Miller Children Research Articles

Isolated abnormal FEF75% detects unsuspected bronchiolar obstruction in CF children.

Physiologic detection of bronchiolar obstruction in children with cystic fibrosis (CF) may be clinically unsuspected because of normal routine spirometry despite bronchiectasis on lung CT. Children from two accredited CF facilities had spirometry obtained every 3 months when clinically stable. Pre-bronchodilator maximum expiratory flow volume curves were retrospectively analyzed over 16 years to detect an isolated abnormal FEF75%, despite normal routine spirometry. At Miller Children's and Women's Hospital (MCWH), an abnormal FEF75% was initially detected in 26 CF children at age 7.5 ± 4 (SD) years despite normal routine spirometry initially. FEF75% remained an isolated abnormality for 2.5 ± 1.5 years after it was initially detected in these 26 CF children. At Cohen Children's Medical Center (CCMC), despite normal routine spirometry initially, abnormal FEF75% occurred in 13 children at age 11.7 ± 4.5 years, and abnormal FEF25-75% in 10 children at age 11.8 ± 5.3 years. FEF75% was most sensitive spirometric test for diagnosing both early and isolated progressive bronchiolar obstruction. Data from CCMC in older children demonstrated the simultaneous detection of abnormal FEF75% and FEF25-75% values consistent with greater bronchiolar obstruction when serial spirometry was initiated at an older age. There is very little published spirometric data regarding diagnosis of isolated small airways obstruction in CF children. FEF75% can easily detect unsuspected small airways obstruction in CF children with normal routine spirometry and bronchiectasis on lung CT and optimize targeted modulatory therapies.

623: VITAMIN C DEFICIENCY IN CRITICALLY ILL CHILDREN

1MemorialCare Miller Childrens Hospital and Womens Hospital Long Beach, Palos Verdes Estates, CA 2Memorial Care - Miller Children’s & Women’s Hospital of Long Beach 3University of West Viginia

Abstract A013: Parental health communication and satisfaction with medical providers of childhood cancer survivors: Differences by race/ethnicity and language

Abstract Purpose: Among childhood cancer survivors (CCS), parents inherently take on the role of informal caregivers. Effective communication between patient and provider or caregiver contributes to better treatment decision making and patient health outcomes. However, few studies have examined the frequency and scope of communication among childhood cancer survivors, caregivers, and medical providers. The purpose of this study was to examine the association between Hispanic ethnicity and language spoken with communication and satisfaction with their CCS health care provider. We hypothesized that Spanish-speaking Hispanic parents would have more barriers with provider communication and would be less satisfied with medical providers than English-speaking Hispanics and non-Hispanic parents. We also hypothesized that Spanish-speaking Hispanic parents would have greater communication with their child about their diagnosis. Methods: We analyzed data from parents of CCS, who were selected from the Los Angeles Cancer Surveillance Program and had been diagnosed between 2000 and 2007 at Children's Hospital Los Angeles (CHLA) or Miller Children's Hospital, Long Beach. We used ANOVA and chi-square statistics to test for differences in demographic characteristics. Results: A total of 173 parents participated in this study, including 50 Spanish-speaking Hispanics, 49 English-speaking Hispanics, and 74 English-speaking non-Hispanics. Spanish-speaking Hispanics were younger, had less than high school education, were lower income, and were less likely to have health care coverage compared to English-speaking Hispanics and non-Hispanic parents. Spanish-speaking Hispanic parents were more likely to report talking to their child about his/her needs for cancer-related follow-up care (p<.001) and health insurance issues (p=.01). Regardless of language spoken, Hispanic parents were more likely to receive health information about their child's cancer from hospital sources. Spanish-speaking Hispanic parents were more likely than English-speaking Hispanics and non-Hispanic parents to report difficulties with written information (p=.02) and understanding doctors due to language barriers (p=.003). However, there was no statistically significant difference by ethnicity/language in parent satisfaction with their child's health care provider or in receiving a survivorship care plan. Conclusion: Despite reporting similar rates of satisfaction with CCS medical providers, Spanish-speaking parents were more likely to report communication barriers with providers. Nevertheless, in order to build sustainable relationships with providers, language barriers need to be addressed to improve communication effectiveness. In future studies, we will explore the role of parent-child and parent-provider communication on their health outcomes. Citation Format: Carol Y. Ochoa, Lourdes Baezconde-Garbanati, Joel Milam. Parental health communication and satisfaction with medical providers of childhood cancer survivors: Differences by race/ethnicity and language [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A013.

Cystic fibrosis patients at risk for disease progression marked by decline in FEV1% predicted: development of the cystic fibrosis risk of disease progression score.

Cystic fibrosis (CF) is one of the most common recessively inherited disorders diagnosed in early childhood in the United States. Determining the phenotype of CF patients likely to experience a significant drop in FEV1% predicted will help target efforts for mitigating this deleterious disorder. This retrospective cohort study evaluated potential risk variables that account for the decline in FEV1% predicted in 81 CF patients treated at Miller Children's and Women's Hospital, CA. Cystic fibrosis risk of disease progression (CF RD-Pro) score was evaluated as a tool to identify high-risk patients for accelerated disease progression (event = drop in FEV1% predicted ≥10 percentage points) based on risk variables identified as significant. ROC analysis determined classification of high versus low-moderate risk of FEV1% decline during year two based on RD-Pro score. Scores ≥2 applied as threshold for high-risk revealed relatively good validity estimates: sensitivity =82.8%, specificity =66.7%, PVP =77.4%, PVN =73.7%, and correct classification =76%. Patients with CF RD-Pro scores suggestive of high (≥2 points) vs. low-moderate (<2 points) risk were nearly 10 times more likely to experience significant disease progression (OR 9.6, 95% CI, 2.6-36.1, P=0.001). Identification of patients at high risk for significant decline in lung function will enable address of potential therapeutic modalities, environmental exposures, and behavioral variants that may improve outcomes in these patients. The power of the CF RD-Pro Score lies in its simplicity. Our study provides a novel readily available score, which incorporates body mass index (BMI) and Staphylococcus aureus infection, both being alterable targets for slowing CF progression.

Allergy Evaluation During Hospitalized Asthma Improves Disease Management Outcomes

Hospitalization for asthma exacerbation is significantly related to overall poor asthma control. The study aimed to contrast post-hospitalization outcomes of those asthmatics who underwent serologic specific IgE (sIgE) testing for regional environmental allergens to an untested cohort. Of 8061 asthma encounters, 273 subjects who met the criteria were included in this retrospective cohort study. Those asthmatics identified with persistent disease were hospitalized at Miller Children’s Hospital during the period June 2008–October 2015. A total of 207 patients underwent sIgE testing during initial hospitalization for asthma and 66 were not tested. The Cox regression analysis assessed time from discharge to first emergency room (ER) visit, required systemic steroids, and next hospitalization in sIgE vs. non-tested groups, stratified by severity (mild or moderate-severe) and adjusted for age (≥ 12 or < 12), gender, and race. Serum allergy evaluation by sIgE testing reduced the hazard of an ER visit and systemic corticosteroids requirement by half in mild asthmatics (p < 0.05). The average time to next ER visit was almost 1 year in the allergy-tested group compared to < 6 months in the no-test group. Blood-based allergy evaluation as part of inpatient asthma treatment was shown to improve disease management specifically in time to next ER and/or exacerbation and systemic corticosteroids requirement in patients with mild disease. In more severe adolescent asthmatics, sIgE testing appeared protective against future hospitalization. Inpatient serologic testing may be beneficial in raising alertness in the asthma population, deploying early comprehensive care and lowering the rate of hospitalization.

Pharmacy Dashboard: An Innovative Process for Pharmacy Workload and Productivity

Background: Innovative approaches, including LEAN systems and dashboards, to enhance pharmacy production continue to evolve in a cost and safety conscious health care environment. Furthermore, implementing and evaluating the effectiveness of these novel methods continues to be challenging for pharmacies. Objective: To describe a comprehensive, real-time pharmacy dashboard that incorporated LEAN methodologies and evaluate its utilization in an inpatient Central Intravenous Additives Services (CIVAS) pharmacy. Methods: Long Beach Memorial Hospital (462 adult beds) and Miller Children's and Women's Hospital of Long Beach (combined 324 beds) are tertiary not-for-profit, community-based hospitals that are served by one CIVAS pharmacy. Metrics to evaluate the effectiveness of CIVAS were developed and implemented on a dashboard in real-time from March 2013 to March 2014. Results: The metrics that were designed and implemented to evaluate the effectiveness of CIVAS were quality and value, financial resilience, and the department's people and culture. Using a dashboard that integrated these metrics, the accuracy of manufacturing defect-free products was ≥99.9%, indicating excellent quality and value of CIVAS. The metric for financial resilience demonstrated a cost savings of $78,000 annually within pharmacy by eliminating the outsourcing of products. People and value metrics on the dashboard focused on standard work, with an overall 94.6% compliance to the workflow. Conclusion: A unique dashboard that incorporated metrics to monitor 3 important areas was successfully implemented to improve the effectiveness of CIVAS pharmacy. These metrics helped pharmacy to monitor progress in real-time, allowing attainment of production goals and fostering continuous quality improvement through LEAN work.

255: Hemoglobin A1c as an early predictor of gestational diabetes in obese patients: a subgroup analysis

255 Hemoglobin A1c as an early predictor of gestational diabetes in obese patients: a subgroup analysis Alex Fong, Allison Serra, Lauryn Gabby, Deborah Wing, Kathleen Berkowitz University of California, Irvine, Obstetrics and Gynecology, Orange, CA, University of California, Irvine, School of Medicine, Irvine, CA, MemorialCare Center for Women at Miller Children’s Hospital, Obstetrics and Gynecology, Long Beach, CA OBJECTIVE: To assess the use of early screening hemoglobin A1c (HgbA1c) of 5.7-6.4% as a predictor of gestational diabetes (GDM) in obese patients. STUDY DESIGN: This is a subgroup analysis on obese parturients using data from a retrospective cohort study of 544 subjects who underwent early screening HgbA1c. Subjects with known pre-existing diabetes or HgbA1c values >1⁄46.5% were excluded. Obese subjects were defined as having a pre-pregnancy body mass index (BMI) >1⁄430. The primary outcome was GDM development. Secondary outcomes included route of delivery, maternal weight gain, and neonatal outcomes. Subjects with HgbA1c 5.7-6.4% were compared to those with HgbA1c 4kg), or neonatal morbidities. CONCLUSION: Obese subjects with an early screening HgbA1c of 5.76.4% have a nearly 50% chance of developing GDM and higher weight gain than those with HgbA1c <5.7%. HgbA1c should be used as a tool in identifying obese subjects who may benefit from closer glycemic surveillance, weight control, and possible early intervention.

Responses of Youth With Diabetes and Their Parents to the Youth Eating Perceptions Survey

The purpose of this study was to investigate the perceptions of youth with diabetes mellitus (DM) and their parents/guardians about issues related to eating habits and to identify the relationships between treatment and lifestyle/daily care factors, youth characteristics, and eating habits of youth with DM. Methods included medical chart review and a written survey for youth with DM (n = 125) aged 10 to 20 years and their parents/guardians (n = 125) at Miller Children’s Hospital in Long Beach, California. Healthier eating was associated with stronger parent-youth relationships (P = .000), eating meals at home (P = .047), parent/guardian involvement in DM management (P = .039), younger age of youth (P = .008), and youth being male (P = .017) but not with treatment duration, special meetings with a registered dietitian, parent/guardian age, BMI z score, race/ethnicity, or language of youth. This study suggests that family-centered interventions for youth with DM should promote strong parent-youth relationships, eating at home, parent involvement in DM management for younger patients with special attention to transition to self-care among older patients, and healthy food choices for older youth with DM, especially girls.

Clinical significance of respiratory isolates for Mycobacterium abscessus complex from pediatric patients

Mycobacterium abscessus complex is the most virulent of rapidly growing mycobacteria causing invasive lung disease. To better delineate clinical pediatric experience and outcomes with M. abscessus complex, we retrospectively gathered 5-year data on M. abscessus complex infection and outcomes in a large, hospital-based pediatric pulmonary center. Patients were selected from the database of the microbiology department at Miller Children's Hospital in Long Beach, CA. Patients had at least one positive pulmonary isolate for M. abscessus complex from February 2006 to May 2011. Treatment modality data were collected and successful therapy of disease was determined as clearance of M. abscessus complex infection after antibiotics proven by culture negative respiratory isolate within at least 12 months of therapy initiation. Two cystic fibrosis patients with M. abscessus complex were identified, one with failed therapy and the other with stable pulmonary status despite persistent isolation. One primary ciliary dyskinesia patient had successful clearance of M. abscessus complex, however is now growing M. avium intracellulare. A patient with no prior medical history was successfully treated with antimycobacterial therapy. Eleven patients with neuromuscular disorders had tracheal aspirates positive for M. abscessus complex. None were treated due to stable lung status and all but two had spontaneous clearance of the mycobacteria. The two remaining persist with sporadic isolation of M. abscessus complex without clinical significance. We concluded that patients with tracheostomy associated M. abscessus complex infections do not appear to require treatment and often have spontaneous resolution. Cystic fibrosis or primary ciliary dyskinesia patients may have clinical disease warranting treatment, but current antimycobacterial therapy has not proven to be completely successful. As M. abscessus complex gains prevalence, standardized guidelines for diagnosis and therapy are needed in the pediatric population. Multicenter cohort analysis is necessary to achieve such guidelines.

Infliximab in the treatment of refractory uveitis. Does dose really matter?

Methods We conducted a retrospective study at Children’s Hospital Los Angeles and Miller Children’s Hospital, Los Angeles. We performed comprehensive medical record review to identify demographic information and clinical data. Ocular outcome was assessed by anterior chamber cell density, flare, visual acuity, intra ocular pressure and ability to reduce or stop concomitant topical or systemic steroids.

9201 ORAL Complete Remissions Observed in a Subset of Pediatric Patients With CD30-expressing Malignant Lymphomas Treated in Clinical Studies of Brentuximab Vedotin (SGN-35)

M. Fanale, A. Franklin, R. Radhakrishnan, A. Termuhlen, A.K. Gopal, A. Shustov, D.A. Kennedy, E.L. Sievers. University of Texas MD Anderson Cancer Center, Department of Lymphoma and Myeloma, Houston TX, University of Texas MD Anderson Cancer Center, Department of Pediatrics Patient Care, Houston TX, Karmanos Cancer Institute, Hematology/Oncology, Detroit MI, Miller Children’s Hospital, Department of Pediatrics, Long Beach CA, University of Washington Medical Center, Medical Oncology Division, Seattle WA, University of Washington Medical Center, Hematology Division, Seattle WA, Seattle Genetics Inc, Clinical Affairs, Bothell WA, USA

Single-Incision Laparoscopic Approach to Management of Splenic Pathology in Children: An Early Experience

Certain splenic conditions in children require surgical interventions, the majority of which are approached via standard laparoscopy with multiple incisions. The single-incision laparoscopic (SIL) technique is gaining popularity. The aim of this study is to review our institutional experience using the SIL technique to surgically manage different splenic pathology in the pediatric population. A retrospective review was performed of the patients who underwent SIL splenic procedures at Miller Children's Hospital (Long Beach, CA) from January 2009 to December 2010. Seven patients underwent a SIL technique for different splenic diseases. Five patients underwent splenectomy, 1 patient underwent a splenic cystectomy and omental patching, and 1 patient underwent reduction of splenic torsion and splenopexy. There were no conversions to open. Six procedures were successfully performed without the need for an additional trocar. However, 1 patient required an additional grasper through a separate stab incision. There were no intraoperative complications. One patient had a superficial wound infection at 2-week postoperative follow-up, which resolved with local wound care. Our preliminary experience shows the SIL technique for the management of splenic pathology in children is safe and feasible.

Case-control study of risk factors and outcomes associated with neonatal candidiasis

Background: Invasive candidiasis is a late-onset sepsis that occurs in infants in the neonatal intensive care units (NICU). Our study aimed to evaluate the risk factors and outcomes associated with neonatal candidiasis. Methods: A case-control retrospective study was conducted at Miller Children's Hospital from January 1990 to December 2008. Cases were matched to controls by birth weight category, birth date and gestational age. Results: A total of 161 neonates, 103 cases and 58 controls, were included. Demographics such as age, sex, weight and underlying disease were similar between groups. Mean time to infection was 38 days from NICU admission. Multivariable logistic regression revealed that congenital heart disease (odds ratio (OR), 6.35; 95% CI 1.75-23.03, p = 0.005), total parenteral nutrition (OR, 42.97; 95% CI 3.35-550.55, p = 0.004) and abdominal surgery (OR, 6.35; 95% CI 1.75-23.03, p = 0.005) were independently associated with neonatal candidiasis. Mean NICU stay was longer and more patients died in the case group vs. control groups (103 ± 63 vs. 66 ± 27 days, p 38 days. Presumptive antifungal therapy should be initiated promptly and antifungal prophylaxis should be considered in these infants.

The Risk of Acute Neonatal Morbidities in the Delivery Room after Primary Cesarean at Term: Influence of Labor and Stage

We evaluated acute neonatal morbidities in the delivery room associated with primary cesarean performed prior to labor and in the first or second stages of labor. A retrospective cohort study was conducted on subjects undergoing term, primary cesareans at the Women's Pavilion, Miller Children's Hospital in Long Beach, California from 2000 to 2007. Acute neonatal morbidities were tabulated as a function of time during labor when cesarean was performed. Composite neonatal morbidity was defined as the presence of at least one of the following: low 5-minute Apgar score, need for intubation, and/or admission to neonatal intensive care unit. One thousand forty-five subjects delivered by cesarean without labor, 3098 in first stage, and 951 in second stage. Five-minute Apgar score < 7 was more common in cesareans performed during second stage than during first stage or without labor [3/1045 (0.3%) versus 28/3098 (0.9%) versus 12/951 (1.3%), P = 0.039]. Composite neonatal morbidity was not significantly different among the stages. Acute neonatal morbidities were not affected by the presence or absence of labor. Potential long-term sequelae require further study.

Impact of Empiric Antibiotic Use on Development of Infections caused by Extended-Spectrum β-Lactamase Bacteria in a Neonatal Intensive Care Unit

The neonatal intensive care unit at Miller Children's Hospital changed from empiric use of cefotaxime and vancomycin (CEF) to tobramycin and vancomycin (TOB) for hospital-acquired infections in November 1999 because of an increase in infections caused by extended-spectrum beta-lactamase (ESBL)-producing bacteria. The objectives of this study were to evaluate the incidence and impact of this change on the development of ESBL infections. We retrospectively reviewed medical records of infants who received CEF or TOB between January 1998 and December 2002. A standardized form was used to collect demographic data, information on antibiotic use, and culture results. The mean gestational age and birth weight of the 250 infants were 28.8 +/- 4.0 weeks and 1213.1 +/- 662 g, respectively. There were no differences between infants who received CEF (N = 130) or TOB (N = 120) in terms of gestational age, birth weight, device use, invasive procedures, or prior antibiotic use. There were 11 ESBL infections. Infants in the CEF group were more likely than those in the TOB group to develop ESBL infection (7.8% versus 0.8%, P = 0.008). There were 11 deaths, with none attributed to ESBL infection. In a multivariate analysis, duration of prior ampicillin and gentamicin use and exposure to CEF were associated with ESBL infection [odds ratio (OR): 3.1, 95% confidence interval (CI): 1.28-7.49, P = 0.012; and OR: 33.7; 95% CI: 1.02-1136, P = 0.05, respectively]. The change from empiric use of CEF to TOB was associated with a significant decrease in the incidence of ESBL infections.

Vaginal indomethacin increases TIMP-2 levels in amniotic fluid and fetal membranes in a rabbit model for RU486-induced preterm birth

FETAL MEMBRANES IN A RABBIT MODEL FOR RU486-INDUCED PRETERM BIRTH WILBERT FORTSON (F), KAY BEHARRY, STEPHEN NAGEOTTE, AMANDA JAN, TAMEROU ASRAT, HOUCHANG MODANLOU, University of California, Irvine, Maternal Fetal Medicine, Irvine, California, University of California, Irvine, Pediatrics, Orange, California, Miller Children’s Hospital, Women’s Pavilion, Maternal Fetal Medicine, Long Beach, California, Miller Children’s Hospital, Women’s Pavilion, Irvine, California OBJECTIVE: Preterm parturition and rupture of fetal membranes are associated with decreased amniotic fluid tissue inhibitor of metalloproteinases (TIMP-2), an endogenous inhibitor of MMPs. We examined the hypothesis that vaginal indomethacin will increase TIMP-2 levels in a rabbit model for RU468-induced preterm birth in amniotic fluid (AF) and fetal membranes (FM) in a rabbit model for RU468-induced preterm birth. STUDY DESIGN: Pregnant rabbits were induced with a single 50 mg IM dose of RU486 at day 24 of a 32 day gestation. The animals received either oral indomethacin (20 mg in a vehicle suspension, OI), a methylcellulose vehicle suspension (OV), a vaginal suppository of indomethacin (20 mg in cocoa butter, VI), or a vaginal suppository of cocoa butter only (placebo, VP) once daily for 2 days. At delivery (expulsion of at least 1 fetus), AF and FM were collected for MMP-2, and -9 activity; and TIMP-1 and -2 levels. RESULTS: Data are meanGSEM. There were not differences in MMP-9 activity. CONCLUSION: Elevated TIMP-2 levels in the amniotic fluid and fetal membranes with vaginal indomethacin suggest decreased breakdown of extracellular matrix and inhibition of membrane rupture in our model.

Reimagining Shakespeare for Children and Young Adults. Ed. Naomi J. Miller (Children’s Literature and Culture Series).

Reimagining Shakespeare for Children and Young Adults. Ed. Naomi J. Miller (Children’s Literature and Culture Series).

Aseptic meningitis in infants younger than six months of age hospitalized with urinary tract infections.

Aseptic meningitis associated with urinary tract infection (UTI) in young infants has not been described in detail in the literature. We performed a retrospective study to determine the incidence and clinical features of aseptic meningitis accompanying UTI. We retrospectively reviewed the medical records of all infants younger than 6 months of age hospitalized with a UTI at Miller Children's Hospital from March 1995 through March 2000. UTI was defined as a urine culture growing > or =10,000 colony-forming units/ml of a single organism from a catheterized specimen or > or =100,000 colony-forming units/ml of a single organism from a bagged urine specimen. Meningitis was defined as a positive cerebrospinal fluid culture or cerebrospinal fluid with >35 white blood cells/mm3 in infants < or =30 days of age or with >10 white blood cells/mm3 in infants >30 days of age. Of 386 infants with UTI, a lumbar puncture was performed in 260, and 31 (11.9%) had aseptic meningitis. One infant had bacterial meningitis. None of the 26 infants with UTI and bacteremia had aseptic meningitis. Two infants with meningitis had confirmed enteroviral infections, but aseptic meningitis did not occur more frequently in any particular month or during times of peak enteroviral activity. A cerebrospinal fluid pleocytosis is relatively common in hospitalized infants <6 months of age who have a UTI and usually does not reflect bacterial meningitis. Knowledge of this may prevent unnecessary courses of antibiotics for presumed bacterial meningitis and lead to evaluation for other possible causes of aseptic meningitis including viral or congenital infections.

Cefepime

To measure first-dose and steady-state plasma, urine, and sputum concentrations of cefepime and make preliminary assessments of the clinical efficacy of cefepime in patients with cystic fibrosis. Open noncomparative clinical trial. Memorial Miller Children's Hospital of Long Beach, Calif. Twelve patients, aged 4 to 41 years, with a confirmed diagnosis of cystic fibrosis and chronic bronchopulmonary infections. Patients received cefepime at 50 mg/kg per dose (maximum dose, 2 g per dose) given intravenously every 8 hours. Clinical evaluations, pulmonary function tests, quantitative sputum cultures, and sensitivity testing were performed before, at the end of, and 2 weeks after therapy. Mean (+/- SD) peak plasma concentrations after the first dose were 148.2 (36.6) mg/L; the following other values were included: half-life, 1.59 (0.46) hours; area under the curve, 292 (94) microgram/h per milliliter; total-body clearance, 3.01 (1.46) mL/min per kilogram; volume of distribution at steady state, 0.32 (0.10) L/kg; and percent of dose recovered in urine, 52% (27%). Steady-state and first-dose values were similar. Trough levels varied from 6.4 to 7.2 mg/L. Mean (+/- SD) sputum concentrations at steady state varied from 6.3 (5.4) to 4.8 (2.3) mg/L. At completion of therapy, nine of 10 patients' conditions were improved as indicated by clinical scores (greater than 10 points), forced vital capacity (greater than 10%), and a greater than or equal to 1 log decrease in sputum bacterial concentration. Cefepime was well tolerated in 10 patients, but rash and light-headedness developed in two patients. Pseudomonas aeruginosa minimum inhibitory concentration90 increased from the start (64 mg/L) to the end of therapy (256 mg/L) and was unchanged 2 weeks later. Based on these data and the potential advantage of a single agent for the treatment of mixed infections (Staphylococcus aureus and P aeruginosa), comparative clinical trials of cefepime and standard therapy for bronchopulmonary exacerbations in patients with cystic fibrosis appear to be warranted.

Design and Long‐Term Performance of Surgically Implanted Electroenzymatic Glucose Sensorsa

Annals of the New York Academy of SciencesVolume 501, Issue 1 p. 534-537 Design and Long-Term Performance of Surgically Implanted Electroenzymatic Glucose Sensorsa LELAND C. CLARK JR., LELAND C. CLARK JR. Children's Hospital Research Foundation Cincinnati, Ohio 45229Search for more papers by this authorLINDA K. NOYES, LINDA K. NOYES Children's Hospital Research Foundation Cincinnati, Ohio 45229Search for more papers by this authorROBERT B. SPOKANE, ROBERT B. SPOKANE Children's Hospital Research Foundation Cincinnati, Ohio 45229Search for more papers by this authorRANJAN SUDAN, RANJAN SUDAN Children's Hospital Research Foundation Cincinnati, Ohio 45229Search for more papers by this authorMARIAN L. MILLER, MARIAN L. MILLER Children's Hospital Research Foundation Cincinnati, Ohio 45229Search for more papers by this author LELAND C. CLARK JR., LELAND C. CLARK JR. Children's Hospital Research Foundation Cincinnati, Ohio 45229Search for more papers by this authorLINDA K. NOYES, LINDA K. NOYES Children's Hospital Research Foundation Cincinnati, Ohio 45229Search for more papers by this authorROBERT B. SPOKANE, ROBERT B. SPOKANE Children's Hospital Research Foundation Cincinnati, Ohio 45229Search for more papers by this authorRANJAN SUDAN, RANJAN SUDAN Children's Hospital Research Foundation Cincinnati, Ohio 45229Search for more papers by this authorMARIAN L. MILLER, MARIAN L. MILLER Children's Hospital Research Foundation Cincinnati, Ohio 45229Search for more papers by this author First published: June 1987 https://doi.org/10.1111/j.1749-6632.1987.tb45768.xCitations: 5 a Supported by National Institutes of Health Grant AM 31054. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume501, Issue1Enzyme Engineering 8June 1987Pages 534-537 RelatedInformation