancer survivors. We evaluated predictors of cancer center-based follow-up among pediatric/AYA cancer survivors, with an emphasis on social determinants of health (SDOH).This retrospective cohort study used electronic health record data at an academic medical center to identify patients aged 0-29 years at last cancer treatment who completed treatment 2010-2019. Cancer center-based follow-up was defined by oncology or survivorship clinic visits through 12/31/2022. Multivariate logistic regression models (overall, ages 0-19 [pediatric], 20-29 [YA]) evaluated the association of demographics, clinical/treatment characteristics, and SDOH (insurance type, distance to cancer center, area deprivation index) with clinic attendance. Further modeling accounted for the service area of a community-based organization (CBO) that supports families of children with cancer.A total of 2210 survivors were included (56% pediatric, 44% YA; 66% non-White). Cancer center-based follow-up decreased from 94% 1-year post-treatment to 35% at > 5-7 years. In adjusted analysis, AYAs had the lowest follow-up (5-7 years post-treatment: OR 0.25 [0.15-0.41] for age 25-29; OR 0.25 [0.16-0.41] for age 20-24; OR 0.32 [0.20-0.52] for age 15-19). Survivors residing within the CBO service area were twice as likely to follow-up (OR 2.10 [1.34-3.29]).Among a diverse population, AYA survivors were vulnerable to loss to follow-up. Other SDOH were not consistently associated with follow-up. Support from a CBO may partly explain these findings.CBOs may strengthen survivorship follow-up within medically underserved communities. More research is needed to understand community support in survivorship.
View details for DOI 10.1007/s11764-023-01463-5
View details for PubMedID 37792162
View details for PubMedCentralID 6804892
Predictors of cancer center-based follow-up among pediatric and adolescent/young adult cancer survivors.
Journal of Clinical Oncology
2023; 41 (16)
View details for DOI 10.1200/JCO.2023.41.16_suppl.10055
- Safety-Net Hospitals’ Performance in Inpatient Pediatric Care in United States Pediatric Academic Societies Annual Meeting 2023
Interpersonal concerns of young adult surgical oncology patients with advanced cancer diagnoses: A mixed methods study.
Journal of Clinical Oncology
2023; 41 (16)
View details for DOI 10.1200/JCO.2023.41.16_suppl.e24225
Evaluating Care in Safety Net Hospitals: Clinical Outcomes and NICU Quality of Care in California.
The Journal of pediatrics
OBJECTIVES: To examine the characteristics of safety net (sn) and non-safety net neonatal intensive care units (NICUs) in California and whether the site of care is associated with clinical outcomes.STUDY DESIGN: This population-based retrospective cohort study of 34 snNICUs and 104 non-snNICUs included 22,081 infants born between 2014-2018 with birth weights of 401-1500g or gestational ages of 22-29 weeks. Quality of care as measured by Baby-MONITOR score and rates of survival without major morbidity were compared between snNICUs and non-snNICUs.RESULTS: Black and Hispanic infants were disproportionately cared for in snNICUs, where care and outcomes varied widely. We found no significant differences in Baby-MONITOR scores (snNICUs: z-score (SD) = -0.31 (1.3); non-snNICUs: 0.03 (1.1), P = 0.1). Among individual components, infants in snNICUs exhibited lower rates of human milk nutrition at discharge (-0.64 (1.0) vs. 0.27 (0.9)), lower rates of no healthcare associated infection (-0.27 (1.1) vs. 0.14 (0.9)) and higher rates of no hypothermia on admission (0.39 (0.7) vs. -0.25 (1.1)). We found small but significant differences in survival without major morbidity (Adjusted rate = 65.9% (63.9-67.9) for snNICUs vs. 68.3% (67.0-69.6) for non-snNICUs, p=0.02) and in some of its components; snNICUS had higher rates of necrotizing enterocolitis (3.8% (3.4-4.3) vs. 3.1% (2.8-3.4)) and mortality (7.1% (6.5-7.7) vs. 6.6% (6.2-7.0)).CONCLUSIONS: Safety net NICUs achieved similar performance to non-snNICUs in quality of care, except for small but significant differences in any human milk at discharge, infection, hypothermia, necrotizing enterocolitis, and mortality.
View details for DOI 10.1016/j.jpeds.2021.12.003
View details for PubMedID 34890584
How is mobile health technology transforming physician-nurse collaboration?
Internal medicine journal
2021; 51 (9): 1522-1525
The integration of mobile health technologies in medical practice has the potential to promote in-person, high-quality care. We examine the impact of Voalte, a healthcare-specific mobile application, on bedside rounding and care coordination. A cross-sectional survey was conducted on 71 medical ward-based nurses from a quaternary-care academic centre, capturing 183 rounding events. The frequency of physician-nurse overlap at the bedside was 50.3%, representing a >20% increase when compared with the 2018 baseline before Voalte's introduction. Our results show that mobile health technologies can strengthen inpatient medicine workflows and interdisciplinary collaboration when implemented successfully.
View details for DOI 10.1111/imj.15484
View details for PubMedID 34541771
A randomized study of a best practice alert for platelet transfusions.
BACKGROUND AND OBJECTIVES: Inappropriate platelet transfusions represent an opportunity for improvements in patient care. Use of a best practice alert (BPA) as clinical decision support (CDS) for red cell transfusions has successfully reduced unnecessary red blood cell (RBC) transfusions in prior studies. We studied the impact of a platelet transfusion BPA with visibility randomized by patient chart.MATERIALS AND METHODS: A BPA was built to introduce CDS at the time of platelet ordering in the electronic health record. Alert visibility was randomized at the patient encounter level. BPA eligible platelet transfusions for patients with both visible and non-visible alerts were recorded along with reasons given for override of the BPA. Focused interviews were performed with providers who interacted with the BPA to assess its impact on their decision making.RESULTS: Over a 9-month study period, 446 patient charts were randomized. The visible alert group used 25.3% fewer BPA eligible platelets. Mean monthly usage of platelets eligible for BPA display was 65.7 for the control group and 49.1 for the visible alert group (p=0.07). BPA-eligible platelets used per inpatient day at risk per month were not significantly different between groups (2.4 vs. 2.1, p=0.53).CONCLUSION: It is feasible to study CDS via chart-based randomization. A platelet BPA reduced total platelets used over the study period and may have resulted in $151,069 in yearly savings, although there were no differences when adjusted for inpatient days at risk. During interviews, providers offered additional workflow insights allowing further improvement of CDS for platelet transfusions.
View details for DOI 10.1111/vox.13132
View details for PubMedID 34081800
- Advancing Health Equity by Translating Lessons Learned from NICU Family Visitations During the COVID-19 Pandemic. NeoReviews 2021; 22 (1): e1–e6
Increased Stiffness Inhibits Invadopodia Formation and Cell Migration in 3D.
Cancer cells typically invade through basement membranes (BMs) at key points during metastasis, including primary tumor invasion, intravasation, and extravasation. Cells extend invadopodia protrusions to create channels in the nanoporous BM through which they can invade, either via proteolytic degradation or mechanical force. Increased matrix stiffness can promote cancer progression, and two-dimensional (2D) culture studies indicate that increased stiffness promotes invadopodia degradation activity. However, invadopodia can function mechanically, independent of their degradative activity, and cells do not form fully matured invadopodia or migrate in the direction of the invadopodia in 2D environments. Here, we elucidated the impact of matrix stiffness on the mechanical mode of invadopodia activity of cancer cells cultured in three-dimensional BM-like matrices. Invadopodia formation and cell migration assays were performed for invasive breast cancer cells cultured in mechanically plastic, nanoporous, and minimally degradable interpenetrating networks of reconstituted BM matrix and alginate, which presented a range of elastic moduli from 0.4 to 9.3kPa. Across this entire range of stiffness, we find that cells form mature invadopodia that often precede migration in the direction of the protrusion. However, at higher stiffness, cells form shorter and more transient invadopodia and are less likely to extend invadopodia overall, contrasting with results from 2D studies. Subsequently, cell migration is diminished in stiff environments. Thus, although previous studies indicate that increased stiffness may promote malignant phenotypes and the degradative activity of invadopodia, our findings show that increased stiffness physically restricts invadopodia extension and cell migration in three-dimensional, BM-like environments.
View details for DOI 10.1016/j.bpj.2020.07.003
View details for PubMedID 32697977