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Critical Care

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The Global Critical Care Program strives to strengthen care for critically ill children with cancer everywhere.

 

Children with cancer and other catastrophic diseases frequently develop acute, critical complications. One in every three or four patients with cancer will require pediatric intensive care unit (PICU) care at least once during their cancer treatment. Unfortunately, these patients also have a higher risk of death during critical illnesses. This risk is especially true in settings with limited resources. 

 

Common critical illnesses in children with cancer and other blood disorders include sepsis (severe widespread infection), respiratory insufficiency and serious neurological complications such as seizures or encephalopathies. Improving the management of these illnesses is integral to developing new global standards and improving patient outcomes, including reducing rates of toxic death.

 

Aligned with the St. Jude Global mission and with more than 1,200 collaborators from 79 countries, the Global Critical Care Program aims to strengthen hospital care for critically ill children with cancer and other catastrophic diseases through its work in five focus areas:

  • Implementation of innovative, evidence-based interventions
  • Education to enhance skills and knowledge
  • Research of the highest quality, paired with effective dissemination
  • Assessment tools to help partner centers improve quality of care
  • Collaboration with a global network of partner institutions and individuals

 

Program Initiatives

 

Implementation of Evidence-Based Interventions

 

The Global Critical Care Program's evidence-based interventions are designed to improve the quality of care for critically ill children with cancer. Currently, key efforts include the multicenter Pediatric Early Warning System (PEWS) program and its sibling program, the PEWS Adaptation to Support Hospitals in the Alliance (PASHA), which are dedicated to supporting participating hospitals in implementing and sustaining a system that promotes the early identification of clinical deterioration in hospitalized children, thus increasing the window for treatment and patients’ chances of recovery.

 

Proyecto EVAT, our most extensive PEWS implementation collaborative effort, now features 99 participating pediatric hematology-oncology centers in Latin America and Europe. During a four-year, multicenter study, PEWS implementation was shown to reduce mortality by 18% over four years in 32 centers in Latin America. 

 

Project PASHA recently launched as an adaptation of the EVAT implementation methodology, focusing on scalability. Project PASHA’s pilot run is now underway, encompassing 11 centers in Sub-Saharan Africa, Pakistan, Eastern Europe and the Asia Pacific region. 

 

Explore where Proyecto EVAT and PASHA is making an impact.

 

View Our Map

 

Education

 

To improve health care providers’ knowledge about the care of critically ill children with cancer, the Global Critical Care Program works with experts in the field to develop curricula, workshops and training materials on pediatric onco-critical care. These efforts include:

  • Pediatric onco-critical care workshops and conferences, including the annual Pediatric Onco-Critical Care Symposium (POCCS) at St. Jude.
  • The St. Jude Global Academy in Pediatric Onco-Critical Care (GA-POCC).
  • Critical care observerships in the St. Jude pediatric intensive care unit. 
  • POC3, a clinical case review resource connecting providers to experts in the field to review and analyze complex cases about onco-critical illness and management.
  • Monthly meetings to discuss relevant topics in pediatric onco-critical care and encourage collaboration between participants to build our pediatric onco-critical care community.

 

Research

 

The Global Critical Care Program develops research tools and conducts high-quality research on topics related to pediatric onco-critical care in high-resource and resource-limited settings. These efforts include:

  • Working with regional experts to develop common data elements that investigators and clinicians can use to study the global epidemiology, burden and outcomes of critical illness in children with cancer. One example is POCIReg, the Pediatric Oncology Critical Illness Registry.
  • Using implementation science methodology to study the implementation and sustainability of evidence-based interventions in low-resource settings. One example is our work with the Clinical Sustainability Assessment Tool (CSAT), a structured assessment of a center’s capacity to sustain an evidence-based practice like PEWS. These findings can guide a sustainability action plan and inform the development of strategies to promote intervention sustainability in these settings.

 

Assessment

 

The Global Critical Care Program has also developed several tools that centers can implement to assess current pediatric onco-critical care services and identify priorities for future interventions. 

 

PROACTIVE (Pediatric Oncology Capacity Assessment Tool for Intensive Care) is a tool to assess the capacity and quality of pediatric onco-critical care in resource-limited settings. Centers participating in annual PROACTIVE cohorts (available in English and Spanish) receive a report identifying areas of strengths and opportunities to improve care.

 

CritCom is a provider survey to evaluate the quality of team communication across disciplines (ICU, oncology, etc.) and professions (nurses, physicians) for children with cancer who are at risk of deterioration. As with PROACTIVE, centers completing the CritCom assessment receive a report evaluating the quality of interdisciplinary communication across six domains.

 

Our Team

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    Asya Agulnik, MD, MPH

    Director, Global Critical Care Program, St. Jude Global

    Director, Euro Regional Program, St. Jude Global

    Asya Agulnik, MD, MPH

    Associate Member, St. Jude Faculty

    Director, Global Critical Care Program, St. Jude Global

    Director, Euro Regional Program, St. Jude Global

    Research Interests

    • Global pediatric health
    • Hospital quality of care
    • Critical care in pediatric oncology
    • Clinical prediction scores

    Contact Information

    Asya Agulnik, MD, MPH

    Global Pediatric Medicine

    MS 721, Room S2012

    St. Jude Children's Research Hospital

    262 Danny Thomas Place

    Memphis, TN 38105-3678

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    Adolfo Cardenas-Aguirre, MD

    Program Manager, Global Critical Care Transversal Program

    Adolfo Cardenas-Aguirre, MD

    Program Manager, Global Critical Care Transversal Program

    Short Biography

    Adolfo Cardenas-Aguirre, MD, is a Program Manager, Global Critical Care Transversal Program for the department of Global Pediatric Medicine.

    Adolfo was born in Guadalajara, Mexico where he trained as a pediatrician and pediatric intensivist. In his role as department head in a pediatric children's cancer center, Adolfo began collaborating with St. Jude Global on Proyecto EVAT and other Critical Care Initiatives. He became captivated by the vision of Global Pediatric Medicine and interested in the implementation of quality improvement initiatives globally. 

    Since joining the GPM team, Adolfo now works diligently in supporting the various critical care related initiatives to improve supportive care for children with cancer along our partner hospitals throughout Latin America and the world. He is particularly interested in Huma Factors, Quality improvement, Patient Safety, Early Recognition of Clinical Deterioration and Simulation & Education of Healthcare providers.  Adolfo hopes that with these tools he can contribute to the mission of GPM and bring quality care to every child, everywhere and make the world a better place. 

    Contact Information

    Adolfo Cardenas-Aguirre, MD

    Global Pediatric Medicine

    St. Jude Children's Research Hospital

    262 Danny Thomas Place

    Memphis, TN 38105-3678

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    Maria Lamia

    Program Manager, Global Critical Care Transversal Program

    Maria Lamia

    Program Manager, Global Critical Care Transversal Program

    Affiliations

    Short Biography

    Maria Lamia is the Program Manager of the Global Critical Care Program at St. Jude Global. Originally from Colombia and holding a degree in Foreign Trade, Maria brings a unique perspective shaped by her experience in finance and importations prior to joining St. Jude. In her current role, she oversees education, research, assessment, and international collaboration initiatives, working closely with multidisciplinary teams to improve pediatric critical care in resource-limited settings. Maria is also responsible for managing the program’s budget and supporting the training and onboarding of new employees.

    Maria is passionate about sharing knowledge and fostering talent development within global healthcare networks. She is dedicated to problem solving and leading quality improvement efforts, ensuring that best practices are effectively implemented across diverse contexts. Through her leadership, Maria helps cultivate a culture of continuous learning and collaboration, advancing St. Jude’s mission to provide every child with access to high-quality critical care, regardless of where they live.

    Contact Information

    Maria Lamia

    Global Pediatric Medicine

    St. Jude Children's Research Hospital

    262 Danny Thomas Place

    Memphis, TN 38105-3678

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    Stacey Wiedower, MS

    Program Coordinator, Global Critical Care Transversal Program

    Stacey Wiedower, MS

    Program Coordinator, Global Critical Care Transversal Program

    Short Biography

    Stacey Wiedower is a Program Coordinator with the Global Critical Care Transversal Program for the department of Global Pediatric Medicine. She has been with St. Jude Children’s Research Hospital since October 2019.

    Stacey began her work at St. Jude in the Office of Quality and Patient Safety as communication and education specialist. In this role, she managed communication strategy and execution, planned education events, and developed tools, programs and publications to support the hospital’s Safe and Sound Strategic Plan. She also collaborated with departments across the institution to produce informational and educational content for multiple audiences as a senior medical content writer for Strategic Communication, Education and Outreach.

    In her role, Stacey supports the development and delivery of educational curricula for the St. Jude Global Academy, coordinates the St. Jude PICU Observership program, facilitates other program initiatives, and develops communication tools, resources and publications to aid in the global dissemination of pediatric onco-critical care research.

    Contact Information

    Stacey Wiedower, MS

    Global Pediatric Medicine

    St. Jude Children's Research Hospital

    262 Danny Thomas Place

    Memphis, TN 38105-3678

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    Samantha Hayes, MPH

    Program Specialist, Global Critical Care Transversal Program

    Samantha Hayes, MPH

    Program Specialist, Global Critical Care Transversal Program

    Affiliations

    Short Biography

    Samantha Hayes is a Program Specialist with the Global Critical Care Transversal Program for the Department of Global Pediatric Medicine. 

    Samantha received a Bachelor of Science in biology from Southern Illinois University and a Master of Public Health with a concentration in epidemiology and biosecurity disaster preparedness from Saint Louis University. While at Saint Louis University, Samantha co-led the COVID-19 contact tracing program. She also collaborated with the Centers for Disease Control and Prevention and Washington University in St. Louis to evaluate COVID-19 transmission within K-12 school settings.

    She furthered her career in research as a Clinical Research Coordinator II at Washington University in St. Louis, where she led a cluster-randomized trial that sought to assess COVID-19 testing strategies within five K-12 school districts. As her focus shifted to data analysis and management, she began examining epidemiological trends of staphylococcus aureus, developing databases for longitudinal research studies, and overseeing datasets from various studies.

    Samantha is excited to bring her expertise in project management and data analysis to St. Jude Children's Research Hospital and the Global Critical Care Transversal Program.

    Contact Information

    Samantha Hayes, MPH

    Global Pediatric Medicine

    St. Jude Children's Research Hospital

    262 Danny Thomas Place

    Memphis, TN 38105-3678

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    Amela Sijecic

    Program Specialist, Global Critical Care

    Amela Sijecic

    Program Specialist, Global Critical Care

    Short Biography

    Amela earned a Bachelor of Science in Epidemiology and a Master of Public Health with a concentration in Epidemiology from Saint Louis University. While at SLU, she played an integral role as a Clinical Research Assistant at Washington University School of Medicine in St. Louis, where she helped lead research on decision-making tools designed to support pediatric cancer patients and their families.

    Amela has a rich cultural background shaped by her roots in Bosnia and Herzegovina, as well as her experiences in Spain. These diverse cultural influences inform both her personal perspective and her professional work, particularly in advancing global pediatric cancer care—a cause deeply meaningful to her. Her unique background and unwavering dedication drive her commitment to improving cancer care for children worldwide.

    Contact Information

    Amela Sijecic

    Global Pediatric Medicine

    St. Jude Children's Research Hospital

    262 Danny Thomas Place

    Memphis, TN 38105

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    Megan Coe, PhD, RN

    Clinical Research Scientist – Global Critical Care Program

    Megan Coe, PhD, RN

    Clinical Research Scientist – Global Critical Care Program

    Affiliations

    Short Biography

    Megan Coe, PhD, RN is a pediatric nurse and implementation researcher. She completed a PhD in Nursing Science at the University of Washington in 2024, where her dissertation focused on the design and evaluation of an implementation strategy to improve care for hospitalized children with severe acute malnutrition in Kenya. Most recently, she has been a Postdoctoral Scholar in the UW Department of Global Health, establishing the Child Health Implementation Science Research and Evaluation Support (CHIMES) Unit. The CHIMES Unit provides scientific consulting services to Ministries of Health and local implementers in low- and middle-income countries, serving as scientific partners to advance child health. 

    Megan holds a BS in International Studies and Sociology from Johns Hopkins University and an MSN in Clinical Nurse Leadership from the University of Virginia. She began her career coordinating training programs for health workers with Operation Smile, which led her to pursue additional training as a nurse. She worked as a Pediatric Intensive Care Unit nurse at New York Presbyterian. She then joined the Global Health Service Partnership (Peace Corps/Seed Global Health) and taught nursing students at Kamuzu College of Nursing in Lilongwe, Malawi for two years, followed by nearly two years piloting a Clinical Nurse Specialist role in the pediatric ward at Kamuzu Central Hospital. 

    Megan is passionate about improving the quality of care for critically ill pediatric patients. Her research focuses on the experiences of front-line health workers and developing implementation strategies that work for them. She is excited to join the Global Critical Care Program and looks forward to collaborating with many members of the team.

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    Rebekah Daniel, MPH, MSW

    Program Specialist – Global Critical Care

    Rebekah Daniel, MPH, MSW

    Program Specialist – Global Critical Care

    Short Biography

    Rebekah Daniel brings over a decade of experience in global health, with a focus on program design, strategic coordination, and operational management in cross-cultural settings. She holds dual master’s degrees in public health and social work from the University of North Carolina at Chapel Hill, where she specialized in maternal and child health, community-centered research, and global systems of care.

    Before joining St. Jude, Rebekah most recently served at a community-based organization in the Portland metropolitan area, where she focused on promoting self-sufficiency, integration, and long-term success among African immigrants and refugees. In this role, she led sustainability planning, workforce development, and capacity-building efforts. Prior to that, she held several roles at the United States Agency for International Development (USAID), where she managed HIV/AIDS programs across South Sudan, India, Nepal, and Southeast Asia under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Her work consistently emphasized sustainable systems development, cross-sector collaboration, and equitable program implementation.

    Rebekah’s commitment to advancing pediatric health equity is deeply personal and ultimately what led her to St. Jude. As someone who grew up navigating chronic illness and time in pediatric ICUs, she is driven by a mission to ensure that children everywhere, regardless of geography or circumstance, have access to high-quality, coordinated, and compassionate care. This lived experience continues to fuel her passion for strengthening interdisciplinary, culturally responsive health systems.

Contact

To learn more about the Global Critical Care Program, email globalcriticalcare@stjude.org.

 

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