Papers by Jacquelyn Baskin
Unrestricted Background: Advances in pediatric cancer care which have improved outcomes in high-i... more Unrestricted Background: Advances in pediatric cancer care which have improved outcomes in high-income countries have not reached the 80% of children with cancer who live in low-income countries. Efforts have been made to improve care for children with leukemia (the commonest childhood cancer) in low-income countries, but there has been virtually no focus on children with brain tumors (the second commonest childhood cancer). This study focused on Paraguay, a low-middle income country in South America. Only approximately 50% of the expected cases are diagnosed each year and of those, only 50% survive more than a few months after diagnosis. For children with central nervous system (CNS) tumors, preliminary data from two hospitals in Paraguay demonstrate that the number of children diagnosed with brain cancer is less than 50% of what is expected for the population based on global statistics. Patients that are referred for treatment have high morbidity and mortality. The goal of this st...
The Journal of the American Board of Family Medicine, 2018
Introduction: Although most patients with rare diseases like sickle cell disease (SCD) are treate... more Introduction: Although most patients with rare diseases like sickle cell disease (SCD) are treated in the primary care setting, primary care physicians may find it challenging to keep abreast of medication improvements and complications associated with treatment for rare and complex diseases. The purpose of this study was to evaluate the effectiveness of a clinical decision support (CDS)-based intervention system for transfusional iron overload in adults with SCD to improve management in primary care. Methods: An electronic medical record based clinical decision support system for potential transfusional iron overload in SCD patients in primary care was evaluated. The intervention was implemented in 3 family medicine clinics with a control group of 3 general internal medicine clinics. Data were collected in the 6 months before the intervention and 6 months after the intervention. There were 47 patients in the family medicine group and 24 in the general internal medicine group. Results: There was no management change in the control group while the intervention group improved primary care management from 0% to 44% (P < .001). Conclusion: A CDS tool can improve management of SCD patients in primary care.
American Journal of Hematology, 2018
AIP Conference Proceedings, 2000
ABSTRACT Alterations in cardiovascular regulation and function that occur during and after space ... more ABSTRACT Alterations in cardiovascular regulation and function that occur during and after space flight have been reported. These alterations are manifested, for example, by reduced orthostatic tolerance upon reentry to the earth’s gravity from space. However, the precise physiologic mechanisms responsible for these alterations remain to be fully elucidated. Perhaps as a result, fully effective countermeasures have yet to be developed. The National Space Biomedical Research Institute Cardiovascular Alterations Team is currently conducting a head-down tilt bed rest study in Boston. These studies involve the application of two powerful new methodologies developed at the NASA Center for Quantitative Cardiovascular Physiology, Modeling and Data Analysis at the Massachusetts Institute of Technology—cardiovascular system identification and T Wave Alternans analysis—for the study of the effects of simulated microgravity on the cardiovascular system. This study is being used as a basis for developing effective countermeasures against microgravity induced orthostatic hypotension and ventricular arrhythmias. © 2000 American Institute of Physics.
Hematology, 2014
Objective and importance Homozygous Southeast Asian alpha-thalassemia mutation (--(SEA)/--(SEA)) ... more Objective and importance Homozygous Southeast Asian alpha-thalassemia mutation (--(SEA)/--(SEA)) results in deletion of all alpha-globin genes (alpha(0)-thalassemia). Since all alpha-globin chains are absent, hemoglobin F cannot be synthesized, and hemoglobin Bart&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s becomes the dominant fetal hemoglobin. Hemoglobin Bart&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s is a γ tetramer with a very high oxygen affinity, thus oxygen delivery to the tissues is poor. Clinical manifestations include severe fetal anemia, hydrops fetalis, fetal demise, and high risk of neurodevelopmental impairment in the rare survivors. Clinical presentation A 39-year-old Vietnamese woman presented to our center at 28 0/7 weeks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; gestation with fetal alpha(0)-thalassemia (--(SEA)/--(SEA) type deletion) and ultrasound markers suggestive of severe fetal anemia. Intervention The fetus was treated with four intrauterine transfusions followed by post-natal chronic transfusions. Formal neurodevelopmental testing (Battelle Developmental Inventory, Second Edition) was performed at 18 months of age, and the developmental quotient was 93 (32nd percentile) with all subdomains noted within normal limits, indicating overall intact neurodevelopment. Conclusion We posit that earlier diagnosis and fetal treatment, prior to clinical findings suggestive of fetal anemia, may improve long-term outcomes by enhancing oxygen delivery to the tissues of the developing fetus.
Pediatric Emergencies, 2020
Children often present to the emergency department for evaluation of a variety of hematologic com... more Children often present to the emergency department for evaluation of a variety of hematologic complaints ranging from pallor to bruising and bleeding. Some may require emergent evaluation and treatment, whereas others pose more of a diagnostic challenge. A detailed history and physical examination along with laboratory evaluation can aid in appropriate diagnosis and management of these patients. Hematologic emergencies include anemia, disorders of clotting, and sickle cell disease. This chapter reviews common presentations of many pediatric hematologic conditions, atypical presentations, and important diagnostic criteria. In addition, the chapter presents evidence-based treatment algorithms. Potential complications of various conditions are also discussed.
Neuro-Oncology, 2012
Background. Cure rates among children with brain tumors differ between low-income and high-income... more Background. Cure rates among children with brain tumors differ between low-income and high-income countries. To evaluate causes of these differences, we analyzed aspects of care provided to pediatric neuro-oncology patients in a low middle-income South American country. Methods. Three methods were used to evaluate treatment of children with brain tumors in Paraguay: (1) a quantitative needs assessment questionnaire for local treating physicians, (2) site visits to assess 3 tertiary care centers in Asunció n and a satellite clinic in an underdeveloped area, and (3) interviews with health care workers from relevant disciplines to determine their perceptions of available resources. Treatment failure was defined as abandonment of therapy, relapse, or death. Results. All 3 tertiary care facilities have access to chemotherapy and pediatric oncologists but lack training and tools for neuropathology and optimal neurosurgery. The 2 public hospitals also lack access to appropriate radiological tests and timely radiotherapy. These results demonstrate disparities in Paraguay, with rates of treatment failure ranging from 37% to 83% among the 3 facilities. Conclusions. National and center-specific deficiencies in resources to manage pediatric brain tumors contribute to poor outcomes in Paraguay and suggest that both national and center-specific interventions are warranted to improve care. Disparities in Paraguay reflect different levels of governmental and philanthropic support, program development, and socioeconomic status of patients and families, which must be considered when developing targeted strategies to improve management. Effective targeted interventions can serve as a model to develop pediatric brain tumor programs in other lowand middle-income countries.
The Lancet, 2009
Long-term central venous catheters (CVC) facilitate care for patients with chronic illnesses, but... more Long-term central venous catheters (CVC) facilitate care for patients with chronic illnesses, but catheter occlusions and catheter-related thrombosis (CRT) are common complications. This review summarizes management of CVC and CRT. Mechanical CVC occlusions require cause-specific therapy; whereas, thrombotic occlusions usually resolve with thrombolytic therapy, such as alteplase. Prophylaxis with thrombolytic flushes may decrease CVC infections and CRT, but confirmatory studies and cost-effectiveness analysis are needed. Risk factors for CRT include previous catheter infections, malposition of the catheter tip, and prothrombotic states. CRT can lead to catheter infection, pulmonary embolism, and post-thrombotic syndrome. CRT is diagnosed primarily using Doppler ultrasound or venography and treated with anticoagulation for 6 weeks to a year, depending on the extent of the thrombus, response to initial therapy, and whether thrombophilic factors persist. Prevention of CRT includes proper positioning of the CVC and prevention of infections; anticoagulation prophylaxis is not recommended at present.
Haematologica, 2011
Long-term central venous catheters have improved the quality of care for patients with chronic il... more Long-term central venous catheters have improved the quality of care for patients with chronic illnesses, but are complicated by obstructions which can result in delay of treatment or catheter removal. Design and Methods This paper reviews thrombolytic treatment for catheter obstruction. Literature from Medline searches using the terms "central venous catheter", "central venous access device" OR "central venous line" associated with the terms "obstruction", "occlusion" OR "thrombolytic" was reviewed. Efficacy of thrombolytic therapy, central venous catheter clearance rates and time to clearance were assessed. Results Alteplase, one of the current therapies, clears 52% of obstructed catheters within 30 min with 86% overall clearance (after 2 doses, when necessary). However, newer medications may have higher efficacy or shorter time to clearance. Reteplase cleared 67-74% within 30-40 min and 95% of catheters overall. Occlusions were resolved in 70 and 83% of patients with one and 2 doses of tenecteplase, respectively. Recombinant urokinase cleared 60% of catheters at 30 min and 73% overall. Alfimeprase demonstrated rapid catheter clearance with resolution in 40% of subjects within 5 min, 60% within 30 min, and 80% within 2 h. Additionally, urokinase prophylaxis decreased the incidence of catheter occlusions from 16-68% in the control group to 4-23% in the treatment group; in some studies, rates of catheter infections were also decreased in the urokinase group. Conclusions Thrombolytic agents successfully clear central venous catheter occlusions in most cases. Newer agents may act more rapidly and effectively than currently utilized therapies, but randomized studies with direct comparisons of these agents are needed to determine optimal management for catheter obstruction.
Pediatrics in Review, 2019
Children face a daily balancing act between antigens, allergy, and immunity. Sometimes, that bala... more Children face a daily balancing act between antigens, allergy, and immunity. Sometimes, that balance turns pathologic. Either the antigen can "win" or the immune response can end up hurting the host. In the review articles and case reports this month, we are reminded of immune reactions gone awry, and we learn how to care for affected children.
American Journal of Hematology, Feb 5, 2020
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Papers by Jacquelyn Baskin