Sarah Hilgenberg

All Publications

• De-escalating Angry Caregivers: A Randomized Controlled Trial of a Novel Communication Curriculum for Pediatric Residents. Academic pediatrics Hilgenberg, S. L., Bogetz, A. L., Leibold, C., Gaba, D., Blankenburg, R. L. 2018

  Abstract

  OBJECTIVE: Medical providers struggle when communicating with angry patients and their caregivers. Pediatric residents perceive communication competencies as an important priority for learning, yet they lack confidence and desire more training in communicating with angry families. Few curricula exist to support trainees with de-escalation skill development. We developed, implemented, and evaluated the impact of a novel de-escalation curriculum on pediatric resident communication skills.METHODS: Randomized controlled trial of a 90-minute de-escalation curriculum for pediatric residents in August-September 2016. Trained standardized patient (SP) actors rated residents' communication skills following two unique encounters before and after the intervention/control session. Residents completed a retrospective pre-post communication skills self-assessment and curriculum evaluation. We used independent and paired t-tests to assess for communication improvements.RESULTS: 84 of 88 (95%) eligible residents participated (43 intervention, 41 control). Residents reported frequent encounters with angry caregivers. At baseline, interns had significantly lower mean SP-rated de-escalation skills than other residents (P = .03). Intervention residents did not improve significantly more than controls on their pre-post change in mean SP-rated de-escalation skills. Intervention residents improved significantly on their pre-post mean self-assessed de-escalation skills (P ≤ .03).CONCLUSIONS: Despite significant self-assessed improvements, residents' SP-rated de-escalation skills did not improve following a skills-based intervention. Nevertheless, our study illustrates the need for de-escalation curricula focused on strategies and peer discussion, suggests optimal timing of delivery during fall of intern year, and offers an assessment tool for exploration in future studies.

  View details for DOI 10.1016/j.acap.2018.10.005

  View details for PubMedID 30368036

• Well-Appearing Newborn With a Vesiculobullous Rash at Birth. Pediatrics Stewart, S. E., Lin, J. L., Everhart, J. L., Pham, T. H., Marqueling, A. L., Rieger, K. E., Hilgenberg, S. L. 2018

  Abstract

  A term, appropriate-for-gestational-age, male infant born via normal spontaneous vaginal delivery presented at birth with a full-body erythematous, vesiculobullous rash. He was well-appearing with normal vital signs and hypoglycemia that quickly resolved. His father had a history of herpes labialis. His mother had an episode of herpes zoster during pregnancy and a prolonged rupture of membranes that was adequately treated. The patient underwent a sepsis workup, including 2 attempted but unsuccessful lumbar punctures, and was started on broad-spectrum antibiotics and acyclovir, given concerns about bacterial or viral infection. The rash evolved over the course of several days. Subsequent workup, with particular attention to his history and presentation, led to his diagnosis.

  View details for PubMedID 29437933

• Outcomes of a Novel Curriculum on De-Escalating Angry Caregivers for Pediatric Residents (Descriptive Abstract) Academic Pediatrics Hilgenberg, S. L., Bogetz, A. L., Leibold, C., Gaba, D., Blankenburg, R. L. 2017; 17 (5): e3
• “Recipient of a finding incidental to research” Incidental Findings in Research, Presidential Commission for the Study of Bioethical Issues Hilgenberg, S. http://bioethics.gov/node/1617. 2013
• Analysis of factors that modify susceptibility and rate of progression in amyotrophic lateral sclerosis (ALS) AMYOTROPHIC LATERAL SCLEROSIS Qureshi, M. M., Hayden, D., Urbinelli, L., Ferrante, K., Newhall, K., Myers, D., Hilgenberg, S., Smart, R., Brown, R. H., Cudkowicz, M. E. 2006; 7 (3): 173-182

  Abstract

  We conducted case-control and prospective longitudinal studies to examine risk factors and predictors of disease progression for ALS. Ninety-five subjects with ALS and 106 healthy control subjects were enrolled. All subjects completed a risk factor questionnaire at enrollment. The ALS subjects were prospectively followed for one year to define factors that influence the rate of disease progression, measured by rate of change in percent predicted forced vital capacity (%FVC) and the ALS functional rating scale (ALSFRS) score. The association of each potential risk factor with ALS was determined using univariate logistic regression. A random slope model was used to determine the association of each risk factor with disease progression. The demographic characteristics of ALS subjects and controls at enrollment did not differ. Significant risk factors for ALS included reported exposure to lead (p = 0.02) and pesticides (p = 0.03). Disease progression was faster in the ALS subjects having bulbar onset and a shorter time period between onset of symptoms and diagnosis. Pertinent variables not associated with either causation or progression of ALS included physical activity, cigarette smoking and a history of physical trauma or other clinical disorders.

  View details for DOI 10.1080/14660820600640596

  View details for Web of Science ID 000241153900007

  View details for PubMedID 16963407

• Transformation: from medical student to patient. Annals of internal medicine Hilgenberg, S. 2006; 144 (10): 779-780

  View details for PubMedID 16702597

• Increased plasma levels of matrix metalloproteinase-9 in patients with Alzheimer's disease NEUROCHEMISTRY INTERNATIONAL Lorenzl, S., Albers, D. S., Relkin, N., Ngyuen, T., Hilgenberg, S. L., Chirichigno, J., Cudkowicz, M. E., Beal, M. F. 2003; 43 (3): 191-196

  Abstract

  Matrix metalloproteinases (MMPs) may play a role in the pathophysiology of Alzheimer's disease (AD). MMP-9 and tissue inhibitors of metalloproteinases (TIMPs) are elevated in postmortem brain tissue of AD patients. MMPs and TIMPs are found in neurons, microglia, vascular endothelial cells and leukocytes. The aim of this study was to determine whether circulating levels of MMP-2, MMP-9, TIMP-1 and TIMP-2 are elevated in the plasma of AD patients. We compared AD patients to age- and gender-matched controls as well as to Parkinson's disease (PD) and amyotrophic lateral sclerosis (ALS) patients. There was constitutive expression of gelatinase A (MMP-2), and gelatinase B (MMP-9), in all the samples as shown by zymographic analysis. Levels of MMP-9 were significantly (P=0.003) elevated in the plasma of AD patients as compared to controls. Plasma levels of MMP-2, TIMP-1 and TIMP-2 were unchanged. There were no significant changes of MMP-2, MMP-9, TIMP-1 and TIMP-2 levels in PD and ALS samples. TIMP-1 and TIMP-2 were significantly correlated with MMP-9 in the AD patients. ApoE genotyping of plasma samples showed that levels of MMP-2, TIMP-1 and TIMP-2 and MMP-9 were not significantly different between the ApoE subgroups. These findings indicate that circulating levels of MMP-9 are increased in AD and may contribute to disease pathology.

  View details for DOI 10.1016/S0197-0186(03)00004-4

  View details for Web of Science ID 000182900400002

  View details for PubMedID 12689599

• Tissue inhibitors of matrix metalloproteinases are elevated in cerebrospinal fluid of neurodegenerative diseases JOURNAL OF THE NEUROLOGICAL SCIENCES Lorenzl, S., Albers, D. S., LeWitt, P. A., Chirichigno, J. W., Hilgenberg, S. L., Cudkowicz, M. E., Beal, M. F. 2003; 207 (1-2): 71-76

  Abstract

  Matrix metalloproteinases (MMPs) are implicated in the pathogenesis of diseases such as Alzheimer's Disease (AD) and amyotrophic lateral sclerosis (ALS). Increased expression of MMP-9 and TIMPs has been reported in postmortem AD and ALS brain tissue, as well as in ALS cerebrospinal fluid (CSF) and plasma. Although individual studies of MMP and TIMP expression in CSF have included AD and ALS samples, there are no studies comparing the expression of these proteins between neurodegenerative diseases. We measured the levels of matrix metalloproteinases (MMPs)-2 and -9 and the tissue inhibitor of MMPs (e.g. TIMP-1 and TIMP-2) in CSF samples from patients with Parkinson's Disease (PD), Huntington's Disease (HD), AD and ALS as compared to age-matched control patients. There was constitutive expression of the proform of gelatinase A (proMMP-2) on zymography gels in all CSF samples. Unexpectedly, there was an additional gelatinolytic band at 130 kDa of unknown etiology in the CSF samples of patients with PD (61% of patients studied), AD (61%), HD (25%) and ALS (39%). Levels of TIMP-1 were significantly elevated in CSF samples from all disease groups. TIMP-2 was significantly increased in CSF of AD and HD patients. MMP-2 levels did not differ significantly between groups. These findings show that TIMPs are elevated in the CSF of patients with neurodegenerative diseases suggesting a potential role of these endogenous inhibitors of matrix metalloproteinases in neurodegenerative diseases.

  View details for Web of Science ID 000181533500012

  View details for PubMedID 12614934