Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-8 (of 8 Records) |
Query Trace: Smith LS[original query] |
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Pulmonary and Critical Care Considerations for e-Cigarette, or Vaping, Product Use-Associated Lung Injury.
Hayes DJr , Board A , Calfee C , Ellington S , Pollack LA , Kathuria H , Eakin MN , Weissman DN , Callahan SJ , Esper AM , Crotty Alexander LE , Sharma NS , Meyer NJ , Smith LS , Novosad S , Evans ME , Goodman AB , Click ES , Robinson RT , Ewart G , Twentyman E . Chest 2022 162 (1) 256-264 BACKGROUND: In 2019, the United States experienced a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI). More than half of these patients required admission to an intensive care unit (ICU). METHODS: To synthesize information critical to pulmonary/critical care specialists in the care of patients with EVALI, we examined data available from patients hospitalized with EVALI between August 2019 and January 2020; reviewed the clinical course and critical care experience with those patients admitted to the ICU; and compiled opinion of national experts. RESULTS: Of the 2,708 confirmed or probable EVALI patients requiring hospitalization as of January 21, 2020, 1,604 (59.2%) had data available on ICU admission; of these, 705 (44.0%) were admitted to the ICU and are included in this analysis. The majority of ICU patients required respiratory support (88.5%), and in severe cases required intubation (36.1%), or extracorporeal membrane oxygenation (ECMO) (6.7%). The majority (93.0%) of these ICU patients survived to discharge. Review of the clinical course and expert opinion provided insight into: imaging; considerations for bronchoscopy; medical treatment, including use of empiric antibiotics, antivirals, and corticosteroids; respiratory support, including considerations for intubation, positioning maneuvers, and ECMO; and patient outcomes. CONCLUSIONS: Review of the clinical course of EVALI patients requiring ICU admission and compilation of expert opinion provided critical insight into pulmonary/critical care-specific considerations for this patient population. As a large proportion of patients hospitalized with EVALI required ICU admission, it is important to remain prepared to care for patients with EVALI. |
Multisystem Inflammatory Syndrome in Children - Initial Therapy and Outcomes.
Son MBF , Murray N , Friedman K , Young CC , Newhams MM , Feldstein LR , Loftis LL , Tarquinio KM , Singh AR , Heidemann SM , Soma VL , Riggs BJ , Fitzgerald JC , Kong M , Doymaz S , Giuliano JS Jr , Keenaghan MA , Hume JR , Hobbs CV , Schuster JE , Clouser KN , Hall MW , Smith LS , Horwitz SM , Schwartz SP , Irby K , Bradford TT , Maddux AB , Babbitt CJ , Rowan CM , McLaughlin GE , Yager PH , Maamari M , Mack EH , Carroll CL , Montgomery VL , Halasa NB , Cvijanovich NZ , Coates BM , Rose CE , Newburger JW , Patel MM , Randolph AG . N Engl J Med 2021 385 (1) 23-34 BACKGROUND: The assessment of real-world effectiveness of immunomodulatory medications for multisystem inflammatory syndrome in children (MIS-C) may guide therapy. METHODS: We analyzed surveillance data on inpatients younger than 21 years of age who had MIS-C and were admitted to 1 of 58 U.S. hospitals between March 15 and October 31, 2020. The effectiveness of initial immunomodulatory therapy (day 0, indicating the first day any such therapy for MIS-C was given) with intravenous immune globulin (IVIG) plus glucocorticoids, as compared with IVIG alone, was evaluated with propensity-score matching and inverse probability weighting, with adjustment for baseline MIS-C severity and demographic characteristics. The primary outcome was cardiovascular dysfunction (a composite of left ventricular dysfunction or shock resulting in the use of vasopressors) on or after day 2. Secondary outcomes included the components of the primary outcome, the receipt of adjunctive treatment (glucocorticoids in patients not already receiving glucocorticoids on day 0, a biologic, or a second dose of IVIG) on or after day 1, and persistent or recurrent fever on or after day 2. RESULTS: A total of 518 patients with MIS-C (median age, 8.7 years) received at least one immunomodulatory therapy; 75% had been previously healthy, and 9 died. In the propensity-score-matched analysis, initial treatment with IVIG plus glucocorticoids (103 patients) was associated with a lower risk of cardiovascular dysfunction on or after day 2 than IVIG alone (103 patients) (17% vs. 31%; risk ratio, 0.56; 95% confidence interval [CI], 0.34 to 0.94). The risks of the components of the composite outcome were also lower among those who received IVIG plus glucocorticoids: left ventricular dysfunction occurred in 8% and 17% of the patients, respectively (risk ratio, 0.46; 95% CI, 0.19 to 1.15), and shock resulting in vasopressor use in 13% and 24% (risk ratio, 0.54; 95% CI, 0.29 to 1.00). The use of adjunctive therapy was lower among patients who received IVIG plus glucocorticoids than among those who received IVIG alone (34% vs. 70%; risk ratio, 0.49; 95% CI, 0.36 to 0.65), but the risk of fever was unaffected (31% and 40%, respectively; risk ratio, 0.78; 95% CI, 0.53 to 1.13). The inverse-probability-weighted analysis confirmed the results of the propensity-score-matched analysis. CONCLUSIONS: Among children and adolescents with MIS-C, initial treatment with IVIG plus glucocorticoids was associated with a lower risk of new or persistent cardiovascular dysfunction than IVIG alone. (Funded by the Centers for Disease Control and Prevention.). |
Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19.
Feldstein LR , Tenforde MW , Friedman KG , Newhams M , Rose EB , Dapul H , Soma VL , Maddux AB , Mourani PM , Bowens C , Maamari M , Hall MW , Riggs BJ , Giuliano JSJr , Singh AR , Li S , Kong M , Schuster JE , McLaughlin GE , Schwartz SP , Walker TC , Loftis LL , Hobbs CV , Halasa NB , Doymaz S , Babbitt CJ , Hume JR , Gertz SJ , Irby K , Clouser KN , Cvijanovich NZ , Bradford TT , Smith LS , Heidemann SM , Zackai SP , Wellnitz K , Nofziger RA , Horwitz SM , Carroll RW , Rowan CM , Tarquinio KM , Mack EH , Fitzgerald JC , Coates BM , Jackson AM , Young CC , Son MBF , Patel MM , Newburger JW , Randolph AG . JAMA 2021 325 (11) 1074-1087 IMPORTANCE: Refinement of criteria for multisystem inflammatory syndrome in children (MIS-C) may inform efforts to improve health outcomes. OBJECTIVE: To compare clinical characteristics and outcomes of children and adolescents with MIS-C vs those with severe coronavirus disease 2019 (COVID-19). SETTING, DESIGN, AND PARTICIPANTS: Case series of 1116 patients aged younger than 21 years hospitalized between March 15 and October 31, 2020, at 66 US hospitals in 31 states. Final date of follow-up was January 5, 2021. Patients with MIS-C had fever, inflammation, multisystem involvement, and positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase-polymerase chain reaction (RT-PCR) or antibody test results or recent exposure with no alternate diagnosis. Patients with COVID-19 had positive RT-PCR test results and severe organ system involvement. EXPOSURE: SARS-CoV-2. MAIN OUTCOMES AND MEASURES: Presenting symptoms, organ system complications, laboratory biomarkers, interventions, and clinical outcomes. Multivariable regression was used to compute adjusted risk ratios (aRRs) of factors associated with MIS-C vs COVID-19. RESULTS: Of 1116 patients (median age, 9.7 years; 45% female), 539 (48%) were diagnosed with MIS-C and 577 (52%) with COVID-19. Compared with patients with COVID-19, patients with MIS-C were more likely to be 6 to 12 years old (40.8% vs 19.4%; absolute risk difference [RD], 21.4% [95% CI, 16.1%-26.7%]; aRR, 1.51 [95% CI, 1.33-1.72] vs 0-5 years) and non-Hispanic Black (32.3% vs 21.5%; RD, 10.8% [95% CI, 5.6%-16.0%]; aRR, 1.43 [95% CI, 1.17-1.76] vs White). Compared with patients with COVID-19, patients with MIS-C were more likely to have cardiorespiratory involvement (56.0% vs 8.8%; RD, 47.2% [95% CI, 42.4%-52.0%]; aRR, 2.99 [95% CI, 2.55-3.50] vs respiratory involvement), cardiovascular without respiratory involvement (10.6% vs 2.9%; RD, 7.7% [95% CI, 4.7%-10.6%]; aRR, 2.49 [95% CI, 2.05-3.02] vs respiratory involvement), and mucocutaneous without cardiorespiratory involvement (7.1% vs 2.3%; RD, 4.8% [95% CI, 2.3%-7.3%]; aRR, 2.29 [95% CI, 1.84-2.85] vs respiratory involvement). Patients with MIS-C had higher neutrophil to lymphocyte ratio (median, 6.4 vs 2.7, P < .001), higher C-reactive protein level (median, 152 mg/L vs 33 mg/L; P < .001), and lower platelet count (<150 ×103 cells/μL [212/523 {41%} vs 84/486 {17%}, P < .001]). A total of 398 patients (73.8%) with MIS-C and 253 (43.8%) with COVID-19 were admitted to the intensive care unit, and 10 (1.9%) with MIS-C and 8 (1.4%) with COVID-19 died during hospitalization. Among patients with MIS-C with reduced left ventricular systolic function (172/503, 34.2%) and coronary artery aneurysm (57/424, 13.4%), an estimated 91.0% (95% CI, 86.0%-94.7%) and 79.1% (95% CI, 67.1%-89.1%), respectively, normalized within 30 days. CONCLUSIONS AND RELEVANCE: This case series of patients with MIS-C and with COVID-19 identified patterns of clinical presentation and organ system involvement. These patterns may help differentiate between MIS-C and COVID-19. |
Multisystem Inflammatory Syndrome in U.S. Children and Adolescents.
Feldstein LR , Rose EB , Horwitz SM , Collins JP , Newhams MM , Son MBF , Newburger JW , Kleinman LC , Heidemann SM , Martin AA , Singh AR , Li S , Tarquinio KM , Jaggi P , Oster ME , Zackai SP , Gillen J , Ratner AJ , Walsh RF , Fitzgerald JC , Keenaghan MA , Alharash H , Doymaz S , Clouser KN , Giuliano JS Jr , Gupta A , Parker RM , Maddux AB , Havalad V , Ramsingh S , Bukulmez H , Bradford TT , Smith LS , Tenforde MW , Carroll CL , Riggs BJ , Gertz SJ , Daube A , Lansell A , Coronado Munoz A , Hobbs CV , Marohn KL , Halasa NB , Patel MM , Randolph AG . N Engl J Med 2020 383 (4) 334-346 BACKGROUND: Understanding the epidemiology and clinical course of multisystem inflammatory syndrome in children (MIS-C) and its temporal association with coronavirus disease 2019 (Covid-19) is important, given the clinical and public health implications of the syndrome. METHODS: We conducted targeted surveillance for MIS-C from March 15 to May 20, 2020, in pediatric health centers across the United States. The case definition included six criteria: serious illness leading to hospitalization, an age of less than 21 years, fever that lasted for at least 24 hours, laboratory evidence of inflammation, multisystem organ involvement, and evidence of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) based on reverse-transcriptase polymerase chain reaction (RT-PCR), antibody testing, or exposure to persons with Covid-19 in the past month. Clinicians abstracted the data onto standardized forms. RESULTS: We report on 186 patients with MIS-C in 26 states. The median age was 8.3 years, 115 patients (62%) were male, 135 (73%) had previously been healthy, 131 (70%) were positive for SARS-CoV-2 by RT-PCR or antibody testing, and 164 (88%) were hospitalized after April 16, 2020. Organ-system involvement included the gastrointestinal system in 171 patients (92%), cardiovascular in 149 (80%), hematologic in 142 (76%), mucocutaneous in 137 (74%), and respiratory in 131 (70%). The median duration of hospitalization was 7 days (interquartile range, 4 to 10); 148 patients (80%) received intensive care, 37 (20%) received mechanical ventilation, 90 (48%) received vasoactive support, and 4 (2%) died. Coronary-artery aneurysms (z scores >/=2.5) were documented in 15 patients (8%), and Kawasaki's disease-like features were documented in 74 (40%). Most patients (171 [92%]) had elevations in at least four biomarkers indicating inflammation. The use of immunomodulating therapies was common: intravenous immune globulin was used in 144 (77%), glucocorticoids in 91 (49%), and interleukin-6 or 1RA inhibitors in 38 (20%). CONCLUSIONS: Multisystem inflammatory syndrome in children associated with SARS-CoV-2 led to serious and life-threatening illness in previously healthy children and adolescents. (Funded by the Centers for Disease Control and Prevention.). |
A systemic approach to achieving population-level impact in injury and violence prevention
Smith LS , Wilkins NJ , McClure RJ . Syst Res Behav Sci 2020 The contemporary public health model for injury and violence prevention is a four-step process, which has been difficult to fully actualize in real-world contexts. This difficulty results from challenges in bridging science to practice and developing and applying population-level approaches. Prevention programmes and policies are embedded within and impacted by a range of system-level factors, which must be considered and actively managed when addressing complex public health challenges involving multiple sectors and stakeholders. To address these concerns, a systemic approach to population-level injury and violence prevention is being developed and explored by the Division of Analysis, Research, and Practice Integration in the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention. This article makes the case for and provides a high-level overview of this systemic approach, its various components, and how it is being applied in one governmental unit. Published 2020. This article is a U.S. Government work and is in the public domain in the USA |
Systemic approach for injury and violence prevention: what we can learn from the Harlem Children's Zone and Promise Neighborhoods
Taylor C , Schorr LB , Wilkins N , Smith LS . Inj Prev 2018 An escalating volume of injury prevention research over the past half century has dramatically increased our understanding of the risk and protective factors associated with injury and violence, and the efficacy of interventions for addressing these risk factors across the social ecology.1,2 However, this increased understanding has not resulted in widespread adoption and implementation of evidence-based and evidence-informed interventions, and countries such as the USA are still experiencing increased rates of injury and violence morbidity and mortality.3 The disassociation between our knowledge of injury causation and effectiveness of our efforts to reduce injury has been discussed in the injury prevention literature as the ‘research to practice gap’ and has focused primarily on the disconnect between evidence-based programmes and their wide-scale adoption.4 |
Mind the gap: Approaches to addressing the research-to-practice, practice-to-research chasm
Smith LS , Wilkins N . J Public Health Manag Pract 2018 24 Suppl 1 S6-s11 The 4-step public health model has been well-touted and applied as an approach toward improving population-level health.1–3 It outlines a 4-step sequential process that moves from studying a health problem epidemiologically (ie, defining the problem and identifying risk and protective factors) to empirically developing and testing effective interventions to address that problem and ending in widespread dissemination and adoption of evidence-based, effective interventions in practice and community-based settings (see the Figure).2 While public health has for the most part developed and successfully applied the first 2 steps in this model, which often take place in controlled, scientific-technical environments (eg, developing surveillance systems, etiological studies), there is a conceptual “leap of faith” that occurs between the third (development of effective interventions) and the fourth (widespread adoption) steps. Specifically, we continue to struggle as a field to ensure widespread adoption of interventions that have been studied and found to be effective—often described as the research-to-practice gap.3 There has also been concern around the “practice-to-research gap” or the relevance of research to the needs of decision makers and community stakeholders.4,5 To address this concern, there have been continuous calls for knowledge to flow from practice to the academic domain to inform more relevant research and transferrable science and ensure that important practice-based knowledge is included as evidence (or “what is known”), is valued, and disseminated.4,6,7 |
The power of academic-practitioner collaboration to enhance science and practice integration: Injury and violence prevention case studies
Smith LS , Wilkins N , Marshall SW , Dellapenna A , Pressley JC , Bauer M , South EC , Green K . J Public Health Manag Pract 2018 24 Suppl 1 S67-s74 One of the most substantial challenges facing the field of injury and violence prevention is bridging the gap between scientific knowledge and its real-world application to achieve population-level impact. Much synergy is gained when academic and practice communities collaborate; however, a number of barriers prevent better integration of science and practice. This article presents 3 examples of academic-practitioner collaborations, their approaches to working together to address injury and violence issues, and emerging indications of the impact on integrating research and practice. The examples fall along the spectrum of engagement with nonacademic partners as coinvestigators and knowledge producers. They also highlight the benefits of academic-community partnerships and the engaged scholarship model under which Centers for Disease Control and Prevention-funded Injury Control Research Centers operate to address the research-to-practice and practice-to-research gap. |
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