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Current Clinical Practices in HTCs for Identifying, Classifying and Providing Care to Hemophilia Carriers
No full textTrends in HU utilization and cerebrovascular outcomes before and after publication of the 2014 National Heart, Lung, and Blood Institute sickle cell disease guidelines.
No full textThe 2014 National Heart, Lung, and Blood Institute (NHLBI) guidelines recommend offering hydroxyurea to all patients with sickle cell disease SS/Sβ0 (SCD) aged ≥ 9 months. The relationship between early hydroxyurea initiation and the development of cerebrovascular disease (CVD) is unclear. This retrospective study describes trends in HU prescriptions and CVD outcomes in patients with SCD SS/S
Classification of Oncologic Drugs and their Potential Renal Adverse Events: suspicion, diagnosis and management
No full text
32. Outcomes of Hyperselective Neurectomy for Pediatric Upper and Lower Extremity Spasticity
No full textCan one-step reinforcement learning guide optimal timing for PEG and tracheostomy in severe TBI? Insights from a 2016-2023 retrospective cohort study at a single academic institution.
No full textBACKGROUND: Acute management of traumatic brain injury (TBI) presents several challenges in hospital resource planning. While early tracheostomy (trach) and percutaneous endoscopic gastrostomy (PEG) tube placement may improve patient outcomes, the optimal timing and selection criteria for these interventions remain unclear. This study evaluates the impact of PEG and trach timing on key clinical outcomes and applies one-step reinforcement learning (RL) to recommend intervention timing.
METHODS: This retrospective cohort study included 263 adult intensive care unit inpatients (194 men, 69 women, age range 18-87), diagnosed with severe TBI requiring trach and/or PEG between 1 January 2016 and 31 December 2023, at a single academic institution. Key outcomes included ICU and hospital length of stay (LOS), complications, time to oral feeding/decannulation, readmission, and mortality. One-step temporal difference (TD) learning and Q-learning were used to predict the expected value of interventions and to recommend optimal timing based on patient states, respectively.
RESULTS: Early PEG and trach interventions were associated with significantly shorter ICU and hospital length of stay (LOS) and fewer complications. Delayed PEG placement, however, was associated with a 67% reduction in the odds of mortality (OR: 0.33,
CONCLUSION: Early interventions are associated with improved outcomes; however, delaying PEG or trach placement may be advantageous in select situations to reduce mortality. RL techniques, such as TD and Q-learning, can aid in decision-making regarding interventions
Safety profile of intracranial neuromodulation for drug-resistant epilepsy in children.
No full textOBJECTIVE: Children with drug-resistant epilepsy (DRE) in whom resection or disconnective surgeries are not recommended can still benefit from neurostimulation. Vagus nerve stimulation (VNS) is FDA approved for those aged 4 years and older, but intracranial stimulators, that is, responsive neurostimulation (RNS) and deep brain stimulation (DBS) devices, are only approved for those aged 18 years and older. Studies in adults and early experience in children suggest that intracranial stimulation may be more effective than VNS but with higher risk. This risk has not been examined in large pediatric cohorts. This study aimed to evaluate the safety profile of RNS and DBS for pediatric DRE as well as the possible risk factors for wound-related complications.
METHODS: This retrospective study examined the records of DRE patients who underwent RNS or DBS at Children\u27s Hospital of Philadelphia from November 2017 to March 2024 with at least 6 months of follow-up. DBS electrodes were placed in the anterior or centromedian nucleus of the thalamus. RNS electrodes were placed in seizure foci.
RESULTS: A total of 54 patients, aged 6-22 years, underwent intracranial stimulator implantation for DRE (24 DBS, 30 RNS). The mean follow-up was 24.4 ± 15.3 months (median 21 months, range 6-69 months). Five (9.3%) patients returned to surgery, 3 (5.6%) of whom required explant and 1 (1.9%) of whom required explant and also had a surgical site infection (SSI). Prior craniotomy was a significant risk factor for wound-related complications (p = 0.0046 in all patients, p = 0.0375 in patients \u3c 18 years). No patient experienced hemorrhage, lead malposition, device malfunction, or long-term stimulation-induced paresthesia, depression, or memory loss. The overall responder rates, defined by achieving 50% or greater reduction in seizure frequency, were 54% in the RNS cohort and 73% in the DBS cohort at the 12-month follow-up.
CONCLUSIONS: To the best of the authors\u27 knowledge, this study represents the largest single-center series of intracranial stimulation for pediatric DRE. In comparison with established rates of SSI and explant in adults (12% and 7.0% in the RNS pivotal trial and 13% and 8.6% in the DBS SANTE [Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy] trial, respectively), the present cohort demonstrated favorable rates of 1.9% and 5.6%, respectively. Studies with larger pediatric DRE cohorts are needed with longer follow-up and seizure outcomes to elucidate the risk/benefit balance of intracranial stimulation in children