Browsing by Author "Drayton Jackson, Meghan"

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    Identifying Sickle Cell Disease Beyond the Neonatal Period: A Case Series
    (2025-03-28) Gupta, Soumya; Slaughter, Mary; Li, Katherine; Harter, Michaela; Goubeaux, Derrick L.; Drayton Jackson, Meghan
    Background: Sickle Cell Disease (SCD) is an autosomal recessive chronic condition that causes hemolytic anemia and vaso-occlusive episodes that can present as dactylitis, pain, acute chest syndrome (ACS), and other complications. For early detection and intervention, newborn screening (NBS) for SCD is mandated in all 50 states. However, this screening is not readily available in many other areas of the world. Case Description : Three children who immigrated from countries outside the United States were diagnosed with SCD beyond the neonatal period. A 17-year-old female adopted from Kenya presented to the ER with dyspnea after starting oral contraceptives and was found to have a pulmonary embolism. Hemoglobin (Hgb) was 8.1 g/dl. She rapidly deteriorated and required intubation. Bronchoalveolar lavage revealed straw-colored fluid, a rare finding consistent with ACS. Electrophoresis confirmed HbSS. A 7-year-old male from the Dominican Republic presented with pneumonia and pain. Hgb was 8.4 g/dl. There was familial anemia, but he had not received work-up due to insufficient insurance coverage. Electrophoresis showed HbSS. A 7-year-old male from Nigeria presented to the ED after an episode of gross hematuria. His baseline Hgb was 10 g/dl, and his mother had SCD. Electrophoresis showed HbSS. Clinical Significance: Sickle cell disease is a multisystem disorder with complications that can lead to severe illness. Physicians must maintain high clinical suspicion for SCD in patients who did not receive NBS presenting with recurrent pain, severe infection, end organ damage, or anemia. Diagnosis is confirmed with hemoglobin electrophoresis. Conclusion: This case series highlights the need for heightened SCD awareness, particularly in those from areas without universal NBS. Providers must obtain relevant family history, recognize SCD’s diverse presentations, and work to reduce healthcare access barriers to ensure that patients receive timely diagnosis and care.
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    Methadone-based Multimodal Analgesia Provides the Best-in-class Acute Surgical Pain Control and Functional Outcomes With Lower Opioid Use Following Major Posterior Fusion Surgery in Adolescents With Idiopathic Scoliosis
    (Wolters Kluwer, 2020-07-27) Ye, Jian; Myung, Karen; Packiasabapathy, Senthil; Yu, Jeffrey S.; Jacobson, Joseph E.; Whittaker, Stephanie C.; Castelluccio, Peter; Drayton Jackson, Meghan; Sadhasivam, Senthilkumar; Anesthesia, School of Medicine
    Introduction: Posterior spinal fusion for idiopathic scoliosis is extremely painful, with no superior single analgesic modality. We introduced a methadone-based multimodal analgesia protocol, aiming to decrease the length of hospital stay (LOS), improve pain control, and decrease the need for additional opioids. Methods: We analyzed 122 idiopathic scoliosis patients with posterior instrumented spinal fusion. They were matched by age, sex, surgeon, and the number of levels fused before and after the implementation of the new protocol. This analysis included 61 controls (intrathecal morphine, gabapentin, intravenous opioids, and adjuncts) and 61 patients on the new protocol (scheduled methadone, methocarbamol, ketorolac/ibuprofen, acetaminophen, and oxycodone with intravenous opioids as needed). The primary outcome was LOS. Secondary outcomes included pain scores, total opioid use (morphine milligram equivalents), time to a first bowel movement, and postdischarge phone calls. Results: New protocol patients were discharged earlier (median LOS, 2 days) compared with control patients (3 days; P < 0.001). Total inpatient morphine consumption was lower in the protocol group (P < 0.001). Pain scores were higher in the protocol group on the day of surgery, similar on postoperative day (POD) 1, and lower by POD 2 (P = 0.01). The new protocol also reduced the median time to first bowel movement (P < 0.001), and the number of postdischarge pain-related phone calls (P < 0.006). Conclusion: Methadone-based multimodal analgesia resulted in significantly lower LOS compared with the conventional regimen. It also provided improved pain control, reduced total opioid consumption, and early bowel movement compared with the control group.
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    Right on Schedule: Improving the Rate of Clinic Appointments Scheduled Prior to Hospital Hospital Discharge
    (Wolters Kluwer, 2022-01-21) Rahim, Mahvish Q.; Griffin, Jordyn; Hege, Kerry; Mueller, Emily L.; Kauffman, Kristine; Corman, Stacey; Anderson, Kari; Woodburn, Stayce; Drayton Jackson, Meghan; Pediatrics, School of Medicine
    Introduction: Children with cancer and blood disorders have many healthcare needs that often require inpatient and outpatient management. There is potential for a lapse in care when patients frequently transition between these settings. We aimed to improve the process and increase the rate of scheduled outpatient follow-up appointments at the time of inpatient discharge for all pediatric hematology-oncology patients from a baseline of 68-80%. Methods: A multidisciplinary team developed several Plan-Do-Study-Act cycles to standardize and improve the process of scheduling follow-up appointments, communication to schedulers, and discussion of discharge planning. QI Macros for Excel Version 2019.06 was used for statistical analysis. Our primary outcome was displayed over time with a p-chart. Results: Plan-Do-Study-Act interventions had a statistically significant impact in increasing the percentage of patients with follow-up outpatient appointments scheduled at the time of inpatient discharge from a baseline of 68% to consistently over 80%. Conclusions: This study demonstrates that standardization of care processes and reminders and education of healthcare providers about the new approaches can improve the rates of outpatient follow-up appointments scheduled at the time of hospital discharge from inpatient care.
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    Understanding caregiver burden with accessing sickle cell care in the Midwest and their perspective on telemedicine
    (BMC, 2023-05-17) Jacob, Seethal A.; Bouck, Jillian; Daas, Roua; Drayton Jackson, Meghan; LaMotte, Julia E.; Carroll, Aaron E.; Pediatrics, School of Medicine
    Background: Survival for children with sickle cell disease (SCD) has improved significantly. However, patients with SCD still encounter several impediments to accessing adequate healthcare. Rural and medically underserved areas, such as parts of the Midwest, can exacerbate these barriers, separating children with SCD from subspecialists even further. Telemedicine has been a means to close these gaps in care for children with other special healthcare needs, but few studies have discussed how caregivers of children with SCD perceive its use. Methods: The objective of this study is to understand the experiences of caregivers of pediatric SCD patients in a geographically diverse area in the Midwest in accessing care, and their perspectives of telemedicine. Caregivers of children with SCD completed an 88-item survey via a secured REDCap link either in-person or via secure text. Descriptive statistics (means, medians, ranges, frequencies) were performed for all responses. Univariate chi square tests were performed to analyze associations, particularly with telemedicine responses. Results: The survey was completed by 101 caregivers. Nearly 20% of families traveled more than 1 hour to reach the comprehensive SCD center. Other than their SCD provider, caregivers reported their child having at least 2 other healthcare providers. Most barriers caregivers identified were financial or resource based. Almost a quarter of caregivers expressed feeling as though these barriers impacted their and/or their child's mental health. Ease of access to team members, as well as scheduling, were common facilitators of care cited by caregivers. The majority were willing to participate in telemedicine visits, regardless of how far they lived from the SCD center, though many noted aspects requiring adaptation. Conclusion: This cross-sectional study describes barriers to care experienced by caregivers of children with SCD, regardless of proximity to an SCD center, as well as caregiver perceptions of the usefulness and acceptability of telemedicine for SCD care.