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1.  Isolation of tracheal aspirate mesenchymal stromal cells predicts bronchopulmonary dysplasia 
Pediatrics  2010;126(5):10.1542/peds.2009-3445.
We have isolated mesenchymal stromal cells (MSCs) from tracheal aspirates of premature infants with respiratory distress. Under the influence of transforming growth factor-β, MSCs differentiate into α-smooth muscle actin-expressing myofibroblasts. Myofibroblasts are increased in the lungs of patients with bronchopulmonary dysplasia (BPD), a chronic lung disease of prematurely-born infants.
We tested whether isolation of MSCs from tracheal aspirates of premature infants with respiratory distress during the first week of life correlates with BPD.
Patients and Methods
Eighty-four infants born at gestational age <33 weeks and requiring mechanical ventilation were studied. Aspirates were collected during suctioning and centrifuged. Cell pellets were resuspended in culture medium and plated. Adherent cells were grown to confluence.
MSCs were isolated from the tracheal aspirates of 56 infants; 28 infants showed no MSCs. There was no statistical difference in gestational age or birth weight between the ‘MSC’ and ‘no MSC’ groups. In the MSC group, 12 died and 25 developed BPD, as defined by a requirement for supplemental O2 at 36 wks post-menstrual age. In the ‘no MSC’ group, 6 infants died and 1 developed BPD. Accounting for the potential influences of gender, birth weight, gestational age, number of tracheal aspirate samples taken and the duration of endotracheal intubation (up to 7 days), isolation of MSCs increased the adjusted odds ratio of BPD over 21-fold (95% confidence intervals: 1.82, 265.85).
Isolation of tracheal aspirate MSCs predicts the development of BPD, which suggests that MSCs play an important role in the pathogenesis of this disease.
PMCID: PMC3887445  PMID: 20937656
chronic lung disease; lipofibroblast; myofibroblast
2.  Variation in lumbar punctures for early onset neonatal sepsis: a nationally representative serial cross-sectional analysis, 2003-2009 
BMC Pediatrics  2012;12:134.
Whether lumbar punctures (LPs) should be performed routinely for term newborns suspected of having early onset neonatal sepsis (EONS) is subject to debate. It is unclear whether variations in performance of LPs for EONS may be associated with patient, hospital, insurance or regional factors. Our objective was to identify characteristics associated with the practice of performing LPs for suspected EONS in a nationally representative sample.
Utilizing data from the 2003, 2006 and 2009 Kids’ Inpatient Database (KID) compiled by the Agency for Healthcare Research and Quality, we examined the frequency and characteristics of term, normal-birth weight newborns receiving an LP for EONS. Survey-weighting was applied for national estimates and used in chi squared and multivariable regression analysis.
In 2009, there were 13,694 discharges for term newborns that underwent LPs for apparent EONS. Newborns having LPs performed were more likely to be covered by Medicaid vs. private insurance (51.9 vs. 45.1 percent; p < 0.001), be born in urban vs. rural hospitals (94.8 vs. 87.3 percent; p < 0.001), teaching vs. non-teaching (60.8 vs. 43.1 percent; p < 0.001) and children’s hospitals vs. non-children’s (23.0 vs. 11.2 percent; p < 0.001). Lastly, newborns having LPs performed were disproportionately born in the Northeast census region (p = 0.03). In multi-year adjusted analysis, infants with Medicaid coverage, and those born in urban or teaching hospitals, consistently had higher odds of having an LP performed.
We found pronounced variation in LPs performed for EONS, even when adjusting for clinical conditions that would prompt LPs. These findings indicate practice variations in newborn care that merit further examination and explanation.
PMCID: PMC3469339  PMID: 22928623
Neonatal; Sepsis; Lumbar puncture; Variation; Early onset neonatal sepsis
3.  A validated search assessment tool: assessing practice-based learning and improvement in a residency program 
The objective of this study was to validate an assessment instrument for MEDLINE search strategies at an academic medical center.
Two approaches were used to investigate if the search assessment tool could capture performance differences in search strategy construction. First, data from an evaluation of MEDLINE searches from a pediatric resident's longitudinal assessment were investigated. Second, a cross-section of search strategies from residents in one incoming class was compared with strategies of residents graduating a year later. MEDLINE search strategies formulated by faculty who had been identified as having search expertise were used as a gold standard comparison. Participants were presented with a clinical scenario and asked to identify the search question and conduct a MEDLINE search. Two librarians rated the blinded search strategies.
Search strategy scores were significantly higher for residents who received training than the comparison group with no training. There was no significant difference in search strategy scores between senior residents who received training and faculty experts.
The results provide evidence for the validity of the instrument to evaluate MEDLINE search strategies. This assessment tool can measure improvements in information-seeking skills and provide data to fulfill Accreditation Council for Graduate Medical Education competencies.
PMCID: PMC3016654  PMID: 21243059
4.  Real-time, evidence-based medicine instruction: a randomized controlled trial in a neonatal intensive care unit* 
Purpose: The study assesses potential for improving residents' evidence-based medicine searching skills in MEDLINE through real-time librarian instruction.
Subjects: Ten residents on a rotation in a neonatal intensive care unit participated.
Methodology: Residents were randomized into an instruction and a non-instruction group. Residents generated questions from rounds and searched MEDLINE for answers. Data were collected through observation, search strategy analysis, and surveys. Librarians observed searches and collected data on questions, searching skills, search problems, and the test group's instruction topics. Participants performed standardized searches before, after, and six-months after intervention and were scored using a search strategy analysis tool (1 representing highest score and 5 representing lowest score). Residents completed pre- and post-intervention surveys to measure opinions about MEDLINE and search satisfaction.
Results: Post-intervention, the test group formulated better questions, used limits more effectively, and reported greater confidence in using MEDLINE. The control group expressed less satisfaction with retrieval and demonstrated more errors when limiting. The test and control groups had the following average search scores respectively: 3.0 and 3.5 (pre-intervention), 3.3 and 3.4 (post-intervention), and 2.0 and 3.8 (six-month post-intervention).
Conclusion: Data suggest that measurable learning outcomes were achieved. Residents receiving instruction improved and retained searching skills six-months after intervention.
PMCID: PMC100764  PMID: 11999177

Results 1-4 (4)