Charles R Woods

Duke University, Durham, North Carolina, United States

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Publications (107)358.2 Total impact

  • [Show abstract] [Hide abstract] ABSTRACT: Background/objective: The impact of family composition on glycemic control in children with type 1 diabetes remains unclear. We sought to evaluate the relationship between health insurance coverage, family composition, and insulin management, and assess their impact on glycemic control in a pediatric type 1 diabetes population. Methods: A retrospective chart review was completed for patients seen in the Pediatric Endocrinology Clinic at the University of Louisville in 2012. Results: The analysis included 729 patients with type 1 diabetes; 268 (37%) had public insurance while 461(63%) had private insurance. Compared with publicly insured patients, privately insured patients had higher rates of intensive insulin management with multiple daily injections (MDI) plans or pump devices (88 vs. 83.2%, p = 0.066) and lower HbA1c levels [8.57 vs. 9.39% (70 vs. 79 mmol/mol), p < 0.001]. Of the 729 patients, 243 were in single-adult homes (33%). Single-adult homes had higher HbA1c levels than two-adult homes, [9.3 vs. 8.6% (78 vs. 70 mmol/mol), p < 0.001]. Among publicly insured, there was no difference in HbA1c levels for single-adult vs. two-adult homes [9.4 (79 mmol/mol), p = 0.868]. For privately insured, patients in single-adult homes had higher HbA1c levels than peers in two-adult homes [9.2 vs. 8.4% (77 vs. 68), p < 0.001]. Conclusion: Insurance type and family composition have significant associative effects on glycemic control and insulin management that may be mitigated by insulin pump therapy. Identifying and addressing factors such as availability of resources, family education, and adult support and supervision, may help improve glycemic control in high-risk pediatric diabetes patients.
    No preview · Article · May 2016 · Pediatric Diabetes
  • Michael J Smith · Charles R Woods · Debra L Palazzi
    No preview · Article · Nov 2015
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    Brian J Holland · John A Myers · Charles R Woods
    [Show abstract] [Hide abstract] ABSTRACT: To determine if prenatal diagnosis improves the chance that a newborn with critical congenital heart disease will survive to undergo planned cardiac surgery. A systematic review of the medical literature identified eight studies which met the following criteria: compared outcomes between groups of newborns with prenatal and postnatal diagnosis of critical congenital heart disease, contained the same anatomic diagnosis in each group, provided detailed information on cardiac anatomy, and included detailed information on the preoperative cause of death. A meta-analysis was performed to assess differences in preoperative mortality rates between newborns with a prenatal diagnosis versus postnatal diagnosis. Patients with established risk factors for increased mortality and those whose families chose comfort care were excluded. In patients with comparable anatomy, standard risk, a parental desire to treat, and optimal care, newborns with a prenatal diagnosis of critical congenital heart disease were significantly less likely to die prior to planned cardiac surgery compared to newborns with a comparable postnatal diagnosis (pooled OR=0.26, 95% CI 0.08-0.84). For newborns most likely to benefit from treatment for their critical congenital heart disease, whose families pursue treatment, and who do not have additional risk factors, prenatal diagnosis reduced the risk of death prior to planned cardiac surgery compared to patients with a comparable postnatal diagnosis. Further study and efforts to improve prenatal diagnosis of congenital heart disease should therefore be considered. This article is protected by copyright. All rights reserved.
    Full-text · Article · Apr 2015 · Ultrasound in Obstetrics and Gynecology
  • [Show abstract] [Hide abstract] ABSTRACT: Introduction The epidemiology and hospital course of children with retropharyngeal abscess (RPA) or parapharyngeal abscess (PPA) have not been fully described at the national level in the United States.
    No preview · Article · Mar 2015
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    [Show abstract] [Hide abstract] ABSTRACT: The treatment of symptomatic congenital cytomegalovirus (CMV) disease with intravenous ganciclovir for 6 weeks has been shown to improve audiologic outcomes at 6 months, but the benefits wane over time. We conducted a randomized, placebo-controlled trial of valganciclovir therapy in neonates with symptomatic congenital CMV disease, comparing 6 months of therapy with 6 weeks of therapy. The primary end point was the change in hearing in the better ear ("best-ear" hearing) from baseline to 6 months. Secondary end points included the change in hearing from baseline to follow-up at 12 and 24 months and neurodevelopmental outcomes, with each end point adjusted for central nervous system involvement at baseline. A total of 96 neonates underwent randomization, of whom 86 had follow-up data at 6 months that could be evaluated. Best-ear hearing at 6 months was similar in the 6-month group and the 6-week group (2 and 3 participants, respectively, had improvement; 36 and 37 had no change; and 5 and 3 had worsening; P=0.41). Total-ear hearing (hearing in one or both ears that could be evaluated) was more likely to be improved or to remain normal at 12 months in the 6-month group than in the 6-week group (73% vs. 57%, P=0.01). The benefit in total-ear hearing was maintained at 24 months (77% vs. 64%, P=0.04). At 24 months, the 6-month group, as compared with the 6-week group, had better neurodevelopmental scores on the Bayley Scales of Infant and Toddler Development, third edition, on the language-composite component (P=0.004) and on the receptive-communication scale (P=0.003). Grade 3 or 4 neutropenia occurred in 19% of the participants during the first 6 weeks. During the next 4.5 months of the study, grade 3 or 4 neutropenia occurred in 21% of the participants in the 6-month group and in 27% of those in the 6-week group (P=0.64). Treating symptomatic congenital CMV disease with valganciclovir for 6 months, as compared with 6 weeks, did not improve hearing in the short term but appeared to improve hearing and developmental outcomes modestly in the longer term. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT00466817.).
    Full-text · Article · Mar 2015 · New England Journal of Medicine
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    [Show abstract] [Hide abstract] ABSTRACT: Hospitals vary widely in the services they offer to care for pediatric burn patients. When a hospital does not have the ability or capacity to handle a pediatric burn, the decision often is made to transfer the patient to another short-term hospital. Transfers may be based on available specialty coverage for children; which adult and non-teaching hospitals may not have available. The effect these transfers have on costs and length of stay (LOS) has on pediatric burn patients is not well established and is warranted given the prominent view that pediatric hospitals are inefficient or more costly. The authors examined inpatient admissions for pediatric burn patients in 2003, 2006, and 2009 using the Kids' Inpatient Database, which is part of the Healthcare Cost and Utilization Project. ICD-9-CM codes 940 to 947 were used to define burn injury. The authors tested if transfer status was associated with LOS and total charges for pediatric burn patients, while adjusting for traditional risk factors (eg, age, TBSA, insurance status, type of hospital [pediatric vs adult; teaching vs nonteaching]) by using generalized linear mixed-effects modeling. A total of n = 28,777 children had a burn injury. Transfer status (P < .001) and TBSA (P < .001) was independently associated with LOS, while age, insurance status, and type of hospital were not associated with LOS. Similarly, transfer status (P < .001) and TBSA (P < .001) was independently associated with total charges, while age, insurance status, and type of hospital were not associated with total charges. In addition, the data suggest that the more severe pediatric burn patients are being transferred from adult and non-teaching hospitals to pediatric and teaching hospitals, which may explain the increased costs and LOS seen at pediatric hospitals. Larger more severe burns are being transferred to pediatric hospitals with the ability or capacity to handle these conditions in the pediatric population, which has a dramatic impact on costs and LOS. As a result, unadjusted, pediatric hospitals are seen as being inefficient in treating pediatric burns. However, since pediatric hospitals see more severe cases, after adjustment, type of hospital did not influence costs and LOS. TBSA and transfer status were the predictors studied that independently affect costs and LOS.
    Full-text · Article · Dec 2014 · Journal of burn care & research: official publication of the American Burn Association
  • Charles R Woods · V Faye Jones
    No preview · Article · Nov 2014 · Pediatrics
  • Claudia Espinosa · Charles R Woods · Gary S Marshall
    [Show abstract] [Hide abstract] ABSTRACT: Background: Intravenous (IV) antibiotics had been the mainstay of therapy for children with complicated para-pneumonic effusion (PPE) and pleural empyema (PE). Whereas oral antibiotics have been used to complete a prescribed course of therapy, when to switch and how long to treat are more a matter of style than a matter of evidence or official guidelines. There is also controversy regarding the use of video-assisted thoracoscopic surgery (VATS) versus chest tube insertion with fibrinolysis when drainage is indicated. Substantial practice variation exists. Methods: Retrospective chart review and descriptive analysis of children managed by the pediatric infectious diseases service at Kosair Children Hospital between 2008 and 2012. Results: A total of 59 children met inclusion criteria. All patients received IV antibiotics at admission. Sixty-seven percent of children had a surgical procedure on the day of admission or the following day; all of these were VATS, except for 2 children who had a chest tube placed and later underwent VATS. The mean time to VATS was 1.4 days [95% CI 1.08, 1.80]. In 70% of the cases that underwent drainage, no organism was identified by culture of the pleural fluid. All patients received IV antibiotics at admission and all were discharged on oral antibiotics; the mean time to switch was 7.9 days [95% CI 6.76, 9.12] and the mean duration of oral antibiotic therapy was 16.98 days [15.3, 18.64]. There were no deaths; 6 patients required repeat surgical intervention, but this was not related to use of oral antibiotic therapy. Conclusion: Children with complicated PPE and PE can be managed effectively with early VATS and early switch from IV to oral antibiotic therapy.
    No preview · Conference Paper · Oct 2014
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    [Show abstract] [Hide abstract] ABSTRACT: Acute respiratory conditions are a leading cause of childhood morbidity and mortality. Corticosteroids are effective and established treatments in some acute respiratory infections (e.g. croup) and asthma exacerbations; however, their role is controversial in other conditions owing to inconsistent effectiveness or safety concerns (e.g. bronchiolitis, acute wheeze).
    Full-text · Article · Sep 2014 · Evidence-Based Child Health A Cochrane Review Journal
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    [Show abstract] [Hide abstract] ABSTRACT: To better understand factors that may impact infant mortality rates (IMR), we evaluated the consistency across birth hospitals in the classification of a birth event as either a fetal death or an early neonatal (infant) death using natality data from North Carolina for the years 1995-2000. A database consisting of fetal deaths and infant deaths occurring within the first 24 hours after birth was constructed. Bivariate, followed by multivariable regression, analyses were used to control for relevant maternal and infant factors. Based upon hospital variances, adjustments were made to evaluate the impact of the classification on statewide infant mortality rate. After controlling for multiple maternal and infant factors, birth hospital remained a factor related to the classification of early neonatal versus fetal death. Reporting of early neonatal deaths versus fetal deaths consistent with the lowest or highest hospital strata would have resulted in an adjusted IMR varying from 7.5 to 10.64 compared with the actual rate of 8.95. Valid comparisons of IMR among geographic regions within and between countries require consistent classification of perinatal deaths. This study demonstrates that local variation in categorization of death events as fetal death versus neonatal death within the first 24 hours after delivery may impact a state-level IMR in a meaningful magnitude. The potential impact of this issue on IMRs should be examined in other state and national populations.
    Full-text · Article · Apr 2014 · BMC Pediatrics
  • [Show abstract] [Hide abstract] ABSTRACT: Objectives: Orbital cellulitis occurs primarily following sinusitis. This infection resides posterior to the orbital septum with inherent risk to the eye, cavernous sinus, meninges, and brain. Fortunately, complications remain rare due to the advent of antibiotics. Surgical drainage through orbitotomy or ethmoidectomy may occur. We aim to characterize the demographic stratification, surgical treatment variation, and cost and resource use related to orbital cellulitis over time.
    No preview · Article · Aug 2013 · Otolaryngology Head and Neck Surgery
  • [Show abstract] [Hide abstract] ABSTRACT: Objectives: Due to the colonization of the nares, the epidemic of community acquired Methicillin-Resistant Staphyloccoccus aureus (MRSA) poses a risk of MRSA head and neck infections. Orbital cellulitis is one such infection that commonly follows sinusitis. This infection occurs posterior to the orbital septum, posing risk to nearby structures. The purpose of this study is to stratify the differences in epidemiology and resource use between MRSA orbital cellulitis and traditional non-MRSA orbital cellulitis.
    No preview · Article · Aug 2013 · Otolaryngology Head and Neck Surgery
  • [Show abstract] [Hide abstract] ABSTRACT: Objectives: Peritonsillar abscesses (PTA) are the most common deep neck space infections. Although many of these infections are treated in the emergency department, these infections can become quite serious, compromising the airway or developing into Lemierre’s Syndrome, requiring hospitalization. We embarked on this study to determine current hospitalized costs, length of stay (LOS), and demographic stratification of peritonsillar abscess.
    No preview · Article · Aug 2013 · Otolaryngology Head and Neck Surgery
  • [Show abstract] [Hide abstract] ABSTRACT: Objectives: Following the peritonsillar space, two confluent spaces house the majority of pediatric deep neck space infections, the retropharyngeal and parapharyngeal sites. Surgical drainage and conservative antibiotic management exist as treatment options.
    No preview · Article · Aug 2013 · Otolaryngology Head and Neck Surgery
  • Charles R Woods
    [Show abstract] [Hide abstract] ABSTRACT: CME EDUCATIONAL OBJECTIVES 1. Review the current epidemiology of meningococcal disease in children. 2. Discuss the history of meningococcal vaccine development and the unique challenges posed by developing a vaccine against this microbe. 3. Determine vaccine recommendations as well as potential roadblocks to routine vaccination of young children. The spectrum of disease caused by Neisseria meningitidis includes bacteremia, fulminant sepsis (meningococcemia), meningitis, and pneumonia. The incidence of meningococcal infection has long been higher in infancy than adolescents or adults older than 65 years (a third group with an increased risk based on age). Five meningococcal serogroups (A, B, C, Y, and W135) cause the great majority of human disease. Serogroup B strains cause about two-thirds of disease in children younger than 6 years. For this reason, new meningococcal vaccine formulations have been developed and evaluated in children younger than 2 years. Of four meningococcal vaccines currently licensed in the United States, two conjugate products, (MenACWY-D [Menactra], Sanofi Pasteur; HibMenCY-TT [MenHibrix], GlaxoSmithKline), are recommended for infants and toddlers younger than 2 years who have an increased risk for invasive meningococcal disease. High-risk conditions are complement deficiencies, community outbreaks, functional or anatomic asplenia, and travel to high-risk areas in which serogroup A infection is prevalent. Recommendations vary by age, dosing, and indication between these two products. Both licensed products are immunogenic and have side-effect profiles that are considered safe for use. In most cases, concomitant use with other recommended childhood vaccines does not interfere with responses to these vaccines. As of yet, there has not been universal adoption of this immunization in the infant population by parents or providers. Factors that weigh against the implementation of a national routine infant program include the prevention of only 40 to 50 meningococcal cases, two to four deaths per year, and a relatively low case fatality among infants. Some argue that costs should not be considered a barrier because infant deaths and morbidity would be prevented. The availability of a serogroup B vaccine would improve impact and cost-effectiveness of a routine infant meningococcal vaccine program. Debate over the implementation of routine infant meningococcal vaccination in the United States is ongoing. This review focuses on vaccines for the prevention of N. meningitidis infection in infants and young toddlers in the first 2 years of life.
    No preview · Article · Aug 2013 · Pediatric Annals
  • [Show abstract] [Hide abstract] ABSTRACT: Objectives: The perineal and gluteal regions are the most frequent areas of skin and soft tissue infection (SSTI) in diapered children. No studies have investigated the relationship between perineal and general hygiene practices and SSTIs in this population. This study was conducted to evaluate this relationship. Methods: A cross-sectional observational study was conducted in an urban pediatric emergency department. Subjects were recruited into 3 study groups as follows: gluteal/perineal SSTIs (SSTI), diaper dermatitis (DD), or healthy normal skin (NS). Survey responses were analyzed for significance followed by a clinically oriented staged regression to model predictors of SSTI compared with the NS and DD groups. Results: There were 100 subjects in the SSTI, 206 in the NS, and 151 in the DD groups. Race was the only demographic characteristic that differed between the groups. After adjustment for race, no day care attendance, history of SSTI, household contact with SSTI history, and higher propensity for diaper rash were associated with SSTI compared with NS. Regression results comparing SSTI to DD revealed no day care attendance, history of SSTI, household contact with SSTI history, less sensitive skin, and less diaper cream use to be predictors of SSTI. Conclusions: Perineal and general hygiene practices were not significantly different between children with SSTI compared with children with NS or DD. Based on the results of this study, further prospective studies should evaluate diaper hygiene practices that prevent DD and subsequent SSTIs, the preventative role of day care attendance, and effective interventions that minimize the risk of recurrent SSTIs.
    No preview · Article · Apr 2013 · Pediatric emergency care
  • [Show abstract] [Hide abstract] ABSTRACT: Objective: An influenza pandemic may demand that a large number of influenza immunizations be rapidly given with limited resources. This study tested the utility and practicality of self-immunization with live attenuated influenza intranasal vaccine in a mass vaccination event. Methods: The self-immunization clinic model was evaluated in a three-tiered fashion using student, first responder, and open community events. Results: A single nurse was easily able to direct 89 people through the process of self-administration of the vaccine in a three-hour first-responder event and 122 people in a three-hour open community event. 96% of participants believed that they had performed the self-administration correctly, and the same percentage reported that they would like to receive influenza immunization by self-vaccination in the future. Conclusions: The self-immunization clinic is a practical and potentially useful model in an influenza pandemic setting.
    No preview · Article · Apr 2013 · Disaster Medicine and Public Health Preparedness
  • Charles R Woods
    [Show abstract] [Hide abstract] ABSTRACT: Rocky Mountain spotted fever is typically undifferentiated from many other infections in the first few days of illness. Treatment should not be delayed pending confirmation of infection when Rocky Mountain spotted fever is suspected. Doxycycline is the drug of choice even for infants and children less than 8 years old.
    No preview · Article · Apr 2013 · Pediatric Clinics of North America
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    Charles R Woods
    Preview · Article · Mar 2013 · PEDIATRICS
  • C. R. Woods
    No preview · Article · Feb 2013

Publication Stats

2k Citations
358.20 Total Impact Points

Institutions

  • 2006
    • Duke University
      Durham, North Carolina, United States
  • 2004
    • Wake Forest University
      Winston-Salem, North Carolina, United States
  • 2003
    • University of North Carolina at Chapel Hill
      North Carolina, United States
  • 2002-2003
    • University of Louisville
      • • Department of Pediatrics
      • • Division of Infectious Diseases
      Louisville, KY, United States