Julie Williamson, DO, FAAP

All Publications

• Pediatric massive transfusion protocols applied to intraoperative complications of common pediatric surgeries. Journal of pediatric surgery Miller, M. J., Josephson, C. D., Pahz, S., Santore, M., Paden, M., Williamson, J. 2022

  View details for DOI 10.1016/j.jpedsurg.2022.01.021

  View details for PubMedID 35193756

• Criteria for Critical Care Infants and Children: PICU Admission, Discharge, and Triage Practice Statement and Levels of Care Guidance PEDIATRIC CRITICAL CARE MEDICINE Frankel, L. R., Hsu, B. S., Yeh, T. S., Simone, S., Agus, M. D., Arca, M. J., Coss-Bu, J. A., Fallat, M. E., Foland, J., Gadepalli, S., Gayle, M. O., Harmon, L. A., Hill, V., Joseph, C. A., Kessel, A. D., Kissoon, N., Moss, M., Mysore, M. R., Papo, M. E., Rajzer-Wakeham, K. L., Rice, T. B., Rosenberg, D. L., Wakeham, M. K., Conway, E. E., Bernard, P. A., Bettencourt, A. P., Bishop, J. M., Carpenter, T., Castello, F. V., Czaja, A., Fayazi, A. R., Kelly, R. B., Kiragu, A. W., Lai, Y., Leonard, C., Lowrie, L. H., Markovitz, B. P., McCrory, M. C., Mehta, R., Nakagawa, T. A., Odetola, F., Parker, M. M., Paulson, T. E., Powel, V. A., Relvas, M. S., Rozenfeld, R. A., Sanders, R. C., Serrao, K., Shankar, V., Shein, S., Stockwell, D., Stryjewski, G., Vats, A., Williamson, J., Voting Panel 2019; 20 (9): 847–87

  Abstract

  To update the American Academy of Pediatrics and Society of Critical Care Medicine's 2004 Guidelines and levels of care for PICU.A task force was appointed by the American College of Critical Care Medicine to follow a standardized and systematic review of the literature using an evidence-based approach. The 2004 Admission, Discharge and Triage Guidelines served as the starting point, and searches in Medline (Ovid), Embase (Ovid), and PubMed resulted in 329 articles published from 2004 to 2016. Only 21 pediatric studies evaluating outcomes related to pediatric level of care, specialized PICU, patient volume, or personnel. Of these, 13 studies were large retrospective registry data analyses, six small single-center studies, and two multicenter survey analyses. Limited high-quality evidence was found, and therefore, a modified Delphi process was used. Liaisons from the American Academy of Pediatrics were included in the panel representing critical care, surgical, and hospital medicine expertise for the development of this practice guidance. The title was amended to "practice statement" and "guidance" because Grading of Recommendations, Assessment, Development, and Evaluation methodology was not possible in this administrative work and to align with requirements put forth by the American Academy of Pediatrics.The panel consisted of two groups: a voting group and a writing group. The panel used an iterative collaborative approach to formulate statements on the basis of the literature review and common practice of the pediatric critical care bedside experts and administrators on the task force. Statements were then formulated and presented via an online anonymous voting tool to a voting group using a three-cycle interactive forecasting Delphi method. With each cycle of voting, statements were refined on the basis of votes received and on comments. Voting was conducted between the months of January 2017 and March 2017. The consensus was deemed achieved once 80% or higher scores from the voting group were recorded on any given statement or where there was consensus upon review of comments provided by voters. The Voting Panel was required to vote in all three forecasting events for the final evaluation of the data and inclusion in this work. The writing panel developed admission recommendations by level of care on the basis of voting results.The panel voted on 30 statements, five of which were multicomponent statements addressing characteristics specific to PICU level of care including team structure, technology, education and training, academic pursuits, and indications for transfer to tertiary or quaternary PICU. Of the remaining 25 statements, 17 reached consensus cutoff score. Following a review of the Delphi results and consensus, the recommendations were written.This practice statement and level of care guidance manuscript addresses important specifications for each PICU level of care, including the team structure and resources, technology and equipment, education and training, quality metrics, admission and discharge criteria, and indications for transfer to a higher level of care. The sparse high-quality evidence led the panel to use a modified Delphi process to seek expert opinion to develop consensus-based recommendations where gaps in the evidence exist. Despite this limitation, the members of the Task Force believe that these recommendations will provide guidance to practitioners in making informed decisions regarding pediatric admission or transfer to the appropriate level of care to achieve best outcomes.

  View details for DOI 10.1097/PCC.0000000000001963

  View details for Web of Science ID 000485040200015

  View details for PubMedID 31483379

• Moving anesthesiology educational resources to the point of care: experience with a pediatric anesthesia mobile app. Korean journal of anesthesiology Monroe, K. S., Evans, M. A., Mukkamala, S. G., Williamson, J. L., Jabaley, C. S., Mariano, E. R., O'Reilly-Shah, V. N. 2018

  Abstract

  Educators in all disciplines recognize the need to update tools for the modern learner. Mobile applications (apps) may be useful, but real-time data is needed to demonstrate the patterns of utilization and engagement amongst learners.We examined the use of an anesthesia app by two groups of learners (residents and anesthesiologist assistant students [AAs]) during a pediatric anesthesiology rotation. The app calculates age and weight-based information for clinical decision support and contains didactic materials for self-directed learning. The app transmitted detailed usage information to our research team.Over a 12-month period, 39 participants consented; 30 completed primary study procedures (18 residents, 12 AAs). AAs used the app more frequently than residents (P = 0.025) but spent less time in the app (P < 0.001). The median duration of app usage was 2.3 minutes. During the course of the rotation, usage of the app decreased over time. 'Succinylcholine' was the most accessed drug, while 'orientation' was the most accessed teaching module. Ten (33%) believed that the use of apps was perceived to be distracting by operating room staff and surgeons.Real-time in-app analytics helped elucidate the actual usage of this educational resource and will guide future decisions regarding development and educational content. Further research is required to determine learners' preferred choice of device, user experience, and content in the full range of clinical and nonclinical purposes.

  View details for PubMedID 29739184

• Off-Label Use of Medications in Children Undergoing Sedation and Anesthesia ANESTHESIA AND ANALGESIA Smith, M. C., Williamson, J., Yaster, M., Boyd, G. J., Heitmiller, E. S. 2012; 115 (5): 1148-1154

  Abstract

  Many drugs used for anesthesia and analgesia in children are administered "off-label." We undertook an audit of drugs commonly used for pediatric anesthesia to determine which drugs have United States Food and Drug Administration (FDA) labeling for pediatric use, which drugs are age-restricted, and which have no labeling for pediatric use.We identified drugs administered during anesthesia to pediatric patients from the operating room pharmacy. FDA approval and indications were determined by using the Thomson Micromedex® online database. Drugs without FDA approval for pediatric use were further examined for strength of evidence and strength of recommendation for their listed indications in the database. We then examined the rate of off-label drug administration to patients younger than the age of 18 years between July 1, 2010, and August 31, 2011.One hundred six drugs were identified. Thirty-six (34%) were not FDA-labeled for use in any pediatric age group, 40 (38%) were FDA-labeled for use in all pediatric age groups, and 30 (28%) were FDA-labeled for use in only specific age groups. Drugs were administered off-label in 73.4% of cases. Of those not labeled for any pediatric age group, some were among the most commonly used drugs in pediatric anesthesia, including neostigmine, hydromorphone, and dopamine.Many drugs used for children during anesthesia continue to lack FDA labeling for pediatric use. Off-label use of these drugs is an accepted practice that is considered superior to the alternative of withholding needed medications. Studies are still needed to determine the safety and efficacy of drugs that lack FDA labeling for this vulnerable patient population.

  View details for DOI 10.1213/ANE.0b013e3182501b04

  View details for Web of Science ID 000310762100021

  View details for PubMedID 22451593