Andreas A Theodorou

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Chapters

• Theodorou, A. (2021). Oxygen Delivery and Oxygen Consumption in Pediatric Critical Care. In Pediatric Critical Care: Text and Study Guide(pp 28-53). Springer. doi:https://doi.org/10.1007/978-3-030-53363-2
• Meyer, R. J., Theodorou, A. A., Theodorou, A. A., & Berg, R. A. (2014). Paediatric Considerations in Drowning. In Handbook on Drowning. Springer, Berlin, Heidelberg. doi:10.1007/978-3-642-04253-9_99
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  Drowning is one of the most common definable aetiologies of out-of-hospital paediatric cardiac arrest and constitutes a major cause of paediatric mortality and morbidity. For children of all ages, drowning was the cause of 5–8 % of out-of-hospital cardiac arrests in the USA and Canada [1], Japan [2] and the Netherlands [3]. For younger children, 1–12 years old, drowning was the cause of 9–13 % of out-of-hospital cardiac arrests [1, 2]. Importantly, children with out-of-hospital cardiac arrests from drowning are more likely to survive than those with arrests from other aetiologies [4].
• Gutierrez, J. A., Theodorou, A. A., & Theodorou, A. A. (2012). Oxygen Delivery and Oxygen Consumption in Pediatric Critical Care. In Pediatric Critical Care. Springer, London. doi:10.1007/978-0-85729-923-9_2
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  The maintenance of adequate oxygen delivery to meet the demands of tissues is the essence of critical care medicine. Inadequate oxygen delivery, which can occur on a global level as in cardiogenic shock, or on a regional level as in traumatic brain injury, must be recognized and treated in order to achieve a good clinical outcome. Therefore, an understanding of the determinants of oxygen delivery and oxygen consumption in the critically ill pediatric patient is essential for any pediatric critical care clinician.

Journals/Publications

• Theodorou, A. (2024).

   "Should they stay or should they go?: description of the largest open-label scorpion antivenom clinical trial reported to the National Poison Data System." 

   

  . Toxicon, 248. doi:https://doi.org/10.1016/j.toxicon.2024.107925.
• Venner, E., Patterson, K., Kalra, D., Wheeler, M. M., Chen, Y. J., Kalla, S. E., Yuan, B., Karnes, J. H., Walker, K., Smith, J. D., McGee, S., Radhakrishnan, A., Haddad, A., Empey, P. E., Wang, Q., Lichtenstein, L., Toledo, D., Jarvik, G., Musick, A., , Gibbs, R. A., et al. (2024). The frequency of pathogenic variation in the All of Us cohort reveals ancestry-driven disparities. Communications biology, 7(1), 174.
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  Disparities in data underlying clinical genomic interpretation is an acknowledged problem, but there is a paucity of data demonstrating it. The All of Us Research Program is collecting data including whole-genome sequences, health records, and surveys for at least a million participants with diverse ancestry and access to healthcare, representing one of the largest biomedical research repositories of its kind. Here, we examine pathogenic and likely pathogenic variants that were identified in the All of Us cohort. The European ancestry subgroup showed the highest overall rate of pathogenic variation, with 2.26% of participants having a pathogenic variant. Other ancestry groups had lower rates of pathogenic variation, including 1.62% for the African ancestry group and 1.32% in the Latino/Admixed American ancestry group. Pathogenic variants were most frequently observed in genes related to Breast/Ovarian Cancer or Hypercholesterolemia. Variant frequencies in many genes were consistent with the data from the public gnomAD database, with some notable exceptions resolved using gnomAD subsets. Differences in pathogenic variant frequency observed between ancestral groups generally indicate biases of ascertainment of knowledge about those variants, but some deviations may be indicative of differences in disease prevalence. This work will allow targeted precision medicine efforts at revealed disparities.
• Theodorou, A. (2022). The All of Us research program: data quality, utility, and diversity. Patterns, 3(8).
• Ojo, T., Theodorou, A., Karnes, J. H., Vemulapalli, T., Ilori, T. O., Viera, E., Wilson, J., Moreno, F., Menon, U., Ehiri, J., Peterson, R., StimsonRiahi, S. C., Rosales, C., Calhoun, E., Sokan, A., Reiman, E., & Ojo, A. (2020). Approach to High Volume Enrollment in Clinical Research: Experiences from an All of Us Research Program Site. Clinical and Translational Science, 13(4), 685-692. doi:10.1111/cts.12759
• Topjian, A., Telford, R., Holubkov, R., Nadkarni, V., Berg, R., Dean, J., Moler, F., Meert, K., Hutchinson, J., Newth, C., Bennett, K., Berger, J., Pineda, J., Koch, J., Schleien, C., Dalton, H., Ofori-Amanfo, G., Goodman, D., Fink, E., , McQuillen, P., et al. (2019). The association of early post-resuscitation hypotension with discharge survival following targeted temperature management for pediatric in-hospital cardiac arrest. Resuscitation, 141. doi:10.1016/j.resuscitation.2019.05.032
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  Aim: Approximately 40% of children who have an in-hospital cardiac arrest (IHCA) in the US survive to discharge. We aimed to evaluate the impact of post-cardiac arrest hypotension during targeted temperature management following IHCA on survival to discharge. Methods: This is a secondary analysis of the therapeutic hypothermia after pediatric cardiac arrest in-hospital (THAPCA-IH) trial. “Early hypotension” was defined as a systolic blood pressure less than the fifth percentile for age and sex for patients not treated with extracorporeal membrane oxygenation (ECMO) or a mean arterial pressure less than fifth percentile for age and sex for patients treated with ECMO during the first 6 h of temperature intervention. The primary outcome was survival to hospital discharge. Results: Of 299 children, 142 (47%) patients did not receive ECMO and 157 (53%) received ECMO. Forty-two of 142 (29.6%) non-ECMO patients had systolic hypotension. Twenty-three of 157 (14.7%) ECMO patients had mean arterial hypotension. After controlling for confounders of interest, non-ECMO patients who had early systolic hypotension were less likely to survive to hospital discharge (40.5% vs. 72%; adjusted OR [aOR] 0.34; 95%CI, 0.12–0.93). There was no difference in survival to discharge by blood pressure groups for children treated with ECMO (30.4% vs. 49.3%; aOR = 0.60; 95%CI, 0.22–1.63). Conclusions: In this secondary analysis of the THAPCA-IH trial, in patients not treated with ECMO, systolic hypotension within 6 h of temperature intervention was associated with lower odds of discharge survival. Blood pressure groups in patients treated with ECMO were not associated with survival to discharge.
• Gerkin, R., Raschke, R. A., Farrer, P., Josey, K., Kasperski, M. D., Kayani, A. S., Smith, M. L., Theodorou, A. A., & Young, G. (2018). Hospitals with more-active participation in conducting standardized in-situ mock codes have improved survival after in-hospital cardiopulmonary arrest.. Resuscitation, 133, 47-52. doi:10.1016/j.resuscitation.2018.09.020
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  The American Heart Association (AHA) and the Institute of Medicine have published a national "call-to-action" to improve survival from in-hospital cardiopulmonary arrest (IHCA). Our aim was to determine if more-active hospital participation in standardized in-situ mock code (ISMC) training is associated with increased IHCA survival..We performed an ecological study across a multi-state healthcare system comprising 26 hospitals. Hospital-level ISMC performance was measured during 2016-2017 and IHCA hospital discharge survival rates in 2017. We performed univariate and multivariate analysis of the hospital-level association between more-active ISCM participation and IHCA survival, with adjustment for hospital expected mortality as determined by a commercial severity scoring system. Other potential confounders were analyzed using univariate statistics..Hospitals with more-active ISMC participation conducted a median of 17.6 ISMCs/100 beds/year (vs 3.2/100 beds/year in less-active hospitals, p = 0.001) in 2016-2017. 220,379 patients were admitted and 3289 experienced IHCA in study hospitals in 2017, with an overall survival rate of 37.4%. Hospitals with more-active ISMC participation had a mean IHCA survival rate of 42.8% vs. 31.8% in hospitals with less-active ISMC participation (p < 0.0001), and a significantly reduced odds ratio (OR) of 0.62 for IHCA mortality (95% CI: 0.54-0.72; p < 0.0001) which was unchanged after adjustment for hospital-level expected mortality (adjusted OR: 0.62; 95% CI: 0.54-0.71; p < 0.001)..Hospitals in our healthcare system with more-active ISMC participation have higher IHCA survival. Prospective trials are needed to establish the efficacy of standardized ISMC training programs in improving patient survival after cardiac arrest.
• Topjian, A., Moler, F., Telford, R., Holubkov, R., Nadkarni, V., Berg, R., Dean, J., Meert, K., Hutchinson, J., Newth, C., Bennett, K., Berger, J., Pineda, J., Koch, J., Schleien, C., Dalton, H., Ofori-Amanfo, G., Goodman, D., Fink, E., , McQuillen, P., et al. (2018). Association of early postresuscitation hypotension with survival to discharge after targeted temperature management for pediatric out-of-hospital cardiac arrest secondary analysis of a randomized clinical trial. JAMA Pediatrics, 172(2). doi:10.1001/jamapediatrics.2017.4043
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  IMPORTANCE Out-of-hospital cardiac arrest (OHCA) occurs in more than 6000 children each year in the United States, with survival rates of less than 10% and severe neurologic morbidity in many survivors. Post-cardiac arrest hypotension can occur, but its frequency and association with survival have not been well described duringtargeted temperature management. OBJECTIVE To determine whether hypotension is associated with survival to discharge in children and adolescents after resuscitation from OHCA. DESIGN, SETTING, AND PARTICIPANTS This post hoc secondary analysis of the Therapeutic Hypothermia After Pediatric Cardiac Arrest (THAPCA) trial included 292 pediatric patients older than 48 hours and younger than 18 years treated in 36 pediatric intensive care units from September 1,2009, through December 31,2012. Participants underwent therapeutic hypothermia (33.0°C) vs therapeutic normothermia (36.8°C) for 48 hours. All participants had hourly systolic blood pressure measurements documented during the initial 6 hours of temperature intervention. Hourly blood pressures beginning at the time of temperature intervention (time 0) were normalized for age, sex, and height. Early hypotension was defined as a systolic blood pressure less than the fifth percentile during the first 6 hours after temperature intervention. With use of forward stepwise logistic regression, covariates of interest (age, sex, initial cardiac rhythm, any preexisting condition, estimated duration of cardiopulmonary resuscitation [CPR], primary cause of cardiac arrest, temperature intervention group, night or weekend cardiac arrest, witnessed status, and bystander CPR) were evaluated in the final model. Data were analyzed from February 5,2016, through June 13,2017. EXPOSURES Hypotension. MAIN OUTCOMES AND MEASURE Survival to hospital discharge. RESULTS Of 292children (194 boys [66.4%] and 98 girls [33.6%]; medianage, 23.0 months [interquartile range, 5.0-105.0 months]), 78 (26.7%) had at least 1 episode of early hypotension. No difference was observed between the therapeutic hypothermia and therapeutic normothermia groups in the prevalence of hypotension during induction and maintenance (73 of 153 [47.7%] vs 72 of 139 [51.8%]; P = .50) orre warming (35 of 118 [29.7%] vs 19 of 95 [20.0%]; P = .10) during the first 72 hours. Participants who had early hypotension were less likely to survive to hospital discharge (20 of 78 [25.6%] vs 93 of 214 [43.5%]; adjusted odds ratio, 0.39; 95% CI, 0.20-0.74). CONCLUSIONS AND RELEVANCE In this post hoc secondary analysis of the THAPCA trial, 26.7% of participants had hypotension within 6 hours after temperature intervention. Early post-cardiac arrest hypotension was associated with lower odds of discharge survival, even after adjusting for covariates of interest.
• Amerongen, H., LeGros, T., Cooley, J., Schloss, E., & Theodorou, A. (2015). Constructive contact: Design of a successful introductory interprofessional education experience. Currents in Pharmacy Teaching and Learning, 7(5). doi:10.1016/j.cptl.2015.06.013
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  Background: Interprofessional education (IPE) programs have been endorsed for health professions students to improve team function in health care delivery and optimize patient outcomes. Educators have had mixed success with IPE for entry-level health professions students, with some observing exacerbated interprofessional tension. This report describes an IPE mini-course for medical, nursing, and pharmacy students structured to meet the criteria of Allport's Contact Hypothesis. Methods: Interprofessional education planners designed and implemented a constructivist exercise for medical, nursing, and pharmacy students examining scope of practice and team behavior. Assigned readings connected improved role knowledge and team behavior with the ultimate goal of enhanced patient safety. Role knowledge prior to the event was measured with a pre-test. Knowledge and attitudes were measured with a post-event survey. Results: Prior knowledge was the highest for the physician role and the lowest for the pharmacist role. Following the mini-course, knowledge of professional roles and behaviors increased. Student groups expressed strong appreciation for IPE, with pharmacy students responding most positively. Conclusions: Students emerge strongly affirming the importance of IPE in achieving quality care and patient safety. Positive outcomes are discussed in relation to predictions of the Contact Hypothesis and Social Identity Theory.
• Moler, F., Silverstein, F., Holubkov, R., Slomine, B., Christensen, J., Nadkarni, V., Meert, K., Clark, A., Browning, B., Pemberton, V., Page, K., Shankaran, S., Hutchison, J., Newth, C., Bennett, K., Berger, J., Topjian, A., Pineda, J., Koch, J., , Schleien, C., et al. (2015). Therapeutic hypothermia after out-of-hospital cardiac arrest in children. New England Journal of Medicine, 372(20). doi:10.1056/NEJMoa1411480
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  Background: Therapeutic hypothermia is recommended for comatose adults after witnessed outofhospital cardiac arrest, but data about this intervention in children are limited. Methods: We conducted this trial of two targeted temperature interventions at 38 children's hospitals involving children who remained unconscious after out-of-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose patients who were older than 2 days and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a Vineland Adaptive Behavior Scales, second edition (VABS-II), score of 70 or higher (on a scale from 20 to 160, with higher scores indicating better function), was evaluated among patients with a VABS-II score of at least 70 before cardiac arrest. Results: A total of 295 patients underwent randomization. Among the 260 patients with data that could be evaluated and who had a VABS-II score of at least 70 before cardiac arrest, there was no significant difference in the primary outcome between the hypothermia group and the normothermia group (20% vs. 12%; relative likelihood, 1.54; 95% confidence interval [CI], 0.86 to 2.76; P = 0.14). Among all the patients with data that could be evaluated, the change in the VABS-II score from baseline to 12 months was not significantly different (P = 0.13) and 1-year survival was similar (38% in the hypothermia group vs. 29% in the normothermia group; relative likelihood, 1.29; 95% CI, 0.93 to 1.79; P = 0.13). The groups had similar incidences of infection and serious arrhythmias, as well as similar use of blood products and 28-day mortality. Conclusions: In comatose children who survived out-of-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a good functional outcome at 1 year. (Funded by the National Heart, Lung, and Blood Institute and others; THAPCA-OH ClinicalTrials.gov number, NCT00878644.)
• Boyer, L., Theodorou, A., Chase, P., Osnaya, N., Berg, M., Mallie, J., Carbajal, Y., De Jesus-Hernandez, T., Olvera, F., & Alagón, A. (2013). Effectiveness of Centruroides scorpion antivenom compared to historical controls. Toxicon, 76. doi:10.1016/j.toxicon.2013.07.014
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  Background Envenomation by North American scorpions of genus Centruroides is associated with a syndrome of neurotoxicity and respiratory compromise that disproportionately affects rural children. Severe scorpion envenomation is rare, which makes treatment difficult to study using conventional controlled clinical trials; and small-scale placebo-controlled trials conducted in tertiary centers are of limited generalizability to the community setting. Open label studies, although safer and easier to conduct, are of limited value unless a suitable comparator group is used. Historical controls may be appropriate when concurrent controls are not feasible or ethical. Methods A successful placebo-controlled, double-blind clinical trial design was adapted for community use in Arizona and Mexico. A comparator population was established by replacement of the placebo group with a retrospective cohort and preservation of criteria for inclusion, exclusion, dosing and endpoint assessment. Study endpoints were selected to demonstrate the clearest possible difference between treatment groups, while minimizing confounders. Results were summarized and endpoints were directly compared between groups and with the prior double-blind study. Results The clinical syndrome remained evident in 95.9% of the historical cohort (93/97) 4 h after admission, and their cumulative dose of midazolam given between baseline and discharge was 5.29 ± 8.68 mg/kg (range 0-62.8). Among 78 prospectively treated cases, none received midazolam and only 2 (2.8%) remained symptomatic at 4 h. Venom was detectable in the plasma of all antivenom recipients tested, and it dropped by 90% of baseline in 95% of cases studied. Conclusions The results of this pragmatic study strongly support the findings of the double-blind, placebo controlled clinical trial of the same antivenom. Recipients of antivenom at rural sites improved at a rate similar to that in the intensive care (ICU) setting, and historical cases resolved at a rate similar to that for untreated ICU controls. Use of antivenom in the primary care setting appeared to be safe and effective and to eliminate the need for intensive care or for transport to a tertiary care center, in all subjects prospectively studied. © 2013 Elsevier Ltd. All rights reserved.
• Theodorou, A. A., Patanwala, A. E., & Erstad, B. L. (2012). Comparison of methods for the detection of medication safety events in the critically ill.. Current drug safety, 7(3), 238-46. doi:10.2174/157488612803251270
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  To categorize and synthesize medication safety event detection methods in the critically ill in order to provide clinicians and administrators with approaches to event detection that are intended to expand and complement traditional voluntary reporting systems..A literature search of OvidMEDLINE was performed to identify articles related to medication safety involving critically ill patients in the intensive care unit setting. The inclusion of articles was restricted to comparative studies. The bibliographies of all retrieved articles were reviewed to obtain additional articles of relevance. The various event detection methods were compared by: evidence supporting their use; number, type and severity of events detected; phase of the medication use process in which events were detected; and ease and cost of implementation. Major limitations of each method were also collated..There are a number of methods that can be used to identify medication safety events in the critically ill. These can broadly be categorized as: 1) voluntary reporting, 2) record review, 3) rules/triggers and 4) direct observation and 5) interviews/surveys. Relatively few studies have directly compared these assessment methods in the ICU setting, although the limitations of the traditional voluntary reporting system as the sole method of event detection are well established. Although not truly dichotomous, these methods can be broken down into more proactive and reactive approaches. Rules/triggers and direct observation of the medication use process in the ICU are examples of proactive approaches to event detection, while the traditional unsolicited voluntary reporting is typically reactive. However, each of the event detection methods has advantages and disadvantages, so the methods should not be considered mutually exclusive with respect to obtaining information about medication safety..Given the limitations of traditional voluntary reporting systems, a multimodal approach used to identify medication safety events is most likely to capture the largest number and type of events. We would advise not trying to implement additional approaches beyond voluntary reporting systems all at once. This would be difficult and costly. Rather, we suggest a systematic implementation of additional event detection approaches that takes into account hospital-specific considerations.
• Typpo, K. V., Theodorou, A. A., Larmonier, C. B., Kiela, P. R., Ghishan, F. K., & Deschenes, J. (2012). 1058: INTESTINAL INJURY IN CHILDREN AFTER CARDIOPULMONARY BYPASS. Critical Care Medicine, 40, 1-328. doi:10.1097/01.ccm.0000425271.92762.5c
• Theodorou, A. A., Parrinello, K., O'keeffe, T., Hokula, C. A., Haas, C. E., & Erstad, B. L. (2011). Interdisciplinary patient care in the intensive care unit: focus on the pharmacist.. Pharmacotherapy, 31(2), 128-37. doi:10.1592/phco.31.2.128
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  The field of critical care medicine began to flourish only within the last 40 years, yet it provides some of the best examples of collaborative pharmacy practice models and evidence for the value of pharmacist involvement in interdisciplinary practice. This collaborative approach is fostered by critical care organizations that have elected pharmacists into leadership positions and recognized pharmacists through various honors. There is substantial literature to support the value of the critical care pharmacist as a member of an interdisciplinary intensive care unit (ICU) team, particularly in terms of patient safety. Furthermore, a number of economic investigations have demonstrated cost savings or cost avoidance with pharmacist involvement. As the published evidence supporting pharmacist involvement in patient care activities in the ICU setting has increased, surveys have demonstrated an increase in the percentage of pharmacists performing clinical activities. In addition, substantial support of pharmacists has been provided by other clinicians, safety officers, and administrative personnel who have been involved with the initiation and expansion of critical care pharmacy services in their own institutions. Although there is still room for improvement in the range of pharmacist involvement, particularly with respect to interdisciplinary activities related to education and scholarship, pharmacists have become essential members of interdisciplinary care teams in ICU settings.
• Hennings, S., Romero, A., Erstad, B., Franke, H., & Theodorou, A. (2010). A comparison of automated infusion device technology to prevent medication errors in pediatric and adult intensive care unit patients. Hospital Pharmacy, 45(6). doi:10.1310/hpj4506-464
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  Objective: To compare possible differences in the proportion of medication errors associated with high-risk medications that were avoided by the use of automated infusion device (AID) technology in pediatric and adult intensive care unit (ICU) patients. A secondary purpose was to investigate the number of serious adverse drug events (ADEs) identified by root-cause analyses (RCA).Method: The study included pediatric and adult patients receiving high-risk medications by continuous infusion in an academic medical center with mixed medical-surgical ICUs. A retrospective evaluation of 1 year's data collected prospectively in an AID database was used to compare the proportion of medication errors avoided based on reprogramming events (2.5 times limit as a low threshold) and overrides (10 times limit as high). Information obtained from RCAs was used to compare the proportion of serious ADEs that occurred during the 5-year periods before and after AID implementation.Results: The pediatric population was 1.68 times (95% confidence interval [CI], 1.18 to 2.38) more likely to require a reprogramming event than the adult acute care population for all high-risk medications combined. Significantly more reprogramming events occurred in the pediatric patients with potassium (relative risk [RR], 2.77; 95% CI, 1.15 to 6.68) and insulin (RR, 2.73; 95% CI, 1.15 to 6.45) infusions. Additionally, there were more overrides in the pediatric compared to the adult population for the high-risk medications (RR, 1.82; 95% CI, 1.32 to 2.53). The number of serious adverse or sentinel events as identified in RCAs decreased from six before (four deemed preventable by AID technology) to three (zero preventable) after AID implementation.Conclusions: This study demonstrates that AID technology when properly used leads to reductions in medication errors and possibly serious ADEs in critically ill patients receiving high-risk medications. The technology appears to be particularly beneficial in pediatric patients with weight-based dosing strategies. However, the potential for clinicians to override the alerts remains a concern. © 2010 Thomas Land Publishers, Inc.
• Theodorou, A. A., Romero, A., Hennings, S., Franke, H. A., & Erstad, B. L. (2010). A Comparison of Automated Infusion Device Technology to Prevent Medication Errors in Pediatric and Adult Intensive Care Unit Patients. Hospital Pharmacy, 45(6), 464-471. doi:10.1310/hpj4506-464
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  ObjectiveTo compare possible differences in the proportion of medication errors associated with high-risk medications that were avoided by the use of automated infusion device (AID) technology in p...
• Boyer, L., Theodorou, A., Berg, R., Mallie, J., Hardiman, S., Alagón, A., Chávez-Méndez, A., & García-Ubbelohde, W. (2009). Antivenom for critically ill children with neurotoxicity from scorpion stings. New England Journal of Medicine, 360(20). doi:10.1056/NEJMoa0808455
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  BACKGROUND: Clinically significant scorpion envenomation by Centruroides sculpturatus produces a dramatic neuromotor syndrome and respiratory insufficiency that often necessitate intensive supportive care. We hypothesized that a scorpion-specific F(ab′)2 antivenom would promptly resolve clinical symptoms in children with this syndrome. METHODS: In a randomized, double-blind study, the efficacy of scorpion-specific F(ab′)2 antivenom, as compared with placebo, was assessed in 15 children 6 months to 18 years of age who were admitted to a pediatric intensive care unit with clinically significant signs of scorpion envenomation. The primary end point was the resolution of the clinical syndrome within 4 hours after administration of the study drug. Secondary end points included the total dose of concomitant midazolam for sedation and quantitative plasma venom levels, before and after treatment. RESULTS: The clinical syndrome resolved more rapidly among recipients of the antivenom than among recipients of placebo, with a resolution of symptoms in all eight antivenom recipients versus one of seven placebo recipients within 4 hours after treatment (P = 0.001). More midazolam was administered in the placebo recipients than in the antivenom recipients (mean cumulative dose, 4.61 vs. 0.07 mg per kilogram of body weight; P = 0.01). Plasma venom concentrations were undetectable in all eight antivenom recipients but in only one placebo recipient 1 hour after treatment (P = 0.001). CONCLUSIONS: Among critically ill children with neurotoxic effects of scorpion envenomation, intravenous administration of scorpion-specific F(ab′) 2 antivenom resolved the clinical syndrome within 4 hours, reduced the need for concomitant sedation with midazolam, and reduced the levels of circulating unbound venom. (ClinicalTrials.gov number, NCT00685230.) Copyright © 2009 Massachusetts Medical Society.
• Walter, F. G., Vazquez, H. L., Theodorou, A. A., Mcnally, J., Chase, P. B., Boyer-hassen, L. V., & Alagon, A. (2009). Serum levels and urine detection of Centruroides sculpturatus venom in significantly envenomated patients.. Clinical toxicology (Philadelphia, Pa.), 47(1), 24-8. doi:10.1080/15563650802039965
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  Envenomation by Centruroides sculpturatus can cause systemic signs and symptoms requiring treatment. The toxicokinetics of C. sculpturatus venom has not been described..Venom components were separated for cross-reactivity testing. Serum and urine collected from three patients envenomated by C. sculpturatus had venom levels determined by sandwich enzyme-linked immunosorbent assay (ELISA)..Western blot analysis indicated recognition of C. sculpturatus venom by Alacramyn, an equine F(ab')(2) antivenom developed against Centruroides scorpion venoms, including C. sculpturatus. Serum venom levels in ng/mL with post-envenomation times in minutes (min) were as follows: 85-year-old woman = 8.2 (approximately 150), 2.8 (515), 1.6 (1,200); 14-month-old girl = 29.7 (approximately 50), 5.0 (729); 3-year-old girl = 11.1 (approximately 313), urine venom level of 9.0 (approximately 490)..There is sufficient venom cross-antigenicity among different Centruroides species to allow this ELISA technique with Alacramyn to determine serum and urine C. sculpturatus venom concentrations in envenomated patients.
• Theodorou, A. A., & Berg, R. A. (2007). It's not easy to save a life.. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 8(5), 495-6. doi:10.1097/01.pcc.0000282162.31615.38
• Theodorou, A. A., Priestley, G., Kopp, B. J., Erstad, B. L., & Buckley, M. S. (2007). Direct observation approach for detecting medication errors and adverse drug events in a pediatric intensive care unit.. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 8(2), 145-52. doi:10.1097/01.pcc.0000257038.39434.04
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  To determine the incidence, type, and stage of occurrence of medication errors and potential and actual adverse drug events (ADEs) in a pediatric intensive care unit (ICU) using trained observers. The preventability and severity of ADEs and the system failures leading to medication error occurrence were also investigated..Prospective, direct observation study..A 16-bed pediatric medical/surgical ICU at a tertiary care academic medical center..One enrolled nurse caring for at least one pediatric ICU patient age
• Theodorou, A., & Rice, S. (2007). Is the silent epidemic keeping patients awake?. Journal of Clinical Sleep Medicine, 3(4). doi:10.5664/jcsm.26854
• Meyer, R. J., Theodorou, A. A., & Berg, R. A. (2006). Childhood drowning.. Pediatrics in review, 27(5), 163-8; quiz 169. doi:10.1542/pir.27-5-163
• Theodorou, A. A., Priestley, G., Kopp, B. J., Erstad, B. L., & Allen, M. E. (2006). Medication errors and adverse drug events in an intensive care unit: direct observation approach for detection.. Critical care medicine, 34(2), 415-25. doi:10.1097/01.ccm.0000198106.54306.d7
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  To determine the incidence and preventability of medication errors and potential/actual adverse drug events. To evaluate system failures leading to error occurrence..Prospective, direct observation study..Tertiary care academic medical center..Patients in a medical/surgical intensive care unit..Observers would intervene only in the event that the medication error would cause substantial patient harm or discomfort..The observers identified 185 incidents during a pilot period and four phases totaling 16.5 days (33 12-hr shifts). Two independent evaluators concluded that 13 of 35 (37%) actual adverse drug events were nonpreventable (i.e., not medication errors). An additional 40 of the remaining 172 medication errors were judged not to be clinically important. Of the 132 medication errors classified as clinically important, 110 (83%) led to potential adverse drug events and 22 (17%) led to actual, preventable adverse drug events. There was one error (i.e., resulting in a potential or actual, preventable adverse drug event) for every five doses of medication administered. The potential adverse drug events mostly occurred in the administration and dispensing stages of the medication use process (34% in each); all of the actual, preventable adverse drug events occurred in the prescribing (77%) and administration (23%) stages. Errors of omission accounted for the majority of potential and actual, preventable adverse drug events (23%), followed by errors due to wrong dose (20%), wrong drug (16%), wrong administration technique (15%), and drug-drug interaction (10%)..Using a direct observation approach, we found a higher incidence of potential and actual, preventable adverse drug events and an increased ratio of potential to actual, preventable adverse drug events compared with studies that used chart reviews and solicited incident reporting. All of the potential adverse drug events and approximately two thirds of the actual adverse drug events were judged to be preventable. There was one preventable error for every five doses of medication administered; most errors were due to dose omission, wrong dose, wrong drug, wrong technique, or interactions.
• Theodorou, A. A., Priestley, G., Kopp, B. J., Erstad, B. L., & Buckley, M. S. (2005). AN EVALUATION OF MEDICATION ERRORS AND ADVERSE DRUG EVENTS (ADES) IN A PEDIATRIC ICU.: 244-T. Critical Care Medicine, 33, A173. doi:10.1097/00003246-200512002-00612
• Dixit, N. M., Dixit, M. P., Hughes, J. D., & Theodorou, A. A. (2004). Hyponatremic hypertensive syndrome (HHS) in an 18-month old-child presenting as malignant hypertension: a case report.. BMC nephrology, 5(1), 5. doi:10.1186/1471-2369-5-5
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  The combination of hyponatremia and renovascular hypertension is called hyponatremic hypertensive syndrome (HHS). Malignant hypertension as a presentation has been reported in adults with HHS but is rare in children..An eighteen month-old male presented with drowsiness, sudden onset status epilepticus and blood pressure of 210/160. The electrolytes on admission revealed sodium of 120 mEq/L and potassium of 2.1 mEq/L. The peripheral renin activity (PRA) was 172 ng/ml/min (normal 3-11 ng/ml/min) and serum aldosterone level was 91 ng/dl (normal 4 to 16 ng/dl). Patient underwent angioplasty with no success, followed by surgical correction. Two years since the diagnosis, the blood pressure is controlled with labetolol and amlodipine (at less than sixth of the pre-operative dosages). The PRA is 2.4 ng/ml/min and aldosterone 15.5 ng/dl. The child not only had three renal arteries on left but all of them were stenosed which to best of our knowledge has not been described..As uncommon as HHS with malignant hypertension may be in adults it is under-reported in children and purpose of the case report is to raise its awareness.
• Theodorou, A. A., Gutierrez, J. A., & Berg, R. A. (2003). Fire attributable to a defibrillation attempt in a neonate.. Pediatrics, 112(3 Pt 1), 677-9. doi:10.1542/peds.112.3.677
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  A fire can occur during a defibrillation attempt because a spark can be generated in an oxygen-enriched atmosphere. Although the risk is small, a fire during patient care can have devastating effects. We describe a case of a fire attributable to a defibrillation attempt in a 10-day-old neonate following open-heart surgery. To our knowledge, this is the first published account of a fire during a defibrillation attempt in an infant or child. We review predisposing factors and preventive strategies, with special emphasis on the importance of removing oxygen from the immediate environment during defibrillation attempts. Fire is a rare but potentially devastating complication of defibrillation attempts.1–3 Despite the severe consequences of patient fires, this risk is not mentioned in standard critical care4,5 or cardiology textbooks,6,7 presumably because of the paucity of clinical reports.1,8,9 We present a case of a fire ignited by a defibrillation attempt in a 10-day-old infant, and discuss the contributing factors and recommended preventive measures. To our knowledge, this represents the first such report in an infant or child. The patient was a term newborn with a type II truncus arteriosus. Surgical correction on day 10 of life was complicated by myocardial ischemia attributable to an anomalous descending coronary artery that was severed during the surgery. Following the repair, the chest was left open and the median sternotomy was covered with a Gore-Tex tissue patch. She returned to the pediatric intensive care unit in an infant warmer and required high ventilator settings including fraction of inspired oxygen of 1.0, positive end-expiratory pressure of 12 cm H2O, tidal volume of 80 mL, and a respiratory rate of 20 breaths per minute. She was also provided with considerable inotropic support including epinephrine, dopamine, … Reprint requests to (A.A.T.) Department of Pediatrics, University of Arizona, 1501 N Campbell Ave, Room 3302, Box 245073, Tucson, AZ 85724-5073. E-mail: aat{at}peds.arizona.edu
• Theodorou, A. A., Gutierrez, J. A., & Berg, R. A. (2003). Incendio debido a un intento de desfibrilación en un neonato. Pediatrics, 56(3), 165-167.
• Theodorou, A. A., Samson, M. P., Gutierrez, J. A., Berg, R. A., & Bagatell, R. (2003). Femoral central venous catheter-associated deep venous thrombosis in children with diabetic ketoacidosis.. Critical care medicine, 31(1), 80-3. doi:10.1097/00003246-200301000-00012
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  To describe the incidence of clinical deep venous thrombosis associated with femoral central venous catheters (CVC-DVT) in children with diabetic ketoacidosis (DKA)..Retrospective case-matched control series..Pediatric intensive care units of two university-affiliated hospitals..All eight pediatric DKA patients with femoral central venous catheters between 1998 and 2001, and 16 age-matched control patients with femoral central venous catheters and circulatory shock..None..The records of all children with DKA and the control patients were reviewed. CVC-DVT was defined as persistent ipsilateral leg swelling after removal of a femoral central venous catheter. Control patients with coagulopathies, thrombocytopenia, cancer, and hyperglycemia were excluded. Four of eight patients with DKA developed CVC-DVT compared with none of the 16 control patients (p = .007, Fisher's exact test). All four patients with DKA and CVC-DVT were
• Yorgin, P. D., Theodorou, A. A., Scott, K. M., Rewari, M., Barton, L. L., & Al-uzri, A. Y. (2001). Coccidioidomycosis in adolescents with lupus nephritis.. Pediatric nephrology (Berlin, Germany), 16(1), 77-81. doi:10.1007/s004670000468
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  Coccidioidomycosis, a fungal infection endemic in the southwestern United States, can cause life-threatening infections in immunosuppressed patients. We report the contrasting cases of two adolescents with lupus nephritis, treated with intravenous pulse cyclophosphamide and daily oral corticosteroids, who developed pulmonary coccidioidomycosis. One patient developed a fatal form of fulminant disseminated coccidioidomycosis, while the other patient developed a solitary pulmonary Coccidioides immitis abscess which was responsive to intravenous liposomal amphotericin and fluconazole therapy. Because serologies and initial X-ray studies can be negative, definitive diagnostic studies including bronchoaveolar lavage and needle aspiration should be performed when there is clinical suspicion of coccidioidomycosis in an immunocompromised patient. Immunosuppressed patients with coccidioidomycosis should receive early intravenous amphotericin therapy and may benefit from long-term suppressive antifungal therapy to prevent relapse.
• Boyer, L. V., Boyer, L. V., Theodorou, A. A., & Binford, G. J. (2000). Spider on the headboard, child in the unit: severe Loxosceles arizonica envenomation confirmed by delayed spider identification and tissue antigen detection. Clinical Toxicology, 38.
• Yorgin, P. D., Whitesell, L., Theodorou, A. A., Eklund, D. K., & Al-uzri, A. (2000). Concurrent centrifugation plasmapheresis and continuous venovenous hemodiafiltration.. Pediatric nephrology (Berlin, Germany), 14(1), 18-21. doi:10.1007/s004670050004
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  Continuous venovenous hemofiltration/hemodiafiltration (CVVH/D) is commonly used to provide renal replacement therapy for critically ill patients who are hemodynamically unstable. Occasionally, the addition of plasmapheresis therapy is necessary for some conditions, including immune-mediated acute renal failure, sepsis, fulminant hepatic failure, and thrombotic thrombocytopenic purpura/hemolytic uremic syndrome. Most tertiary care facilities provide centrifugation plasmapheresis instead of membrane plasmapheresis, because of the requirement for both therapeutic plasma exchange and pheresis of cellular blood products. We report a new technique where centrifugation plasmapheresis and CVVHD (P-CVVHD) are combined and used concurrently. Blood from the patient was concurrently filtered utilizing a Hospal BSM 22 machine with a Multiflow 60 hemofilter and a Cobe Spectra continuous cell separator in a parallel configuration. P-CVVHD is technically possible and can be used for long periods of time with limited risks. There may be advantages to P-CVVHD compared with discontinuous combined CVVH/D and plasmapheresis therapy.
• Bice, D., Weger, N., Theodorou, A. A., Rhee, K. H., Muggenberg, B., Lemen, R. J., Kunke, K., & Bice, D. E. (1997). Ragweed sensitization alters pulmonary vascular responses to bronchoprovocation in beagle dogs.. Journal of applied physiology (Bethesda, Md. : 1985), 83(3), 912-7. doi:10.1152/jappl.1997.83.3.912
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  In ragweed (RW)-sensitized beagle dogs, we tested the hypothesis that reactivity of the pulmonary vasculature was enhanced with aerosolized histamine (Hist) and RW. Seven dogs were neonatally sensitized with repeated intraperitoneal RW injections, and 12 dogs were controls (Con). The dogs were anesthetized with intravenous chloralose, mechanically ventilated, and instrumented with femoral arterial and pulmonary artery catheters. Specific lung compliance (CLsp), specific lung conductance (Gsp), systemic vascular resistance index, and pulmonary vascular resistance index (PVRI) were measured before and after bronchoprovocation with Hist and RW. After Hist inhalation (5 breaths of 30 mg/ml), both Con and RW dogs had significant (P < 0.05) decreases in CLsp (-51 +/- 4 and -53 +/- 5%, respectively) and Gsp (-65 +/- 5 and -69 +/- 3%, respectively), but only RW-sensitized dogs had a significant increase in PVRI (38 +/- 10%). After RW inhalation (60 breaths of 0.8 mg/ml), only RW-sensitized dogs had significant increases (62 +/- 20%) in PVRI and decreases in Gsp (-77 +/- 4%) and CLsp (-65 +/- 7%). We conclude that, compared with Con, RW-sensitized beagle dogs have increased pulmonary vasoconstrictive responses with Hist or RW inhalation.
• Gibly, R., Walter, F., James Kloster, R., Theodorou, A., & Osterloh, J. (1997). Cisapride poisoning. Veterinary and Human Toxicology, 39(4).
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  A MEDLINE search from 1966-1996 revealed no reports of cisapride poisoning. An 8-mo-old, 8.9 kg girl received 8 mL of cisapride (Propulsid Suspension, 1 mg/mL, Janssen Pharmaceutica, Titusville, NJ) rather than the usual dose of 0.8 mL, resulting in an inadvertent, 10-fold, iatrogenic, dosing error. She developed emesis, hyperactive bowel sounds, abnormal behavior, mild hyperthermia, tachycardia, hypertension, and thrombocytosis. This is the first published report of poisoning with cisapride.
• Yorgin, P. D., Theodorou, A. A., Johnson, M. I., Davenport, K. M., Boyer-hassen, L. V., & Al-uzri, A. (1997). Propylene glycol-induced proximal renal tubular cell injury.. American journal of kidney diseases : the official journal of the National Kidney Foundation, 30(1), 134-9. doi:10.1016/s0272-6386(97)90577-1
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  Propylene glycol is a solvent that is used in many oral, injectable, and topical medications. Although uncommon, acute renal failure has been attributed to propylene glycol. The mechanism of propylene glycol-mediated renal injury is unknown. We report a case of acute renal failure in a 16-year-old boy given large doses of pentobarbital and phenobarbital, both of which are solubilized with propylene glycol. A renal biopsy showed proximal renal tubular cell swelling and vacuole formation. The data from this case suggest that the reversible acute renal failure caused by propylene glycol is attributable to proximal renal tubular cell injury.
• Theodorou, A., Barton, L., Rice, S., & Rieder, M. (1995). Trimethoprim-sulfamethoxazole-associated central nervous system disease. Pediatric Infectious Disease Journal, 14(1). doi:10.1097/00006454-199501000-00021
• Griesemer, D., Theodorou, A., Berg, R., & Spera, T. (1994). Local fibrinolysis in cerebral venous thrombosis. Pediatric Neurology, 10(1). doi:10.1016/0887-8994(94)90075-2
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  Extensive cerebral venous sinus thrombosis may cause death or severe neurologic sequelae. A minimally responsive 10-year-old boy with thrombosis of the superior sagittal sinus, left transverse and left sigmoid sinus, torcular, vein of Galen, and straight sinus under-went fibrinolytic therapy with urokinase during transfemoral venous angiography. He improved dramatically during the procedure as antegrade venous flow was re-established. Local thrombolytic therapy may be beneficial for other patients with rapid neurologic deterioration caused by extensive thrombosis of superficial and deep venous structures. © 1994.
• Theodorou, A. A., Konduri, G. G., & Gervasio, C. T. (1993). Role of adenosine triphosphate and adenosine in oxygen-induced pulmonary vasodilation in fetal lambs.. Pediatric research, 33(5), 533-9. doi:10.1203/00006450-199305000-00022
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  We investigated the hypothesis that purine nucleotides, ATP and adenosine, mediate the pulmonary vasodilation that occurs at birth in response to an increase in arterial O2 pressure (PaO2). We studied 20 fetal lambs 1 to 3 d after placement of intravascular catheters and a flow transducer around left pulmonary artery. In 16 lambs, we investigated the effects of 1) an increase in fetal PaO2 on ATP levels in pulmonary circulation and 2) 8-phenyl-theophylline (8-PT) and cibacron blue, antagonists of receptors for adenosine and ATP, on pulmonary vasodilation caused by increased PaO2. In four other lambs, we investigated the specificity of 8-PT and cibacron blue for purine receptors by investigating their effects on pulmonary vasodilation caused by acetylcholine, bradykinin, and nitroprusside. The fetal PaO2 increased by 7 +/- 2 during administration of 100% O2 to the pregnant ewe, resulting in a 3-fold decrease in PVR and increase in pulmonary blood flow. Blood and plasma concentrations of ATP in fetal pulmonary artery and left atrium increased significantly during the increase in fetal PaO2. 8-PT and cibacron blue caused increases in baseline pulmonary and systemic vascular pressures and pulmonary vascular resistance and inhibited the pulmonary vasodilation caused by O2. 8-PT and cibacron blue did not alter the pulmonary vascular effects of acetylcholine, bradykinin, and nitroprusside. An increase in baseline pulmonary vascular resistance caused by infusion of U46619 (in four lambs) did not alter the pulmonary vasodilation caused by O2. In summary, O2-induced pulmonary vasodilation is accompanied by increased ATP levels in pulmonary circulation and is attenuated by antagonists of purine receptors.(ABSTRACT TRUNCATED AT 250 WORDS)
• Sarnaik, A. P., Meert, K. L., Theodorou, A. A., Sarnaik, A. P., Moylan, P. M., Meert, K. L., Lieh-lai, M. W., & Canady, A. I. (1992). Limitations of the Glasgow Coma Scale in predicting outcome in children with traumatic brain injury.. The Journal of pediatrics, 120(2 Pt 1), 195-9. doi:10.1016/s0022-3476(05)80426-3
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  To study the hypothesis that, in the absence of an ischemic-hypoxic state, children with severe traumatic brain injury and with unfavorable Glasgow Coma Scale scores may have good recovery..Retrospective, observational, cross-sectional study with factorial design..Inpatient population in a university hospital..Seventy-nine children with traumatic brain injury admitted to the intensive care unit..All patients received close monitoring and strict control of intracranial pressure (less than 20 mm Hg) and cerebral perfusion pressure (greater than 60 mm Hg)..Admission Glasgow Coma Scale score, survival, need for cardiopulmonary resuscitation, presence of shock, peak intracranial pressure, duration of coma, Glasgow Outcome Scale score, and the results of neuropsychologic tests were analyzed. Of 79 children, 70 (89%) survived. Although the mortality rate was higher among patients with Glasgow Coma Scale scores of 3 to 5, 14 (64%) of 22 of these children survived. Nonsurvivors had a significantly higher incidence of shock and need for cardiopulmonary resuscitation. Except for two patients who had prolonged hypoxemia, all children, including those with Glasgow Coma Scale scores of 3 to 5, had a satisfactory outcome (Glasgow Outcome Scale scores of 4 or 5). Neuropsychologic outcome was not significantly different in the survivors with Glasgow Coma Scale scores of 3 to 5 and those with Glasgow Coma Scale scores of 6 or more..A low Glasgow Coma Scale score does not always accurately predict the outcome of severe traumatic brain injury; in the absence of hypoxic-ischemic injury, children with traumatic brain injury and Glasgow Coma Scale scores of 3 to 5 can recover independent function.
• Theodorou, A. A., Mukhopadhyay, A., Konduri, G. G., & Deshmukh, D. R. (1992). Adenosine triphosphate and adenosine increase the pulmonary blood flow to postnatal levels in fetal lambs.. Pediatric research, 31(5), 451-7. doi:10.1203/00006450-199205000-00007
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  We investigated the hypothesis that purine nucleotides may mediate the pulmonary vasodilation that occurs at birth in fetal lambs. We studied nine fetal lambs 3 d after placement of intravascular catheters, a flow transducer around the left pulmonary artery, and an inflatable vascular occluder around the ductus arteriosus. The pressure-flow relationship of left lung during a brief occlusion of the ductus arteriosus was studied as an index of pulmonary vascular resistance. We investigated the pulmonary vascular effects of adenosine, ATP, or saline (control) in doses of 0.01-2.50 mumol/kg/min infused into the right atrial line, and measured blood adenosine and ATP levels in samples from the pulmonary artery and left atrium. We also investigated the mechanism of pulmonary vascular effects of adenosine and ATP. Adenosine and ATP caused significant decreases in pulmonary vascular resistance and increases in pulmonary blood flow in doses of 0.08-2.5 mumol/kg/min. The pulmonary blood flow increased to levels seen in postnatal lambs at doses of 1.2 and 2.5 mumol/kg/min of adenosine and ATP. The baseline blood adenosine and ATP levels in fetus were 8 and 70% of levels in postnatal lambs. ATP concentrations increased to postnatal levels and adenosine levels increased to 20% of postnatal levels at infusion rates of 1.2 and 2.5 mumol/kg/min. The pulmonary vasodilation caused by adenosine and ATP was attenuated by 8-phenyltheophylline and cibacron blue, respectively, but not by indomethacin. We conclude that adenosine and ATP are pulmonary vasodilators and increase the fetal pulmonary flow to postnatal levels in doses that increase their blood concentrations to less than or equal to postnatal levels.(ABSTRACT TRUNCATED AT 250 WORDS)
• Sarnaik, A. P., Wade, D. D., Theodorou, A. A., Shayevitz, J. R., Sarnaik, A. P., Sanfilippo, D., & Alvarez, D. M. (1987). CHANGES IN BODY COMPOSITION IN PEDIATRIC INTENSIVE CARE UNIT (PICU) VS WARD (W) PATIENTS. Pediatric Research, 21(4), 206-206. doi:10.1203/00006450-198704010-00242
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  We performed a prospective survey of PICU and W patients to compare changes in body composition over time. On admission and hospital day 3, we recorded weight (WT), midarm circumference (MAC), triceps skinfold thickness (TST), and therapeutic intervention score (TIS). Anthropometries were normalized as a percentage of the value for day 1 to minimize size and age effects. We compared WT, MAC, TST, and TIS score on day 1 with day 3 by 2-way ANOVA. P≤0.05 was considered significant. Values are expressed as mean ± SD. By Least Significant Difference (P ≤0.05), day 3 PICU TST is less than both day 1 PICU and day 3 W TST. These results suggest that a rapid loss of fat stores occurs in PICU but not in W patients over time (P=0.04). TIS scores were higher in PICU vs W patients on both days (P=0.045). Decline in fat stores may be related to severity of illness or to deficient provision of supplemental nutrition. We can make no conclusions about differences in premorbid nutritional state between PICU and W patients.

Presentations

• Theodorou, A. (2024). Healthcare Culture of Safety. Med 101 UA BS in Medicine Undergraduate Curriculum . Med 101 UA BS in MedicineU of Arizona.
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  Presentation on the culture of safety in medicine.  Presented once each semester (2x/year)
• Theodorou, A. (2024, Spring).

  , “Precision Medicine in Pediatrics” 

  . UA Dept. Of Pediatrics Grand Rounds. UA Department of Pediatrics, Virtual: UA Department of Pediatrics.
• Theodorou, A. (2023).  Healthcare Culture of Safety. . Med 101 UA BS in Medicine Undergraduate Curriculum.
• Theodorou, A. (2023, Spring). Healthcare Culture of Safety. Med 101 UA BS in Medicine Undergraduate Curriculum. University of Arizona, Main Campus: U of A.

Poster Presentations

• Amerongen, H. M., Theodorou, A. A., Cooley, J. H., Larson, W. J., LeGros, T. A., LeGros, T. A., Larson, W. J., Cooley, J. H., Theodorou, A. A., & Amerongen, H. M. (2016, April 2016). A Constructivist Tool for Teaching Role Knowledge and Respect in Early Interprofessional Education. Western Group on Educational Affairs. Tucson, AZ: Western Group on Educational Affairs.

Other Teaching Materials

• Theodorou, A., Thienhaus, O. J., Winegar, B., Desoky, S. M., Ebert, V., Plitt, J., Combs, D. A., Matika, R. W., Pritchard, G., Thajudeen, B., Sam, A., & Kutob, R. M. (2021. Professionalism: Communicating with the Health Care Team. Virtual Lecture Hall.
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  Collaborated with University of Arizona College of Medicine Continuing Medical Education committee on development of this online, case-based, interactive course accredited for 1.5 CME credits, available to physicians nationwide on Virtual Lecture HallAvailable from: https://www.vlh.com/shared/courses/course_info.cfm?courseno=1807 (accessed September 16, 2021).