Lisa J. Chamberlain

Journal Articles

• Increased utilization of pediatric specialty care: a population study of pediatric oncology inpatients in california. Journal of pediatric hematology/oncology Chamberlain, L. J., Pineda, N., Winestone, L., Saynina, O., Rangaswami, A., Link, M., Wise, P. H. 2014; 36 (2): 99-107

  Abstract

  To examine inpatient utilization of pediatric cancer specialty centers (PCSCs) by pediatric oncology patients.We performed a retrospective (1999 to 2010) population-based analysis of oncology hospitalizations for pediatric patients aged 0 through 18 years using the California Office of Statewide Health Planning and Development database. Logistic regression examined hospitalization at 29 PCSCs and variables of age, sex, tumor type, payer, race, income, and distance to admission site.Analysis of 103,961 pediatric oncology discharges revealed that 93% occurred at PCSCs. These sites experienced a 20% increase in pediatric oncology discharges, conversely non-PCSCs exhibited a 70% decrease (P<0.0001). Multivariate analyses revealed increased utilization with young age (odds ratio [OR], 4.58; 95% CI, 3.88-5.42), African American (OR, 1.26; 95% CI, 1.11-1.43), and middle income (OR, 1.36; 95% CI, 1.29-1.45). Decreased utilization was seen for females (OR, 0.88; 95% CI, 0.84-0.93) and Hispanics (OR, 0.72; 95% CI, 0.68-0.77). Payer and proximity were not significantly associated with change in utilization. Tumor types less likely to utilize a PCSC included germ cell, solid, and central nervous system tumors. Adolescents were >3 times less likely to be treated at a PCSC.Inpatient pediatric oncology care in California has become increasingly regionalized with the vast majority of patients accessing PCSCs. However, variability in hospitalizations of adolescent patients and children not treated in PCSCs deserve further evaluation.

  View details for DOI 10.1097/01.mph.0000438027.07467.f1

  View details for PubMedID 24517965

• Legislative advocacy: evaluation of a grand rounds intervention for pediatricians. Academic pediatrics Bensen, R., Roman, H., Bersamin, M., Lu, Y., Horwitz, S., Chamberlain, L. J. 2014; 14 (2): 181-185

  Abstract

  To evaluate the impact of a Grand Rounds Action Alert (GRAA) intervention on the behaviors, knowledge, and attitudes of pediatric grand rounds (GR) attendees; and to assess its acceptability.A cross-sectional, quasi-experimental study was performed at a freestanding children's hospital. GRAA on child health legislative topics were presented in the first 2 minutes of the pediatric GR session as well as posted outside. Each session included an action item, such as writing/signing letters to elected officials or informational sheets with legislator contact information. Main outcome measures included self-reported behavior, advocacy knowledge, attitudes, and acceptability.One year after GRAA implementation, GR attendees with high exposure to the intervention were more likely to have written/signed a letter to a legislator compared to those with low/no exposure (60% vs 35%, P = .016). Those with high exposure were also more knowledgeable regarding financing of health care for low-income children (20% vs 5%, P = .027). Attitudes toward advocacy at baseline were positive: respondents agreed it is important to remain informed about (98%) and advocate for (94%) legislation favorable to children's health. Implementing this program was challenging, but the intervention was accepted favorably: 93% of respondents agreed that GRAA should continue.GRAA facilitated participation in legislative advocacy behaviors while improving self-perceived knowledge of legislative issues relating to children's health. They were well received in a large tertiary children's hospital.

  View details for DOI 10.1016/j.acap.2013.08.004

  View details for PubMedID 24126045

• Innovations in Practice: Exploring an intensive meditation intervention for incarcerated youth CHILD AND ADOLESCENT MENTAL HEALTH Barnert, E. S., Himelstein, S., Herbert, S., Garcia-Romeu, A., Chamberlain, L. J. 2014; 19 (1): 69-73

  View details for DOI 10.1111/camh.12019

  View details for Web of Science ID 000330639100012

• A Multi-Institutional Medical Educational Collaborative: Advocacy Training in California Pediatric Residency Programs ACADEMIC MEDICINE Chamberlain, L. J., Wu, S., Lewis, G., Graff, N., Javier, J. R., Park, J. S., Johnson, C. L., Woods, S. D., Patel, M., Wong, D., Blaschke, G. S., Lerner, M., Kuo, A. K. 2013; 88 (3): 314-321

  Abstract

  Educational collaboratives offer a promising approach to disseminate educational resources and provide faculty development to advance residents' training, especially in areas of novel curricular content; however, their impact has not been clearly described. Advocacy training is a recently mandated requirement of the Accreditation Council for Graduate Medical Education that many programs struggle to meet.The authors describe the formation (in 2007) and impact (from 2008 to 2010) of 13 California pediatric residency programs working in an educational collaboration ("the Collaborative") to improve advocacy training. The Collaborative defined an overarching mission, assessed the needs of the programs, and mapped their strengths. The infrastructure required to build the collaboration among programs included a social networking site, frequent conference calls, and face-to-face semiannual meetings. An evaluation of the Collaborative's activities showed that programs demonstrated increased uptake of curricular components and an increase in advocacy activities. The themes extracted from semistructured interviews of lead faculty at each program revealed that the Collaborative (1) reduced faculty isolation, increased motivation, and strengthened faculty academic development, (2) enhanced identification of curricular areas of weakness and provided curricular development from new resources, (3) helped to address barriers of limited resident time and program resources, and (4) sustained the Collaborative's impact even after formal funding of the program had ceased through curricular enhancement, the need for further resources, and a shared desire to expand the collaborative network.

  View details for DOI 10.1097/ACM.0b013e3182806291

  View details for Web of Science ID 000315522600015

  View details for PubMedID 23348081

• Global Health Training in Pediatric Residency: A Qualitative Analysis of Faculty Director Insights ACADEMIC PEDIATRICS Eneriz-Wiemer, M., Nelson, B. D., Bruce, J., Chamberlain, L. J. 2012; 12 (3): 238-244

  Abstract

  Interest and participation in global health (GH) has been growing rapidly among pediatric residents. Residency programs are responding by establishing formal GH programs. We sought to define key insights in GH education from pediatric residency programs with formal GH tracks.Seven model pediatric residency programs with formal GH training were identified in 2007. Faculty directors representing 6 of these programs participated in expert interviews assessing 6 categories of questions about GH tracks: understanding how GH tracks establish partnerships with global sites; defining organizational and financing structure of GH tracks; describing resident curriculum and pre-trip preparation; describing clinical experiences of residents in GH tracks; defining evaluation of residents and GH tracks; and defining factors that affect development and ongoing implementation of GH tracks. Data were analyzed using qualitative methodology.All programs relied on faculty relationships to establish dynamic partnerships with global sites. All programs acknowledged resident burden on GH partners. Strategies to alleviate burden included improving resident supervision and providing varying models of GH curricula and pre-trip preparation, generally based on core residency training competencies. Support and funding for GH programs are minimal and variable. Resident experiences included volunteer patient care, teaching, and research. Commitment of experienced faculty and support from institutional leadership facilitated implementation of GH programs.Directors of 6 model GH programs within pediatric residencies provided insights that inform others who want to establish successful GH partnerships and resident training that will prepare trainees to meet global child health needs.

  View details for Web of Science ID 000304212400014

  View details for PubMedID 22503444

• A neonatal resuscitation curriculum in Malawi, Africa: did it change in-hospital mortality? International journal of pediatrics Hole, M. K., Olmsted, K., Kiromera, A., Chamberlain, L. 2012; 2012: 408689-?

  Abstract

  Objective. The WHO estimates that 99% of the 3.8 million neonatal deaths occur in developing countries. Neonatal resuscitation training was implemented in Namitete, Malawi. The study's objective was to evaluate the training's impact on hospital staff and neonatal mortality rates. Study Design. Pre-/postcurricular surveys of trainee attitude, knowledge, and skills were analyzed. An observational, longitudinal study of secondary data assessed neonatal mortality. Result. All trainees' (n = 18) outcomes improved, (P = 0.02). Neonatal mortality did not change. There were 3449 births preintervention, 3515 postintervention. Neonatal mortality was 20.9 deaths per 1000 live births preintervention and 21.9/1000 postintervention, (P = 0.86). Conclusion. Short-term pre-/postintervention evaluations frequently reveal positive results, as ours did. Short-term pre- and postintervention evaluations should be interpreted cautiously. Whenever possible, clinical outcomes such as in-hospital mortality should be additionally assessed. More rigorous evaluation strategies should be applied to training programs requiring longitudinal relationships with international community partners.

  View details for DOI 10.1155/2012/408689

  View details for PubMedID 22164184

• Do Medical Professionalism and Medical Education Involve Commitments to Political Advocacy? ACADEMIC MEDICINE Palfrey, J. S., Chamberlain, L. J. 2011; 86 (9): 1062-1063

  View details for DOI 10.1097/ACM.0b013e3182267696

  View details for Web of Science ID 000294254300005

  View details for PubMedID 21865894

• Access to Pediatric Subspecialty Care: A Population Study of Pediatric Rheumatology Inpatients in California ARTHRITIS CARE & RESEARCH Pineda, N., Chamberlain, L. J., Chan, J., Cidon, M. J., Wise, P. H. 2011; 63 (7): 998-1005

  Abstract

  To examine trends in the specialty care hospitalization of pediatric rheumatology patients and determine how nonclinical factors influence access.This study used California's Office of Statewide Health Planning and Development discharge database to perform a retrospective population analysis of pediatric rheumatology hospitalizations in California between 1999 and 2007. We used logistic regression to examine the relationship between hospitalization in specialty care centers with a pediatric rheumatologist and nonclinical patient characteristics.A total of 18,641 pediatric discharges revealed that 57% were discharged from a specialty care center with a pediatric rheumatologist. Multivariate analysis showed that the factors associated with increased utilization of specialty care centers with a pediatric rheumatologist were public insurance (odds ratio [OR] 1.62, 95% confidence interval [95% CI] 1.51-1.74; P < 0.0001), being Hispanic (OR 1.29, 95% CI 1.19-1.40; P < 0.0001) or Asian non-Hispanic (OR 1.39, 95% CI 1.26-1.54; P < 0.0001), and high pediatric rheumatology specialty care bed supply (OR 2.79, 95% CI 2.49-3.14; P < 0.0001). A decreased utilization of specialty care centers with a pediatric rheumatologist was seen for patients ages <1 year (OR 0.45, 95% CI 0.40-0.52; P < 0.0001), ages 1-4 years (OR 0.50, 95% CI 0.46-0.55; P < 0.0001), ages 5-9 years (OR 0.68, 95% CI 0.62-0.75; P < 0.0001), ages 15-18 years (OR 0.51, 95% CI 0.47-0.56; P < 0.0001), males (OR 0.75, 95% CI 0.70-0.80; P < 0.0001), and patients residing farther away from a specialty care center with a pediatric rheumatologist (OR 0.57, 95% CI 0.51-0.63; P < 0.0001).Nonclinical factors play an increasingly important role in the hospitalization patterns of pediatric rheumatology patients in California. Understanding these factors is crucial if we are to ensure that the variation in access to care reflects clinical need.

  View details for DOI 10.1002/acr.20458

  View details for Web of Science ID 000292809200011

  View details for PubMedID 21360697

• Health, Occupational and Environmental Risks of Emancipated Migrant Farmworker Youth JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED Peoples, J. D., Bishop, J., Barrera, B., Lamas, O., Dunlap, J. L., Gonzalez, P. A., Horwitz, S. M., Chamberlain, L. J. 2010; 21 (4): 1215-1226

  Abstract

  This study examines the perceptions of health, health seeking behavior, access to information and resources, work related hazards, substance abuse, and social support of emancipated migrant youth (EMY) who come to the United States without their families to work.Semi-structured interviews were performed with EMY living without their families in Santa Clara County, California. Interviews were digitally recorded in Spanish, transcribed, translated into English, and analyzed by a five-person analysis team.Eleven interviews were conducted with 29 participants. Work was identified as the overarching priority of the EMY Their greatest concern was becoming sick and unable to work. They described their work environment as demanding and stressful, but felt obliged to work regardless of conditions. Alcohol and drug abuse were reported as prevalent problems.Emancipated migrant youth are a vulnerable population who have significant occupational stress, hazardous environmental exposures, social isolation, and drug/alcohol abuse.

  View details for Web of Science ID 000283622700012

  View details for PubMedID 21099073

• Variation in Specialty Care Hospitalization for Children With Chronic Conditions in California PEDIATRICS Chamberlain, L. J., Chan, J., Mahlow, P., Huffman, L. C., Chan, K., Wise, P. H. 2010; 125 (6): 1190-1199

  Abstract

  Despite the documented utility of regionalized systems of pediatric specialty care, little is known about the actual use of such systems in total populations of chronically ill children. The objective of this study was to evaluate variations and trends in regional patterns of specialty care hospitalization for children with chronic illness in California.Using California's Office of Statewide Health Planning and Development unmasked discharge data set between 1999 and 2007, we performed a retrospective, total-population analysis of variations in specialty care hospitalization for children with chronic illness in California. The main outcome measure was the use of pediatric specialty care centers for hospitalization of children with a chronic condition in California.Analysis of 2 170 102 pediatric discharges revealed that 41% had a chronic condition, and 44% of these were discharged from specialty care centers. Specialty care hospitalization varied by county and type of condition. Multivariate analyses associated increased specialty care center use with public insurance and high pediatric specialty care bed supply. Decreased use of regionalized care was seen for adolescent patients, black, non-Hispanic children, and children who resided in zip codes of low income or were located farther from a regional center of care.Significant variation exists in specialty care hospitalization among chronically ill children in California. These findings suggest a need for greater scrutiny of clinical practices and child health policies that shape patterns of hospitalization of children with serious chronic disease.

  View details for DOI 10.1542/peds.2009-1109

  View details for Web of Science ID 000278268600013

  View details for PubMedID 20439593

• Lessons learned from a community-academic partnership addressing adolescent pregnancy prevention in Filipino American families. Progress in community health partnerships : research, education, and action Javier, J. R., Chamberlain, L. J., Rivera, K. K., Gonzalez, S. E., Mendoza, F. S., Huffman, L. C. 2010; 4 (4): 305-313

  Abstract

  Filipino Americans have more adolescent pregnancies than other Asian-Pacific Islanders (APIs). Few community-academic collaborations have addressed adolescent pregnancy prevention in this community.We sought to describe the lessons learned from and impact of a community-based teen pregnancy prevention program for Filipino Americans implemented by a Filipina pediatrics resident.We formed a community-academic partnership between the Filipino Youth Coalition, a community-based organization (CBO) in San Jose, California, and the Stanford School of Medicine's Pediatric Advocacy Program. We developed a culturally tailored parent-teen conference addressing adolescent pregnancy prevention in Filipino Americans. We qualitatively and quantitatively evaluated this intervention by collecting both pre- and post-conference data using a convenience sample design.Engaging particular aspects of Filipino culture (i.e., religion and intergenerational differences) helped to make this community-academic partnership successful. For physicians-in-training who are conducting community-based participatory research (CBPR), project challenges may include difficulties in building and maintaining academic- community relationships, struggles to promote sustainability, and conflicting goals of "community insiders" and "academic outsiders." Authors offer insights and implications for residents interested in practicing CBPR.CBPR is a key tool for exploring health issues in understudied populations. CBPR experiences can provide meaningful educational opportunities for physicians-in-training and can build sustained capacity in CBOs. They can also help residents to develop analytic skills, directly affect the health of the communities they serve, and, for minority physicians, give back to the communities they call home.

  View details for DOI 10.1353/cpr.2010.0023

  View details for PubMedID 21169708

• Impact of Managed Care on Publicly Insured Children with Special Health Care Needs ACADEMIC PEDIATRICS Huffman, L. C., Brat, G. A., Chamberlain, L. J., Wise, P. H. 2010; 10 (1): 48-55

  Abstract

  The aim of this review was to evaluate the impact of managed care on publicly insured children with special health care needs (CSHCN).We conducted a review of the extant literature. Using a formal computerized search, with search terms reflecting 7 specific outcome categories, we summarized study findings and study quality.We identified 13 peer-reviewed articles that evaluated the impact of Medicaid and State Children's Health Insurance program (SCHIP) Managed Care (MSMC) on health services delivery to populations of CSHCN, with all studies observational in design. Considered in total, the available scientific evidence is varied. Findings concerning care access demonstrate a positive effect of MSMC; findings concerning care utilization were mixed. Little information was identified concerning health care quality, satisfaction, costs, or health status, whereas no study yielded evidence on family impact.The available studies suggest that the evaluated record of MSMC for CSHCN has been mixed, with considerable heterogeneity in the definition of CSHCN, program design, and measured outcomes. These findings suggest caution should be exercised in implementing MSMC for CSHCN and that greater emphasis on health outcomes and cost evaluations is warranted.

  View details for Web of Science ID 000279188000010

  View details for PubMedID 20129481

• Integrating Collaborative Population Health Projects into a Medical Student Curriculum at Stanford ACADEMIC MEDICINE Chamberlain, L. J., Wang, N. E., Ho, E. T., Banchoff, A. W., Braddock, C. H., Gesundheit, N. 2008; 83 (4): 338-344

  Abstract

  The authors describe the population health curriculum at the Stanford University School of Medicine from 2003 to 2007 that includes a requirement for first-year medical students to engage in community-based population health projects. The new curriculum in population health comprises classroom and experiential teaching methods. Population health projects, a key component of the curriculum, are described and classified by topic and topic area (e.g., health education; health services) and the intended outcome of the intervention (e.g., establishing new policies; advocacy). During the past four years, 344 students have entered the curriculum and have participated in 68 population health projects. The projects were determined both by students' interests and community needs, and they represented diverse topics: 51% of the 68 projects addressed topics in the area of disease prevention and health promotion; 28% addressed health care access; 15% addressed health services; 4% addressed emergency preparedness; and 1% addressed ethical issues in health. Each project had one of three targets for intervention: community capacity building, establishing policies and engaging in advocacy, and bringing about change or improvement in an aspect of the health care system. Projects represented diverse stages in the evolution of a community-campus partnership, from needs assessment to planning, implementation, and evaluation of project outcomes. Experience to date shows that classroom-based sessions and experiential learning in the area of population health can be successfully integrated in a medical school curriculum. When contextualized in a population health curriculum, population health projects can provide future physicians with an experiential counterpart to their classroom learning.

  View details for Web of Science ID 000267654000005

  View details for PubMedID 18367891

• Introduction of a Pediatric Palliative Care Curriculum for pediatric residents JOURNAL OF PALLIATIVE MEDICINE Schiffman, J. D., Chamberlain, L. J., Palmer, L., Contro, N., Sourkes, B., Sectish, T. C. 2008; 11 (2): 164-170

  Abstract

  The Pediatric Palliative Care Curriculum (PPCC) was introduced as a pilot study in response to the published need for increased pediatric education in end-of-life (EOL) care. The PPCC was designed to better train residents in EOL issues so they could become more comfortable and knowledgeable in caring for children and adolescents with life-threatening illnesses.The PPCC consisted of six hour-long sessions run by a clinical psychologist, a licensed social worker, and faculty with experience in EOL care. The curriculum repeated every 6 weeks for 1 year. Residents in the training program at Stanford University rotating through oncology, pulmonology, and pediatric intensive care unit (PICU) were invited to attend. Session topics included: (1) personal coping skills, (2) being a caring professional, (3) recognizing cultural and familial differences, (4) pain management, (5) practical issues, and (6) meeting a bereaved parent. Pretest and posttest surveys with five-point Likert scale questions were used to measure curricular impact.Statistically significant improvement was found in resident self-report of: feeling prepared to initiate do-not-resuscitate discussions (p

  View details for DOI 10.1089/jpm.2007.0194

  View details for Web of Science ID 000254651600010

  View details for PubMedID 18333729

• Making pediatrics residency programs family friendly: Views along the professional educational continuum JOURNAL OF PEDIATRICS Sectish, T. C., Rosenberg, A. R., Pageler, N. M., Chamberlain, L. J., Burgos, A., Stuart, E. 2006; 149 (1): 1-2

  View details for DOI 10.1016/j.jpeds.2006.06.006

  View details for Web of Science ID 000239352000001

  View details for PubMedID 16860111

• Advocacy by any other name would smell as sweet ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Chamberlain, L. J., Sanders, L. M., Takayama, J. I. 2006; 160 (4): 453-453

  View details for Web of Science ID 000236516500024

  View details for PubMedID 16585499

• Does children's screen time predict requests for advertised products? Cross-sectional and prospective analyses ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Chamberlain, L. J., Wang, Y., Robinson, T. N. 2006; 160 (4): 363-368

  Abstract

  To examine children's screen media exposure and requests for advertised toys and food/drinks.Prospective cohort study.Twelve elementary schools in northern California.Eight hundred twenty-seven third grade children participated at baseline; 386 students in 6 schools were followed up for 20 months.None.Child self-reported requests for advertised toys and foods/drinks.At baseline, children's screen media time was significantly associated with concurrent requests for advertised toys (Spearman r = 0.15 [TV viewing] and r = 0.20 [total screen time]; both P<.001) and foods/drinks (Spearman r = 0.16 [TV viewing] and r = 0.18 [total screen time]; both P<.001). In prospective analysis, children's screen media time at baseline was significantly associated with their mean number of toy requests 7 to 20 months later (Spearman r = 0.21 [TV viewing] and r = 0.24 [total screen time]; both P<.001) and foods/drinks requests (Spearman r = 0.14 [TV viewing] and r = 0.16 [total screen time]; both P<.01). After adjusting for baseline requests and sociodemographic variables, the relationship between screen media exposure and future requests for advertised foods/drinks remained significant for total TV viewing and total screen media exposure. The relationship with future requests for toys remained significant for total screen media exposure.Screen media exposure is a prospective risk factor for children's requests for advertised products. Future experimental studies on children's health- and consumer-related outcomes are warranted.

  View details for Web of Science ID 000236516500004

  View details for PubMedID 16585480

• Universal health care coverage for children: Impact on pediatric health care providers JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED Chamberlain, L. J., Hughes, D. C., Bishop, J. S., Matsuda, D. H., Sassoubre, L. 2005; 16 (4): 622-633

  Abstract

  A Northern California county expanded health coverage to cover nearly all children in the state through a new insurance program. In two years, 75,500 children entered a health care system near capacity. We hypothesized that the influx of thousands of previously uninsured children into the health system would affect providers in many ways. This cross-sectional study sought to investigate how this influx affected provider practices, job satisfaction, access to specialists, and overarching views about the program. Qualitative analyses of expert interviews were performed. Providers reported improved access to health care, specialists, and medications for patients. They cited increased job satisfaction for providers due to fewer limits on care, improved referral process, and decreased patient family financial stress. Providers noted the persistence of long appointment wait times for specialist care. After moving to near universal coverage, safety net providers described increased job satisfaction. Because this study examined safety-net providers, future research requires a more representative sample of providers.

  View details for Web of Science ID 000233779500005

  View details for PubMedID 16311488

• Child advocacy training - Curriculum outcomes and resident satisfaction ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Chamberlain, L. J., Sanders, L. M., Takayama, J. I. 2005; 159 (9): 842-847

  Abstract

  Many health problems affecting children today are based in the community and cannot be easily addressed in the office setting. Child advocacy is an effective approach for pediatricians to take.To describe pediatric residents' choices of advocacy topics and interventions.Cross-sectional observational study.Residents from 3 pediatric training programs participated in the Child Advocacy Curriculum, which featured standardized workshops and the development of individual advocacy projects. To evaluate the curriculum, project descriptions and material products were analyzed to determine individual advocacy topics, topic themes, and targets of project interventions. Differences among programs were assessed. Residents also completed an anonymous questionnaire assessing their experience with the Child Advocacy Curriculum.Residents demonstrated a wide range of interests in selecting advocacy topics: 99 residents chose 38 different topics. The most common topic was obesity (13 residents) followed by health care access (9), teen pregnancy prevention (6), and oral health (5). Themes included health promotion and disease prevention, injury prevention, health care access, children with special health care needs, child development, at-risk populations, and the impact of media on child health. The project interventions targeted the local community most frequently (37%), followed by resident education (27%), hospital systems (21%), and public and health policy (15%). The vast majority of participating residents reported a positive experience with the Child Advocacy Curriculum.The wide range of topics and settings in which residents developed projects illustrates residents' extensive interests and ingenuity in applying needed advocacy solutions to complex child health issues.

  View details for Web of Science ID 000231653800007

  View details for PubMedID 16143743

• Creating an analytic voice in the policy storm AMBULATORY PEDIATRICS Wise, P. H., Chamberlain, L. 2005; 5 (1): 45-46

  View details for Web of Science ID 000226460500004

  View details for PubMedID 15656704

• Lead paint dangers and physician advocacy. The virtual mentor : VM Chamberlain, L. J., Hoff, T. 2005; 7 (12)

  View details for DOI 10.1001/virtualmentor.2005.7.12.ccas2-0512

  View details for PubMedID 23256972

• The crucial role of the vanishing school nurse ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Chamberlain, L. J., Bauer, L. 2004; 158 (11): 1091-1091

  View details for Web of Science ID 000224837700016

  View details for PubMedID 15520352

• Wernicke encephalopathy and Beriberi during total parenteral nutrition attributable to multivitamin infusion shortage PEDIATRICS Hahn, J. S., Berquist, W., Alcorn, D. M., Chamberlain, L., Bass, D. 1998; 101 (1)

  Abstract

  Wernicke encephalopathy (WE) is an acute neurologic disorder characterized by a triad of ophthalmoplegia, ataxia, and mental confusion. WE is attributable to thiamine (vitamin B1) deficiency. Beriberi is the systemic counterpart of thiamine deficiency and often manifests in cardiovascular collapse. WE is usually associated with alcoholism and malnutrition. It has also been seen in people with gastrointestinal diseases with malabsorption. Patients who have received total parenteral nutrition (TPN) without proper replacement of thiamine have also developed WE. Since November 1996, there has been a shortage of multivitamin infusion (MVI). Many patients who were on chronic TPN with MVI ceased to receive the MVI and were converted to an oral form of the multivitamin. As a result, there have been several reports of children and adults on TPN who have developed WE as a result of thiamine deficiency. With this case report, we bring to attention the association of the MVI shortage and WE. Early diagnosis of WE is important, because if it is treated with thiamine in the acute stages, the neurologic and cardiovascular abnormalities can be reversed.We report a 20-year-old female patient with Crohn's disease who developed WE as a result of thiamine deficiency. She had Crohn's disease since age 9 years and was on chronic TPN. Two months before admission, MVI was discontinued in the TPN because of the shortage of its supply. An oral multivitamin tablet was substituted instead. She was admitted to the hospital for persistent vomiting. In the hospital, she continued to receive TPN without MVI, but continued taking an oral multivitamin preparation. Two weeks after admission, she developed signs of WE including diplopia, ophthalmoplegia, nystagmus, and memory disturbance. She also developed hypotension that was thought to be caused by beriberi. She was treated with 50 mg of intravenous thiamine. Within hours of the intravenous thiamine, her hypotension resolved. The day after the infusion, she no longer complained of diplopia, and her ophthalmoplegia had improved dramatically. Magnetic resonance imaging showed several areas of abnormally high signal on T2-weighted images in the brainstem, thalamus, and mamillary bodies. The topographic distribution of these changes was typical of WE. After 2 months, her mental status and neurologic status had recovered completely.WE and thiamine deficiency should be considered in all patients with malabsorption, malnutrition, and malignancies. WE from thiamine deficiency can occur as a result of cessation of MVI in the TPN infusion. Even if an oral multivitamin preparation is given instead of MVI, patients with malabsorption may not absorb thiamine adequately. Prompt diagnosis of WE is important because it is potentially fatal and readily treatable with thiamine supplementation. Early recognition of WE may be more difficult in children, because the classic triad of symptoms may not develop fully. Magnetic resonance imaging may be useful in these cases to confirm the diagnosis of WE. Because the shortage of MVI is expected to be a long-term, there are likely to be more cases of WE in the pediatric population of TPN-dependent children. Because there is no shortage of intravenous thiamine, it should be administered with TPN even if MVI is not available.

  View details for Web of Science ID 000071331400026

  View details for PubMedID 9417174