Mallikarjuna Rettiganti

Attributable Cost and Length of Stay for Central Line–Associated Bloodstream Infections

BACKGROUND AND OBJECTIVE: Central line–associated bloodstream infections (CLABSI) are common types of hospital-acquired infections associated with high morbidity. Little is known about the attributable cost and length of stay (LOS) of CLABSI in pediatric inpatient settings. We determined the cost and LOS attributable to pediatric CLABSI from 2008 through 2011. METHODS: A propensity score–matched case-control study was performed. Children <18 years with inpatient discharges in the Nationwide Inpatient Sample databases from the Healthcare Cost and Utilization Project from 2008 to 2011 were included. Discharges with CLABSI were matched to those without CLABSI by age, year, and high dimensional propensity score (obtained from a logistic regression of CLABSI status on patient characteristics and the presence or absence of 262 individual clinical classification software diagnoses). Our main outcome measures were estimated costs obtained from cost-to-charge ratios and LOS for pediatric discharges. RESULTS: The mean attributable cost and LOS between matched CLABSI cases (1339) and non-CLABSI controls (2678) was

Mobile-based asthma action plans for adolescents

55 646 (2011 dollars) and 19 days, respectively. Between 2008 and 2011, the rate of pediatric CLABSI declined from 1.08 to 0.60 per 1000 (P < .001). Estimates of mean costs of treating patients with CLABSI declined from

SGLT2 inhibitor therapy improves blood glucose but does not prevent diabetic bone disease in diabetic DBA/2J male mice

111 852 to

Risk factors for mechanical ventilation and reintubation after pediatric heart surgery

98 621 (11.8%; P < .001) over this period, but cost of treating matched non-CLABSI patients remained constant at ∼

Uncontrolled asthma and factors related to morbidity in an impoverished, rural environment

48 000. CONCLUSIONS: Despite significant improvement in rates, CLABSI remains a burden on patients, families, and payers. Continued attention to CLABSI-prevention initiatives and lower-cost CLABSI care management strategies to support high-value pediatric care delivery is warranted.

Association Between Extracorporeal Membrane Oxygenation Center Volume and Mortality Among Children With Heart Disease: Propensity and Risk Modeling.

Abstract Purpose: To examine feasibility and utilization of a mobile asthma action plan (AAP) among adolescents. Methods: Adolescents (aged 12–17 years) with persistent asthma had their personalized AAP downloaded to a smartphone application. Teens were prompted by the mobile application to record either daily symptoms or peak flow measurements and to record medications. Once data were entered, the application provided immediate feedback based on the teen’s AAP instructions. Asthma Control Test (ACT®) and child asthma self-efficacy scores were examined pre- and post-intervention. Results: Adolescents utilized the mobile AAP a median 4.3 days/week. Participant satisfaction was high with 93% stating that they were better able to control asthma by utilizing the mobile AAP. For participants with uncontrolled asthma at baseline, median (interquartile range) ACT scores improved significantly from 16 (5) to 18 (8) [p = 0.03]. Median asthma attack prevention self-efficacy scores improved from 34 (3.5) to 36 (5.3) [p = 0.04]. Conclusions: Results suggest that personalized mobile-based AAPs are a feasible method to communicate AAP instructions to teens.

Temporal discounting rates and their relation to exercise behavior in older adults.

Persons with type 1 and type 2 diabetes have increased fracture risk, attributed to deficits in the microarchitecture and strength of diabetic bone, thought to be mediated, in part, by the consequences of chronic hyperglycemia. Therefore, to examine the effects of a glucose-lowering SGLT2 inhibitor on blood glucose (BG) and bone homeostasis in a model of diabetic bone disease, male DBA/2J mice with or without streptozotocin (STZ)-induced hyperglycemia were fed chow containing the SGLT2 inhibitor, canagliflozin (CANA), or chow without drug, for 10weeks of therapy. Thereafter, serum bone biomarkers were measured, fracture resistance of cortical bone was assessed by μCT analysis and a three-point bending test of the femur, and vertebral bone strength was determined by compression testing. In the femur metaphysis and L6 vertebra, long-term diabetes (DM) induced deficits in trabecular bone microarchitecture. In the femur diaphysis, a decrease in cortical bone area, cortical thickness and minimal moment of inertia occurred in DM (p<0.0001, for all) while cortical porosity was increased (p<0.0001). These DM changes were associated with reduced fracture resistance (decreased material strength and toughness; decreased structural strength and rigidity; p<0.001 for all). Significant increases in PTH (p<0.0001), RatLAPs (p=0.0002), and urine calcium concentration (p<0.0001) were also seen in DM. Canagliflozin treatment improved BG in DM mice by ~35%, but did not improve microarchitectural parameters. Instead, in canagliflozin-treated diabetic mice, a further increase in RatLAPs was evident, possibly suggesting a drug-related intensification of bone resorption. Additionally, detrimental metaphyseal changes were noted in canagliflozin-treated control mice. Hence, diabetic bone disease was not favorably affected by canagliflozin treatment, perhaps due to insufficient glycemic improvement. Instead, in control mice, long-term exposure to SGLT2 inhibition was associated with adverse effects on the trabecular compartment of bone.

Outcomes associated with preoperative use of extracorporeal membrane oxygenation in children undergoing heart operation for congenital heart disease: a multi-institutional analysis.

OBJECTIVE To determine the prevalence of and risk factors associated with the need for mechanical ventilation in children following cardiac surgery and the need for subsequent reintubation after the initial extubation attempt. METHODS Patients younger than 18 years who underwent cardiac operations for congenital heart disease at one of the participating pediatric intensive care units (ICUs) in the Virtual PICU Systems (VPS), LLC, database were included (2009-2014). Multivariable logistic regression models were fitted to identify factors likely associated with mechanical ventilation and reintubation. RESULTS A total of 27,398 patients from 62 centers were included. Of these, 6810 patients (25%) were extubated in the operating room (OR), whereas 20,588 patients (75%) arrived intubated in the ICU. Of the patients who were extubated in the OR, 395 patients (6%) required reintubation. In contrast, 2054 patients (10%) required reintubation among the patients arriving intubated postoperatively in the ICU. In adjusted models, patient characteristics, patients undergoing high-complexity operations, and patients undergoing operations in lower-volume centers were associated with higher likelihood for the need for postoperative mechanical ventilation and need for reintubation. Furthermore, the prevalence of mechanical ventilation and reintubation was lower among the centers with a dedicated cardiac ICU in propensity-matched analysis among centers with and without a dedicated cardiac ICU. CONCLUSIONS This multicenter study suggests that proportion of patients extubated in the OR after heart operation is low. These data further suggest that extubation in the OR can be done successfully with a low complication rate.

Temporal Trends of Respiratory Syncytial Virus–associated Hospital and Icu Admissions Across the United States*

BACKGROUND Asthma disproportionately affects children living in impoverished communities; however, factors related to asthma morbidity among impoverished rural children have not been adequately described. OBJECTIVE To examine factors associated with asthma morbidity among rural children living in the Arkansas Delta region. METHODS We performed a cross-sectional investigation of 109 rural children with asthma enrolled in public schools in the Arkansas Delta region. A questionnaire format and home inspection were used to examine participant, caregiver, and home characteristics. RESULTS The median age of the study participants was 9 years, 83% were African American, and 71% had an annual household income of

Integrating Safe Sleep Practices into a Pediatric Hospital: Outcomes of a Quality Improvement Project.

20,000 or less. Ninety-eight percent of participants were insured, and most fit the criteria for uncontrolled asthma, yet only 23% reported taking inhaled corticosteroids. Transportation problems were cited by 20%. In the past 4 weeks, more than 50% reported rescue medication use or exercise limitations of 2 or more days per week or nocturnal symptoms of more than 2 nights per month. Emergency department visits in the past 6 months were reported by 28%, and 43% reported an unscheduled physicians visits for asthma in the past 3 months. Sixty-four percent had 1 or more positive allergen skin test results, and allergic sensitization was associated with exposure to dust mite, dog, mouse, and cockroach allergens in the home. CONCLUSION Asthma morbidity was high among this cohort of atopic asthmatic children in the Arkansas Delta. Overuse of rescue medications and underuse of inhaled corticosteroids were prevalent even though the population was highly insured and had frequent health care use. Future asthma health initiatives should focus on the unique challenges associated with translating national guidelines-based care to rural pediatric populations. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00590304.