Mia Lei Karamatsu

All Publications

• Association of Time to Antibiotics With Outcome in Pediatric Patients Receiving Chemotherapy for Cancer With Fever in Neutropenia-An International Individual Patient Data Meta-Analysis. Cancer medicine Salomon, A. L., Ammann, R. A., Aftandilian, C., Bochennek, K., Brack, E., Dupuis, L., Elgarten, C. W., Esbenshade, A., Haeusler, G. M., Karamatsu, M., Moenster, M. B., Phillips, B., Schaeffer, E., Sung, L., Tragiannidis, A., Vissing, N. H., Koenig, C. 2026; 15 (1): e71512

  Abstract

  Fever in neutropenia (FN) is a potentially lethal complication of chemotherapy for cancer. Prompt administration of broad-spectrum antibiotics is standard of care. Despite conflicting results on the association of time to antibiotics (TTA) with outcomes, TTA limits are used as FN quality measure both in adult and pediatric oncology. This individual patient data (IPD) meta-analysis studied the association between TTA and outcomes in pediatric patients with FN.IPD on TTA in pediatric patients with FN receiving chemotherapy for any malignancy was collected internationally. Three-level mixed binomial logistic regression analyzed the association of TTA with safety relevant events (SRE; death, admission to intensive care unit [ICU], bacteremia), primarily in patients with severe disease at presentation and secondarily in all patients.Data on 4006 FN episodes in 2073 patients, diagnosed 2016-2023, were reported from 15 study sites in eight countries. Median TTA was 61 min overall and 53 min in the 345 (8.6%) episodes with severe disease at presentation. Among these with severe disease, an SRE was reported in 119 (34%) episodes. Longer TTA (> 60 vs. ≤ 60 min) was associated with less SRE (odds ratio, 0.41; 95% CI, 0.24-0.70). This primary finding was confirmed in secondary and additional exploratory analyses.This large, international and adequately powered IPD meta-analysis found no association between shorter TTA and improved clinical outcomes in pediatric patients with FN. This finding was consistent across analyses. These results challenge the continued use of TTA limits as a quality measure for pediatric oncology centers.

  View details for DOI 10.1002/cam4.71512

  View details for PubMedID 41521162

  View details for PubMedCentralID PMC12790953

• Preparing Italian residents for global medical practice: the role of internationalization in education. Advances in simulation (London, England) Ebm, C., Smith, C., Milani, M., Karamatsu, M., Pokrajac, N., Dannenberg, B., Cecconi, M. 2025; 10 (1): 61

  Abstract

  As medical education becomes increasingly global, there is a need to prepare residents for culturally diverse clinical environments. Key questions remain about how best to define, measure, and demonstrate the achieved benefits of international education initiatives, particularly regarding intercultural competence and global adaptability for healthcare professionals. This study addresses this gap by assessing a hybrid educational model that combines international faculty mobility with simulation-based learning.We implemented the Paediatric EmergenSIMs Pathway, where visiting U.S. faculty led high-fidelity pediatric emergency simulations and culture-focused lectures, followed by debriefings. A cross-sectional mixed-methods design was used, including post-course surveys, interviews, and a separate faculty survey. Quantitative data were analyzed descriptively; qualitative data underwent thematic analysis.Thirty-five participants (70% response rate) completed the survey. Residents reported learnings of cultural awareness (M = 4.72, 95% CI [4.66–4.78]) and cultural competency (M = 4.65, 95% CI [4.54–4.75]), with slightly lower but still positive learnings in cultural sensitivity (M = 4.08, 95% CI [3.93–4.23]). Qualitative feedback confirmed that international faculty and simulations broadened cultural perspectives and fostered social skills; faculty noted mutual learning and challenges in sustaining partnerships.Integrating international faculty and simulation-based education fostered intercultural competence, reflective practice, and professional growth. The hybrid format enabled safe, experiential learning and mutual exchange. These findings highlight the need for standardized frameworks to assess intercultural learning linked to faculty mobility and to inform future global medical curricula.The online version contains supplementary material available at 10.1186/s41077-025-00394-8.

  View details for DOI 10.1186/s41077-025-00394-8

  View details for PubMedID 41291956

  View details for PubMedCentralID PMC12645667

• Parental Stress in Academic Emergency Medicine Physicians. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Diercks, D. B., Lall, M., Messman, A., O'Connell, E., Hunt, M., Karamatsu, M., Pettit, K., Courtney, D. M. 2025

  Abstract

  Recent publications have shown that women are more likely to leave emergency medicine at a younger age than men. We aim to describe the prevalence of parental stress in academic emergency medicine and its association with scheduling practices and desire to leave medicine.Blinded survey sent to eight geographically diverse academic sites. Survey included five domains: academic rank and perception of progress, child and childcare characteristics, clinical scheduling practices, plans to leave medicine, and validated psychometric measures including the Parental Stress Scale (PSS: normal population score 35-45). Likert scale responses were dichotomized as either moderate/extremely likely versus less than moderately likely/unsure. Descriptive statistics were calculated, and linear and multivariate regression analyses were performed using STATA 16.A total of 280 surveys were accessed, and 225 (80%) surveys had PSS completed. Of this cohort, there were 90 females, 123 men, 1 intersex, and 15 surveys had no sex reported. The median number of children was 2 (IQR 1-3), and the median age of the youngest child was 4 (IQR 1-9). The parental stress scale median score was 40 (IQR 35-46). There was no significant difference in the parental stress scale by sex. The number of children (B-coeff -1.88, p = 0.007), age of the youngest child (B-coeff -4.2, p = 0.000), use of daycare (B-coeff 3.8, p = 0.027), ability to preference times of shifts (day, swing, night shift) (B-coeff -2.4, p = 0.046), being a nocturnist (B-coeff 2.75, p = 0.006), and being able to completely set their own schedule in terms of days and times worked (B-coeff -2.19, p = 0.03) were associated with the PSS score. The parental stress scale was not associated with the likelihood to leave emergency medicine or leave the current job in 5 years.Academic emergency physicians had parental stress scale scores similar to the general population. Parental stress scale score was not associated with a plan to leave emergency medicine.

  View details for DOI 10.1111/acem.70145

  View details for PubMedID 40944430

• From Why to How in Physician Well-Being: Aligning Strategies for Sustainable Cultural Change in Healthcare. Rhode Island medical journal (2013) Alvarez, A., Winkel, M., Karamatsu, M. L. 2025; 108 (3): 11-15

  Abstract

  The evolution from the Triple Aim to the Quintuple Aim has highlighted physician well-being as crucial for healthcare delivery. While evidence- based interventions exist, implementing sustainable well- being initiatives remains challenging for healthcare organizations.This report demonstrates how three established business frameworks - McKinsey 7S Framework, Kotter's 8-Step Change Model, and PESTEL analysis - can be adapted to implement physician well-being initiatives in healthcare settings.These frameworks analyzed three initiatives: promoting break-taking behaviors (McKinsey 7S), transitioning from a sick-call to a back-up call system (Kotter's model), and updating Work-Family-Career Guidelines (PESTEL). Each framework provided unique insights: 7S enabled systematic organizational alignment, Kotter's model facilitated change management, and PESTEL assessed external factors influencing implementation.Adapting business frameworks to healthcare settings provides structured approaches for implementing physician well-being initiatives, demonstrating how cross-sector tools can advance the Quintuple Aim while addressing systemic drivers of burnout.

  View details for PubMedID 40009094

• Changes in community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections presenting to the pediatric emergency department: comparing 2003 to 2008. Pediatric emergency care Karamatsu, M. L., Thorp, A. W., Brown, L. 2012; 28 (2): 131-5

  Abstract

  This study aimed to compare the differences in the type and location of skin infections, organisms cultured, and antibiotic resistance patterns presenting to the same pediatric emergency department from 2003 to 2008 with specific focus on community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections.We performed a retrospective chart review of children younger than 18 years who presented to the pediatric emergency department with a skin or soft tissue infection from January 1 to December 31, 2008, and compared these data to a similar data set collected at the same institution from January 1 to December 31, 2003.From 2003 to 2008, the proportion of abscesses among all skin or soft tissue infections increased from 14% (95% confidence interval [CI], 8.4%-21.2%) to 65% (95% CI, 58.4%-70.6%). Cultures positive for MRSA increased from 21% (95% CI, 14.3%-29.0%) in 2003 to 42% (95% CI, 35.2%-47.8%) in 2008 (z score = -3.98, P < 0.001). Similar to 2003, all MRSA culture-positive abscesses were sensitive to trimethoprim-sulfamethoxazole and vancomycin in 2008. The most common anatomic location for MRSA abscesses in 2003 and 2008 was the buttocks, with a wider variation of anatomic sites in 2008 to include head/neck, trunk, and extremities.The prevalence of CA-MRSA skin infections, specifically abscesses, has significantly increased at our institution from 2003 to 2008. The antibiotic resistance patterns have not significantly changed. The most common anatomic location for CA-MRSA abscesses continues to be the buttocks, but more children are presenting with multiple abscesses in a wider variety of anatomic locations.

  View details for DOI 10.1097/PEC.0b013e318243fa36

  View details for PubMedID 22270497

• Inhibition of intra-abdominal adhesions: a comparison of hemaseel APR and cryoprecipitate fibrin glue. Journal of investigative surgery : the official journal of the Academy of Surgical Research Meek, K., de Virgilio, C., Murrell, Z., Karamatsu, M., Stabile, B., Amin, S., Sandoval, M., French, S., Pierre, K. 2001; 14 (4): 227-33

  Abstract

  Our previous studies demonstrated fibrin glue (FG) prepared from cryoprecipitate (cryo) inhibits intra-abdominal adhesions in rats. A new FG, Hemaseel APR, is Food and Drug Administration (FDA) approved for hemostasis during cardiac surgery and splenic trauma. This study was undertaken to determine if Hemaseel FG prevents intra-abdominal adhesions, and to compare it to cryo FG. Forty-five rats underwent laparotomy. Bilateral peritoneal-muscular defects were created. Polypropylene mesh was sewn into each defect with a running silk suture. The bowel was abraded with gauze. The rats were then randomized to mesh covered with Hemaseel FG, cryo FG, or control. On postoperative day 7, the severity of adhesions were graded by percentage of mesh covered by adhesion (0-100%) and degree of adhesion (0-3). The mean percentage of mesh covered by adhesion was 9% for Hemaseel FG, 43% for cryo FG (p = .005), and 65% for the controls (p < .0001). The mean density adhesion score was 0.5 for Hemaseel FG, 1.2 for cryo FG (p = .04), and 2.1 for the controls (p < .0001). In the Hemaseel FG group, 77% of patches had no adhesions, compared with 37% in the cryo FG group (p = .004) and 13% in the controls (p < .0001). Thus, Hemaseel FG significantly decreases intra-abdominal adhesions, and is more effective than cryo FG.

  View details for DOI 10.1080/089419301750420269

  View details for PubMedID 11680533