Pediatric blood & cancer
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Pediatric blood & cancer · Feb 2012
Randomized Controlled Trial Comparative StudyLong-term complications in totally implantable venous access devices: randomized study comparing subclavian and internal jugular vein puncture.
This prospective randomized study evaluated complications related to long-term totally implantable catheters in oncologic children and adolescents by comparing venopunction performed either in the jugular or subclavian vein. ⋯ Catheters implanted by puncture in the subclavian vein were more prone to late complications than those implanted in the jugular vein.
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Pediatric blood & cancer · Feb 2012
Time-to-antibiotic administration as a quality of care measure in children with febrile neutropenia: a survey of pediatric oncology centers.
Time-to-antibiotic administration (TTA) has been suggested as a quality-of-care (QOC) measure for pediatric oncology patients with febrile neutropenia (FN). Unknown, however, is to what extent pediatric oncology centers utilize TTA. ⋯ Most reported using a benchmark of less than 60 min from arrival. TTA is a commonly used QOC measure for pediatric FN despite an absence of studies establishing its validity and a lack of data supporting its impact on outcomes of FN.
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Pediatric blood & cancer · Jan 2012
Randomized Controlled Trial Multicenter Study Comparative StudyThe utility of performing the initial lumbar puncture on day 8 in remission induction therapy for childhood acute lymphoblastic leukemia: TCCSG L99-15 study.
Traumatic lumbar puncture with leukemic blasts (TLP+), which has been reported to occur 5-10%, in the previous studies, adversely affects the outcome of children with acute lymphoblastic leukemia (ALL). Based on the results from our previous study, we deferred the initial lumbar puncture until day 8 in remission induction therapy in order to reduce the frequency of cases with TLP+. ⋯ Our strategy reduced the frequency of CNS-positive patients who required reinforcement of CNS-directed therapy without compromising overall outcome.
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Pediatric blood & cancer · Jan 2012
Thirty-day readmission rates following hospitalization for pediatric sickle cell crisis at freestanding children's hospitals: risk factors and hospital variation.
Readmission within 30 days after hospitalization for sickle cell crisis was developed by The National Association of Children's Hospitals (NACHRI) to improve hospital quality, however, there have been few studies validating this. ⋯ In a sample of free-standing children's hospitals, 17% of hospitalizations for sickle cell crisis result in readmission within 30 days. Older patients, those treated with steroids and those admitted for pain are more likely to be readmitted; simple transfusion is protective. Even after adjusting for case mix substantial hospital variation remains, but specific hospital to hospital comparisons differ depending on the exact methods used.
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Pediatric blood & cancer · Jan 2012
Sickle cell disease in California: sociodemographic predictors of emergency department utilization.
Patients with sickle cell disease (SCD) visit emergency departments (EDs) in rates leading to a significant health system burden. However, limited comprehensive evaluations of utilization patterns have been published using data connecting visits to patients across facilities. This study aims to examine sociodemographic predictors of ED utilization in SCD. ⋯ Adulthood ≥ 21 years of age, distance from comprehensive SCD care, and insurance status are significant predictors of ED utilization in SCD. As a routine source of care decreases ED utilization, these findings prompt concern that these factors act as barriers to accessing comprehensive SCD care.