{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T02:38:08Z","timestamp":1767494288670,"version":"3.40.5"},"reference-count":10,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"6","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Oncology Practice"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec><jats:title>PURPOSE:<\/jats:title><jats:p> Hypoglycemia has been observed in children receiving acute lymphoblastic leukemia (ALL) therapy, and it can negatively affect patient outcomes. We documented a 4%-6% prevalence of hypoglycemia among patients in the two clinics in this study. We aim to reduce morning hypoglycemia in children on chemotherapy for ALL at two community pediatric oncology clinics (A and B) by 50% in 9 months. <\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p> We used the Institute for Healthcare Improvement (IHI) Model for Improvement as the framework. Prolonged hours of fasting for procedural sedation, gaps in the caregivers' knowledge of hypoglycemia risk, and a lack of awareness of the new mercaptopurine administration guidelines were the most likely contributing factors for hypoglycemia. We developed a hypoglycemia prevention educational program for staff and caregivers followed by a knowledge assessment tool. <\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p> Each month, the average number of patients seen in both clinics was 43. The monthly average of blood glucose tests in these patients was 94. After implementing the intervention, the percentage of caregivers who received hypoglycemia education reached 88%. Of those, 78% scored \u2265 75% in the knowledge reassessment resurvey. The combined average hypoglycemic episodes in the two clinics decreased by 46%. A higher reduction in hypoglycemic episodes was observed in clinic A (75%) compared with clinic B (17%). <\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION:<\/jats:title><jats:p> Implementing hypoglycemia education led to a significant drop in hypoglycemic episodes among children on ALL therapy. Despite using a similar approach, one of the two clinics showed a more than fourfold improvement compared with the other. <\/jats:p><\/jats:sec>","DOI":"10.1200\/op.20.00652","type":"journal-article","created":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T19:59:17Z","timestamp":1616011157000},"page":"e901-e907","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":1,"title":["Reducing Morning Hypoglycemia Among Children Undergoing Treatment for Acute Lymphoblastic Leukemia"],"prefix":"10.1200","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9785-8035","authenticated-orcid":false,"given":"Ashraf","family":"Mohamed","sequence":"first","affiliation":[{"name":"Department of Hematology\/Oncology and Stem Cell Transplant, Cook Children's Medical Center, Fort Worth, TX"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Bolen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, St Jude Affiliate Clinic at Novant Health Hemby Children's Hospital, Charlotte, NC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Morgan","sequence":"additional","affiliation":[{"name":"Affiliate Program Office, St Jude Children's Research Hospital, Memphis, TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia Ann","family":"Rice","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology-Oncology, St Jude Affiliate Clinic at St Francis Children's Hospital, Tulsa, OK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meredith","family":"Speas","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, St Jude Affiliate Clinic at Novant Health Hemby Children's Hospital, Charlotte, NC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Abdelmonem","sequence":"additional","affiliation":[{"name":"OU-TU School of Community Medicine, Tulsa, OK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8034-7260","authenticated-orcid":false,"given":"Carolyn","family":"Russo","sequence":"additional","affiliation":[{"name":"Department of Hematology, St Jude Children's Research Hospital, Memphis, TN"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"233","reference":[{"key":"b1","doi-asserted-by":"publisher","DOI":"10.15520\/ijmhs.v9i1.2430"},{"key":"b2","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2019.01027"},{"key":"b3","doi-asserted-by":"publisher","DOI":"10.1097\/00043426-199703000-00002"},{"key":"b4","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.20582"},{"key":"b5","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2018.05.011"},{"key":"b6","doi-asserted-by":"publisher","DOI":"10.1067\/mpd.2001.111273"},{"key":"b7","doi-asserted-by":"publisher","DOI":"10.1002\/mpo.10097"},{"key":"b8","doi-asserted-by":"publisher","DOI":"10.6065\/apem.2018.23.4.226"},{"key":"b9","doi-asserted-by":"publisher","DOI":"10.1080\/00224065.1984.11978921"},{"key":"b10","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2011-000010"}],"container-title":["JCO Oncology Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/OP.20.00652","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,29]],"date-time":"2022-05-29T10:33:04Z","timestamp":1653820384000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/OP.20.00652"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6]]},"references-count":10,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021,6]]}},"alternative-id":["10.1200\/OP.20.00652"],"URL":"https:\/\/doi.org\/10.1200\/op.20.00652","relation":{},"ISSN":["2688-1527","2688-1535"],"issn-type":[{"type":"print","value":"2688-1527"},{"type":"electronic","value":"2688-1535"}],"subject":[],"published":{"date-parts":[[2021,6]]},"assertion":[{"value":"2020-07-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-01-19","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-02-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}