A5002209208- Sepsis Diagnosis and Treatment
- Respiratory Support and Mechanisms
- Clinical Reasoning and Diagnostic Skills
- Healthcare Technology and Patient Monitoring
- Patient Safety and Medication Errors
- Cardiac Arrest and Resuscitation
- Electronic Health Records Systems
- Neonatal Respiratory Health Research
- Cardiac, Anesthesia and Surgical Outcomes
- Healthcare Operations and Scheduling Optimization
- Bacterial Identification and Susceptibility Testing
- Emergency and Acute Care Studies
- Machine Learning in Healthcare
- Mechanical Circulatory Support Devices
- Anesthesia and Sedative Agents
- Heart Failure Treatment and Management
- Organ Donation and Transplantation
- Airway Management and Intubation Techniques
- Time Series Analysis and Forecasting
- Intensive Care Unit Cognitive Disorders
- Healthcare cost, quality, practices
- Streptococcal Infections and Treatments
- Artificial Intelligence in Healthcare and Education
- Hospital Admissions and Outcomes
- Organ Transplantation Techniques and Outcomes
Johns Hopkins University
2016-2025
Johns Hopkins Medicine
2015-2025
Bloomberg (United States)
2012-2024
Children's Center
2012-2024
Monroe Carell Jr. Children's Hospital
2023
Vanderbilt University
2023
Johns Hopkins Hospital
2000-2021
Johns Hopkins Children's Center
2012-2021
Johns Hopkins All Children's Hospital
2018-2019
Society for Healthcare Epidemiology of America
2019
Recent discoveries suggesting essential bioactivities of nitric oxide (NO.) in the lung are difficult to reconcile with established pulmonary cytotoxicity this common air pollutant. These conflicting observations suggest that metabolic intermediaries may exist modulate bioactivity and toxicity NO.. We report S-nitrosothiols (RS-NO), predominantly adduct glutathione, present at nano- micromolar concentrations airways normal subjects their levels vary different human pathophysiologic states....
Abstract The primary practice of healthcare artificial intelligence (AI) starts with model development, often using state-of-the-art AI, retrospectively evaluated metrics lifted from the AI literature like AUROC and DICE score. However, good performance on these may not translate to improved clinical outcomes. Instead, we argue for a better development pipeline constructed by working backward end goal positively impacting clinically relevant outcomes leading considerations causality in...
Objective To identify areas requiring the most urgent improvement in intensive care unit (ICU); and to accurately determine positive predictive value of routine critical patient monitoring alarms, as well common causes for false-positive alarms. Design Prospective, observational study. Setting A multidisciplinary ICU a university-affiliated children's hospital (excluding children with primary heart disease). Interventions The occurrence rate, cause, appropriateness all alarms from tracked...
Objective To measure and describe hospital noise determine whether can be correlated with nursing stress measured by questionnaire, salivary amylase, heart rate. Design Cohort observational study. Setting Tertiary care center pediatric intensive unit. Subjects Registered nurses working in the Interventions None. Measurements Main Results Eleven nurse volunteers were recruited. An audiogram, questionnaire data, rate collected a quiet room. Each was observed for 3-hr period during patient...
<h3>Importance</h3> Blood culture overuse in the pediatric intensive care unit (PICU) can lead to unnecessary antibiotic use and contribute resistance. Optimizing blood practices through diagnostic stewardship may reduce cultures antibiotics. <h3>Objective</h3> To evaluate association of a 14-site multidisciplinary PICU collaborative with rates, use, patient outcomes. <h3>Design, Setting, Participants</h3> This prospective quality improvement (QI) involved 14 PICUs across United States from...
Objective Extracorporeal membrane oxygenation (ECMO) has been used with increasing frequency in the treatment of acute respiratory failure pediatric patients. Our objective this study was to test hypothesis that ECMO improves outcome patients failure. Design Multicenter, retrospective cohort analysis. Setting Forty one intensive care units participated under auspices Pediatric Critical Care Study Group. Patients All admitted participating institutions during 1991 were included. congenital...
Electronic medical record systems (EMRSs) currently do not lend themselves easily to cross-institutional clinical care and research. Unique system designs coupled with a lack of standards have led this difficulty. The authors designed preliminary EMRS architecture (W3-EMRS) that exploits the multiplatform, multiprotocol, client-server technology World Wide Web. abstracts information model visual presentation away from underlying EMRS. As result, computation upon data elements their are no...
Objective To evaluate the safety and effectiveness of high-frequency oscillatory ventilation using a protocol designed to achieve maintain optimal lung volume in pediatric patients with respiratory failure. Setting Tertiary care ICU university hospital. Design A prospective, clinical study. Patients Seven aged 1 month 15 yrs diffuse alveolar disease airleak variety primary diagnoses, including pneumonia, adult distress syndrome, pulmonary hemorrhage. Interventions After varying periods...
Abstract Introduction For better or worse, the imposition of work-hour limitations on house-staff has imperiled continuity and/or improved decision-making. Regardless, workflow every physician team in academic medical centre been irrevocably altered. We explored use cognitive task analysis (CTA) techniques, most commonly used other high-stress and time-sensitive environments, to analyse key activities critical care medicine. The study objective was assess usefulness CTA as an analytical tool...
Abstract Septic shock is a life-threatening condition in which timely treatment substantially reduces mortality. Reliable identification of patients with sepsis who are at elevated risk developing septic therefore has the potential to save lives by opening an early window intervention. We hypothesize existence novel clinical state referred as “pre-shock” state, and that enter this highly likely develop some future time. apply three different machine learning techniques electronic health...
Sepsis and septic shock are common and, at times, fatal in pediatrics. Blood cultures often obtained when clinicians suspect sepsis, yet low-yield with a false-positive rate up to 50%.To determine whether novel, 2-part, clinical practice guideline could decrease the rates of total blood collected from central venous catheters critically ill children examine effect on patient outcomes.A retrospective cohort study was performed new culture practices 36-bed, combined medical/surgical pediatric...
Objective: To identify independent predictors of intracranial hemorrhage (ICH) during neonatal extracorporeal membrane oxygenation (ECMO). Study design: This retrospective cohort consisted all neonates who did not have an ICH before treatment with ECMO identified in the Extracorporeal Life Support Organization Registry from 1992 to 1995 (n = 4550). Multiple logistic regression analysis was used factors independently correlated and develop a model that could be predict risk treated ECMO....
To evaluate whether girls have better outcomes after traumatic brain injury than boys.Retrospective cohort study.University hospital.A 16,586 patient subset of the National Pediatric Trauma Registry with nonpenetrating injury.Retrospective review.The patients were subdivided by age into prepubertal (0-7 yrs), indeterminate pubertal (8-12 and probable (13-19 yrs). All analyses adjusted for severity using Injury Severity Score. Outcome variables in-hospital death rate, intensive care unit...
To understand expert and team cognition of complex patients in the pediatric intensive care unit through use cognitive task analysis.Qualitative study with semistructured interviews.Academic medical center unit.Physicians, nurses, nurse practitioners.None.Semistructured interviews were conducted members critical involved seven patients. Interviews transcribed themes identified based on grounded theory further divided into categories. A focus group refined validated findings. From interviews,...
To develop a model to produce real-time, updated forecasts of patients' intensive care unit length stay using naturally generated provider orders. The was designed be integrated within computerized decision support system improve patient flow management.Retrospective cohort study.Twenty-six bed pediatric an urban, academic children's hospital order entry system.A total 2,178 consecutive admissions during 16-month time period.We obtained measurements, time-stamped orders, age, admission...
Determine the effectiveness of a structured systems-oriented morbidity and mortality conference in improving process reviewing responding to adverse events PICU.Prospective time series analysis before after implementation conference.Single tertiary referral PICU Baltimore, MD.Thirty-three patients discussed 31 over total 20 conferences, from April 2013 March 2014.Systems-oriented incorporating elements medical incident analysis.There was significant increase meeting attendance (mean, 12 vs...
The capacity of pediatric hospitals to provide treatment large numbers patients during a large-scale disaster remains concern. Hospitals are expected function independently for as long 96 hours. Reverse triage (early discharge), strategy that creates surge bed while conserving resources, has been modeled adults but not patients.To estimate the potential reverse in an academic hospital.In this retrospective cohort study, blocked, randomized sampling scheme was used including inpatients from 7...