Newswise — LOS ANGELES — Critically ill children on ventilator support can experience a mismatch between their breathing efforts and) the rhythm delivered by the ventilator. This mismatch, called patient-ventilator asynchrony (PVA), is difficult to detect and can worsen patient outcomes. PVA is commonly associated with longer stays on a ventilator for adults and can raise the risks of infection, lung injury and brain damage. However, little is known about PVA in children, where it could be just as, if not more, common. Robinder Khemani, MD, MsCI, Attending Physician in Pediatric Intensive Care at Children’s Hospital Los Angeles, is using machine learning to improve the outcomes of children put on ventilators.
A CHLA research team led by Dr. Khemani has received a $3.4 million grant from the National Institutes of Health to examine the frequency and risk factors for common types of PVA in critically ill children. Working with hospitals in Canada and the Netherlands, the researchers will investigate whether PVA is independently associated with poor clinical outcomes and determine the effects on the body when breathing doesn’t match the flow of air provided by the ventilator.
Children can need ventilator support for multiple reasons, including severe pneumonia or acute respiratory distress syndrome (ARDS), when infection or trauma causes swelling, inflammation and fluid buildup in the lungs. The body’s response to the initial injury can harm the lungs even more than the infection or trauma itself.
“Many of these very sick patients can develop unexpected complications from the very procedures that we use to help them,” says Dr. Khemani. Ventilator-induced lung injury can lead to heart and kidney damage, or can increase vulnerability to future lung disease, asthma or sleep-disordered breathing.
“Brain function can also be impaired by all the medications, anesthetics and sedation patients receive to help them to tolerate the ventilator,” says Dr. Khemani. “We weigh the risks and benefits to minimize potential harms and hopefully get them off the ventilator as soon as they are ready.”
Measuring patient-ventilator mismatch
“There are many types of PVA, but we still don’t know which PVA subtypes are most harmful or are the most frequent,” says Dr. Khemani. “We need to develop a common set of definitions and measurements, especially for pediatric patients.”
Mismatches between patient breathing and the rhythm the ventilator provides can occur in different ways, as children’s breathing varies according to their weight, size and age. Respiration patterns can also change during the course of a child’s stay in the pediatric intensive care unit. But existing studies use different definitions for PVA subtypes and no study so far has been large enough to evaluate the relationship between different types of PVA and patient outcomes, or has yet focused on the highest-risk patients.
Automating ventilator-patient breathing
“It takes a very highly trained human to recognize PVA,” says Dr. Khemani. “But computers can do this very well. Our colleagues at the Virtual Pediatric Intensive Care Unit (vPICU) here at CHLA have been working with us on this project for a few years and have developed machine-learning algorithms that can identify different types of breathing asynchronies in children on ventilators.”
The study team will collect measurements from 200 children and combine this data with the analysis of 350 children in other studies, including a clinical trial that is testing a novel ventilator strategy. “By the end of this project, we hope to have developed these algorithms and validate that they work in three different hospitals using data from many different children,” says Dr. Khemani. “Simultaneously we will build a tool to automatically detect PVA by analyzing ventilator data through machine-learning algorithms. We will test how well the tool helps providers to identify the minute-to-minute changes in patients and potentially alert the bedside team that an adjustment to the ventilator may be needed.”
To minimize the risks of ventilator support, medical teams want to keep patients participating in breathing for themselves as much as possible. “So that’s where this study really comes into play, by constantly tracking the interaction between the child and the ventilator to ask if the ventilator is supplying just the right amount of help, precisely when needed,” says Dr. Khemani.
About Children’s Hospital Los Angeles
Founded in 1901, Children’s Hospital Los Angeles is the largest provider of hospital care for children in California. Renowned pediatric experts work together across disciplines to deliver inclusive and compassionate health care to one of the world’s most diverse populations, driving advances that set child health standards across the nation and around the globe. With a mission to create hope and build healthier futures for children, the hospital consistently ranks in the top 10 in the nation, No. 1 in California and No. 1 in the Pacific U.S. region on U.S. News & World Report’s Honor Roll of Best Children’s Hospitals. The Saban Research Institute of Children’s Hospital Los Angeles supports the full continuum of child health research and is among the top 10 pediatric academic medical centers for National Institutes of Health funding, meaning physicians and scientists translate discoveries into treatments and bring answers to families faster. Home to one of the largest pediatric training programs in the United States, Children’s Hospital Los Angeles graduates a new class of physicians each year who have learned world-class children’s health care at the forefront of medicine. And as an anchor institution, the hospital strengthens the economic health of surrounding communities by fighting food insecurity, enhancing health education and literacy, and introducing early careerists to health care. To learn more, follow us on Facebook, Instagram, LinkedIn, YouTube and Twitter, and visit our blog at CHLA.org/blog.
Source: Children’s Hospital Los Angeles
Set Children Up for Day Care Success: 6 ways parents can prep little ones for child care
Long days of school, first trips to day care or even a return from a period of at-home care can be difficult or downright nerve-wracking for parents and children alike.
(Family Features) Long days of school, first trips to day care or even a return from a period of at-home care can be difficult or downright nerve-wracking for parents and children alike. This new adventure can bring challenges from keeping children healthy to supporting their nutrition and more. Sending a little one to day care can even result in maternal separation anxiety.
To help alleviate some of the anxiety and parental concerns, the childhood nutrition experts at Gerber teamed up with Dr. Whitney Casares – a board-certified practicing pediatrician and creator of “Modern Mommy Doc” – to share these tips for families preparing their little ones for child care.
Keep Important Factors Top of Mind
As part of appreciating the milestone of the first time at day care, Casares encourages parents to remember that, while daunting, day care means new experiences, new friends and opportunities for growth, fun and healthy development. As part of the transition, she suggests paying attention to critical factors like sleep, nutrition, illness prevention and emotional development.
Support Their Immune Systems
Offer little ones a diverse array of nutritious foods during the transition to day care. A diet rich in fruits, vegetables and whole grains is essential for building immune systems. Additionally, iron-rich foods like iron-fortified baby cereals, eggs, beans and meat are critical for a strong body. Caregivers should frequently wash hands and focus on good sleep hygiene.
Put Nutrition on the Menu
When packing lunch boxes for a day of care, it’s important to keep nutrition in mind. Once children transition to finger foods, Casares recommends snacks from Gerber like Peach Puffs, Fruit and Veggie Melts and Wonderfoods Superfood Hearts, which come in a variety of flavors and include vital nutrients to optimize health.
Be Prepared for Separation Anxiety
Not all infants and toddlers experience separation anxiety, but many can, so it’s good to be prepared. Casares encourages parents to pack a familiar swaddle blanket in infants’ diaper bags to help ease those anxieties. Some toddlers benefit from having a beloved stuffed animal or blanket with them. Try introducing these transitional objects to little ones early so they smell and feel familiar when drop-off comes around.
Pack the Essentials
While nutritious foods, like Gerber Fruit and Veggie Pouch Blends, are certainly near the top of the list, there are plenty of other essentials to pack for each day. Don’t forget to add breast milk or formula, bottles and extra nipples alongside snacks and meals. Also remember to pack extra sets of clothes, diapers, wipes and those anxiety-soothing must-haves like blankets and stuffed animals.
Prepare for Appetite Changes
It’s common for children’s appetites to decrease during their first few days of child care as they may eat a little less while growing accustomed to their new environment and surroundings. There’s no need to worry – parents can adapt to these changes by understanding they’re often a natural part of the transition. While you may find little ones are hungrier before and after day care, this behavior should ease over time. If it doesn’t, schedule an appointment with your pediatrician to be sure babies stay on track.
To find more childhood nutrition advice, visit Gerber.com.
Photos courtesy of Getty Images
CVS Health survey finds more than two-thirds of Americans plan to get a flu shot this season
CVS Pharmacy® and MinuteClinic® encourage consumers to get an annual flu shot and stay up to date on routine vaccinations
WOONSOCKET, R.I. /PRNewswire/ — CVS Health® (NYSE: CVS) is prepared to meet patients’ vaccination and other preventive health care needs as flu season approaches. CVS Pharmacy® and MinuteClinic® are offering the annual flu vaccine at locations nationwide. CVS Pharmacy is also offering the new respiratory syncytial virus (RSV) vaccine, which has been approved for adults ages 60 and up. In addition, CVS Pharmacy and MinuteClinic are preparing to offer a new CDC-recommended COVID-19 vaccine once approved and available. To help patients plan ahead, appointments can be scheduled in advance using the digital scheduler at CVS.com or in the CVS Pharmacy app. MinuteClinic is offering the flu vaccinations and routine wellness visits with appointments available at MinuteClinic.com.
Experience the full interactive Multichannel News Release here: https://www.multivu.com/players/English/9196451-cvs-health-minuteclinic-flu-and-rsv-vaccinations/
“Receiving vaccinations for common illnesses like flu and RSV is a cornerstone of preventive care, and helps patients protect not only themselves, but also the health of their broader community,” said Sree Chaguturu, Executive Vice President and Chief Medical Officer, CVS Health. “Access is key, and with our national footprint of pharmacies and retail medical clinics, we’re making it easier than ever to get vaccinated in a timely, safe and convenient way.”
According to a survey of U.S. consumers commissioned by CVS Health*, timing, convenience and scheduling were cited as important factors when choosing when and where to get a flu vaccine. Other findings include:
- 75% of people who plan to receive their flu shot, plan to do so before November
- Seniors are the demographic most likely to get vaccinated (74%); but 2/3 of those over age 18 expect to get a shot
- 42% of patients are likely to visit a retail pharmacy for their flu shot, followed by a doctor’s office (33%)
- 78% of patients said convenient hours that work with their schedule was an important factor when choosing a pharmacy for their flu shot
- Of those planning to get a flu shot, 62% plan to schedule their appointment online, up 43% over the last two years
Digital scheduling at CVS.com and in the CVS Pharmacy app offers the flexibility to schedule multiple patients at once, allowing families, caregivers and other groups to get vaccinated together. Patients can also schedule multiple vaccinations in one appointment, such as flu and RSV, as recommended by the Centers for Disease Control and Prevention (CDC). In addition, patients can choose to walk into their local CVS Pharmacy and request a vaccination, seven days a week, including during evening and weekend hours. MinuteClinic flu vaccination and sick symptom visits (during which patients can get tested for flu, COVID-19, strep throat, etc.) are available by appointment at MinuteClinic.com.
“Pharmacists are trusted community health providers, thanks to their frequent and meaningful interactions with patients,” said Prem Shah, Executive Vice President and Chief Pharmacy Officer, CVS Health, Co-President, Pharmacy and Consumer Wellness. “As a result of their long-standing relationships with patients, our pharmacy teams can help identify vaccination gaps and recommend other care interventions on the spot, ensuring that patients always have access to advice and support.”
In addition to flu and RSV, CVS Pharmacy and MinuteClinic offer more than 15 of the most common recommended vaccinations, including shingles, pneumonia (pneumococcal), hepatitis B and more. Patients who receive any CDC-recommended vaccine at CVS Pharmacy will also receive a $5 off $20 to use on in-store purchases.*
According to the CDC, patients should get their flu vaccination early in the fall, before flu season begins, and ideally no later than the end of October. CVS Pharmacy and MinuteClinic offer multiple flu vaccine options, including the adjuvanted and higher dose vaccine which is recommended by the CDC for seniors. COVID-19 vaccinations are available at no cost for all patients, and flu vaccines are available at no cost with most insurance plans, including Medicare Part B.
About CVS Health
CVS Health® is the leading health solutions company, delivering care like no one else can. We reach more people and improve the health of communities across America through our local presence, digital channels and over 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day. Follow @CVSHealth on social media.
*”Flu Intention” Survey, commissioned by CVS Health in July 2023
* FOR $5 OFF $20 COUPON: Redeemable in store at CVS Pharmacy® and Longs Drugs® locations only for one-time use only between 8/14/23-12/31/23. Coupon received via email after vaccination. Limit one per customer per eligible vaccine visit. $5 savings applied to total qualifying purchase of at least $20 (after other coupons and discounts are applied). Reward cannot be issued in AR, NJ, NY, at Target or Schnucks locations, or at MinuteClinic® locations in AR, MA, NJ, NY, PA and RI. Coupon is void if copied or transferred and where prohibited by law. Internet printed or counterfeit coupons prohibited. Original must be relinquished with purchase. ExtraCare® card required to receive savings. Coupon cannot be combined with any other CVS Pharmacy coupon, Coupon excludes alcohol, lottery, money orders, prescriptions and copays, pseudoephedrine/ephedrine products, postage stamps, prepaid cards, gift cards, newspapers and magazines, milk (where required by law or regulation), sale/promotional merchandise, bottle deposits, bus passes, hunting and fishing licenses and any imposed governmental fees or items reimbursed by a government health plan. Tax charged on precoupon price where required. No cash back. Retailer’s coupon. Bearer assumes all sales/use tax liability. CVS reserves the right to modify this offer.
SOURCE CVS Health
FDA Issues Warning Letters to Three Infant Formula Manufacturers
Today, the U.S. Food and Drug Administration issued warning letters to three infant formula manufacturers as part of the agency’s ongoing commitment to enhance regulatory oversight to help ensure that the industry is producing infant formula under the safest conditions possible.
These warning letters for violations of the Federal Food, Drug, and Cosmetic Act (FD&C Act) and the FDA’s Infant Formula regulations were issued to ByHeart Inc., Mead Johnson Nutrition (Reckitt), and Perrigo Wisconsin, LLC. They reflect findings from FDA inspections of these facilities over the last several months. At the time of each inspection, the FDA issued inspectional observations and exercised oversight of each firm as they initiated recalls (in December 2022, February 2023 and March 2023) to remove product potentially contaminated with Cronobacter sakazakii from the marketplace.
Importantly, the FDA does not advise parents and caregivers to discard or avoid purchasing any particular infant formula at this time. The agency is not aware of any distributed product where contamination was confirmed and believes that the recalls were effective in removing the potentially contaminated batches of product from the market. Additionally, these warning letters are not associated with any current recalls and therefore the FDA does not anticipate any impact to the availability of infant formula on the market.
The FDA is issuing these letters now as part of its normal regulatory process and to reinforce to these firms the importance of instituting and maintaining appropriate corrective actions when they detect pathogens to ensure compliance with the FDA’s laws and regulations. As part of this, the firms must, among other things, thoroughly conduct root cause investigations and perform subsequent cleaning and sanitation activities. Notably, firms also need to properly evaluate their cleaning and sanitation practices, schedules, and procedures before releasing product. Each company will have 15 working days to respond to the FDA to explain what corrective actions they are taking. The FDA will assess the adequacy of the companies’ corrective actions in the agency’s review of the responses and during the FDA’s next inspection of each facility. During these inspections the agency will verify proper implementation of appropriate corrective actions taken by each company.
“Infant formula manufacturers are responsible for ensuring they make safe products, and the agency has remained in ongoing discussions with the infant formula industry to address the agency’s concerns. The FDA is committed to identifying and acting on issues early to prevent any firms from reaching the level of concern that prompted last year’s large-scale recall and contributed to the infant formula shortage,” said Donald Prater, acting director of the FDA’s Center for Food Safety and Applied Nutrition. “Over the last year the FDA has continued to increase our oversight of powdered infant formula facilities. These letters are a reflection of this enhanced oversight and are intended to help the industry continuously improve the safety of their manufacturing practices, so that parents and caregivers can be confident that the formula they feed their children is safe and nutritious.”
Today’s actions are the latest in the FDA’s ongoing effort to strengthen the safety and resiliency of the infant formula supply in the U.S. In November 2022, the agency released an outline of a prevention strategy to prevent Cronobacter sakazakii illnesses associated with consumption of powdered infant formula. As part of that strategy, the FDA has been working with Congress to strengthen our regulatory tools and increase funding to oversee the infant formula industry and has worked closely with the U.S. Center for Disease Control and Prevention (CDC) to support the Council of State and Territorial Epidemiologists decision to add invasive Cronobacter infections among infants under one year of age to the Nationally Notifiable Conditions List. The agency has already started to hire staff as part of our work to establish a dedicated cadre of infant formula investigators and an Office of Critical Foods, both of which will strengthen the regulatory oversight of infant formula.
Healthy supply of infant formula available in the U.S. market
Consumers should know that the U.S. infant formula supply is healthy with in-stock rates at 85% or higher since the beginning of 2023. The current strength of this market can be largely attributed to the many actions taken by the FDA and other U.S. government partners through 2022 and 2023, which are outlined in the FDA’s National Strategy to Increase the Resiliency of the Infant Formula Market.
Ensuring the safety of powdered infant formula at home
Parents and caregivers should follow manufacturer instructions for preparing powdered infant formula. For babies less than 2 months old, born prematurely, or with weakened immune systems the CDC recommends, if possible, using ready-to-feed liquid infant formula. Liquid infant formula is made to be sterile (without germs) and is the safest option for infants not receiving breast milk. However, parents and caregivers can also take extra steps to prepare powdered formula for these infant groups by heating water to at least 158°F/70°C to help protect against Cronobacter, adding the powdered infant formula and mixing, and then cooling the formula to body temperature (98.6°F) before feeding.
However, certain metabolic and specialty products include statements on their packaging warning consumers against heating because heating that particular product above 100°F could result in a loss of vitamins and nutrients. Therefore, caregivers should be especially mindful of the manufacturer’s instructions included on the packaging for metabolic and specialty formulas.
The FDA will continue its regulatory oversight and engagement with industry to enhance infant formula safety, including continuing to conduct annual inspections of infant formula facilities, maintaining a dialogue with infant formula manufacturers on these issues, and furthering prevention-based research and activities.
In addition to around-the-clock regulatory work, the FDA remains steadfast in upholding the commitment to unify and strengthen the FDA Human Foods Program. This new vision comes as a result of the agency’s review of findings and recommendations from an external evaluation conducted by the Reagan-Udall Foundation, at the request of the FDA Commissioner, following the agency’s infant formula supply chain response.
Senior Pickleball Report8 months ago
ACE PICKLEBALL CLUB TO DEBUT THEIR HIGHLY ANTICIPATED INDOOR PICKLEBALL FRANCHISES IN THE US, IN EARLY 2023
Community7 months ago
Diana Gregory Talks to us about Diana Gregory’s Outreach Services
Entertainment9 months ago
The Absolute Most Comfortable Pickleball Shoe I’ve Ever Worn!
Automotive7 months ago
2023 Nissan Sentra pricing starts at $19,950
Blog8 months ago
Unique Experiences at the CitizenM
Senior Pickleball Report8 months ago
“THE PEOPLE’S CHOICE AWARDS OF PICKLEBALL” – VOTING OPEN
influencers7 months ago
Keeping Pickleball WEIRD, INEXPENSIVE and FUN? These GUYS are!
Blog9 months ago
Assistory Showing Support on Senior Assist Day