Browsing by Author "Wolf, Joshua"

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    Prospective External Validation of the Esbenshade Vanderbilt Models Accurately Predicts Bloodstream Infection Risk in Febrile Non-Neutropenic Children With Cancer
    (American Society of Clinical Oncology, 2024) Zhao, Zhiguo; Patel, Pratik A.; Slatnick, Leonora; Sitthi-Amorn, Anna; Bielamowicz, Kevin J.; Nunez, Farranaz A.; Walsh, Alexandria M.; Hess, Jennifer; Rossoff, Jenna; Elgarten, Caitlin; Myers, Regina; Saab, Raya; Basbous, Maya; Mccormick, Meghan; Aftandilian, Catherine; Richards, Rebecca; Nessle, C. Nathan; Tribble, Alison C.; Sheth Bhutada, Jessica K.; Coven, Scott L.; Runco, Daniel; Wilkes, Jennifer; Gurunathan, Arun; Guinipero, Terri; Belsky, Jennifer A.; Lee, Karen; Wong, Victor; Malhotra, Megha; Armstrong, Amy; Jerkins, Lauren P.; Cross, Shane J.; Fisher, Lyndsay; Stein, Madison T.; Wu, Natalie L.; Yi, Troy; Orgel, Etan; Haeusler, Gabrielle M.; Wolf, Joshua; Demedis, Jenna M.; Miller, Tamara P.; Esbenshade, Adam J.; Pediatrics, School of Medicine
    Purpose: The optimal management of fever without severe neutropenia (absolute neutrophil count [ANC] ≥500/µL) in pediatric patients with cancer is undefined. The previously proposed Esbenshade Vanderbilt (EsVan) models accurately predict bacterial bloodstream infections (BSIs) in this population and provide risk stratification to aid management, but have lacked prospective external validation. Materials and methods: Episodes of fever with a central venous catheter and ANC ≥500/µL occurring in pediatric patients with cancer were prospectively collected from 18 academic medical centers. Variables included in the EsVan models and 7-day clinical outcomes were collected. Five versions of the EsVan models were applied to the data with calculation of C-statistics for both overall BSI rate and high-risk organism BSI (gram-negative and Staphylococcus aureus BSI), as well as model calibration. Results: In 2,565 evaluable episodes, the BSI rate was 4.7% (N = 120). Complications for the whole cohort were rare, with 1.1% (N = 27) needing intensive care unit (ICU) care by 7 days, and the all-cause mortality rate was 0.2% (N = 5), with only one potential infection-related death. C-statistics ranged from 0.775 to 0.789 for predicting overall BSI, with improved accuracy in predicting high-risk organism BSI (C-statistic 0.800-0.819). Initial empiric antibiotics were withheld in 14.9% of episodes, with no deaths or ICU admissions attributable to not receiving empiric antibiotics. Conclusion: The EsVan models, especially EsVan2b, perform very well prospectively across multiple academic medical centers and accurately stratify risk of BSI in episodes of non-neutropenic fever in pediatric patients with cancer. Implementation of routine screening with risk-stratified management for non-neutropenic fever in pediatric patients with cancer could safely reduce unnecessary antibiotic use.
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    Telemedicine services for living kidney donation: A US survey of multidisciplinary providers
    (Elsevier, 2022) Al Ammary, Fawaz; Motter, Jennifer D.; Sung, Hannah C.; Lentine, Krista L.; Sharfuddin, Asif; Kumar, Vineeta; Yadav, Anju; Doshi, Mona D.; Virmani, Sarthak; Concepcion, Beatrice P.; Grace, Terry; Sidoti, Carolyn N.; Jan, Muhammad Yahya; Muzaale, Abimereki D.; Wolf, Joshua; Medicine, School of Medicine
    Individuals considering living kidney donation face geographic, financial, and logistical challenges. Telemedicine can facilitate healthcare access/care coordination. Yet difficulties exist in telemedicine implementation and sustainability. We sought to examine centers' practices and providers' attitudes toward telemedicine to improve services for donors. We surveyed multidisciplinary providers from 194 active adult US living donor kidney transplant centers; 293 providers from 128 unique centers responded to the survey (center representation rate = 66.0%), reflecting 83.9% of practice by donor volume and 91.5% of US states/territories. Most centers (70.3%) plan to continue using telemedicine beyond the pandemic for donor evaluation/follow‐up. Video was mostly used by nephrologists, surgeons, and psychiatrists/psychologists. Telephone and video were mostly used by social workers, while video or telephone was equally used by coordinators. Half of respondent nephrologists and surgeons were willing to accept a remote completion of physical exam; 68.3% of respondent psychiatrists/psychologists and social workers were willing to accept a remote completion of mental status exam. Providers strongly agreed that telemedicine was convenient for donors and would improve the likelihood of completing donor evaluation. However, providers (65.5%) perceived out‐of‐state licensing as a key policy/regulatory barrier. These findings help inform practice and underscore the instigation of policies to remove barriers using telemedicine to increase living kidney donation.