Digital Commons Network^™

A Pilot Intervention Combining Assessment And Feedback With Communication Training And Behavioral Nudges To Increase Hpv Vaccine Uptake., Andrea Bradley-Ewing, Brian R. Lee, Jason N. Doctor, Georgann Meredith, Kathy Goggin, Angela Myers

Manuscripts, Articles, Book Chapters and Other Papers

Human papillomavirus (HPV) causes >40,000 cancer diagnoses each year, yet vaccination rates remain low because widespread implementation of strategies to increase vaccinations has not occurred. Behavioral nudges have demonstrated efficacy in improving uptake of desired behaviors in health care settings but have not been tested for increasing HPV vaccinations. We assessed the impact of an intervention combining behavioral nudges with other proven strategies (i.e., assessment and feedback, provider communication training) on HPV vaccination rates and parental satisfaction in four Midwestern pediatric, outpatient practices. Practices were randomly assigned to receive either assessment and feedback or assessment and feedback combined with vaccine …

Gender Dysphoria In Adolescents With Ehlers-Danlos Syndrome., Jordan T. Jones, William R. Black, Christine Moser, Eric T. Rush, Lindsey Malloy-Walton

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: Ehlers-Danlos Syndrome represents a family of heritable connective tissue disorders that include joint hypermobility, tissue fragility, and skin hyperextensibility. Ehlers-Danlos Syndrome presents with clinical sequela across multiple body systems that require multidisciplinary care. Little is known about adolescents with Ehlers-Danlos Syndrome who are transgender and gender diverse. To date, there have been no reports of transgender and gender diverse youth in pediatric patients with Ehlers-Danlos Syndrome. The objective of this study was to characterize transgender and gender diverse adolescents with Ehlers-Danlos Syndrome seen in a pediatric multidisciplinary specialty clinic.

METHODS: A retrospective chart review was performed and it was …

Impact Of Diabetes Status And Related Factors On Covid-19-Associated Hospitalization: A Nationwide Retrospective Cohort Study Of 116,370 Adults With Sars-Cov-2 Infection., Erin M. Tallon, Osagie Ebekozien, Janine Sanchez, Vincent S. Staggs, Diana Ferro, Ryan Mcdonough, Carla Demeterco-Berggren, Sarit Polsky, Patricia Gomez, Neha Patel, Priya Prahalad, Ori Odugbesan, Priyanka Mathias, Joyce M. Lee, Chelsey Smith, Chi-Ren Shyu, Mark A. Clements

Manuscripts, Articles, Book Chapters and Other Papers

Aims: We examined diabetes status (no diabetes; type 1 diabetes [T1D]; type 2 diabetes [T2D]) and other demographic and clinical factors as correlates of coronavirus disease 2019 (COVID-19)-related hospitalization. Further, we evaluated predictors of COVID-19-related hospitalization in T1D and T2D.

Methods: We analyzed electronic health record data from the de-identified COVID-19 database (December 2019 through mid-September 2020; 87 US health systems). Logistic mixed models were used to examine predictors of hospitalization at index encounters associated with confirmed SARS-CoV-2 infection.

Results: In 116,370 adults ( >=18 years old) with COVID-19 (93,098 no diabetes; 802 T1D; 22,470 T2D), factors that independently increased …

A Methodological And Clinical Approach To Measured Energy Expenditure In The Critically Ill Pediatric Patient., Jaime Silva-Gburek, Paola Hong Zhu, Marwa Mansour, David Walding, Jorge A. Coss-Bu

Manuscripts, Articles, Book Chapters and Other Papers

The metabolic response to injury and stress is characterized initially by a decreased energy expenditure (Ebb phase) followed by an increased metabolic expenditure (Flow phase). Indirect calorimetry is a methodology utilized to measure energy expenditure and substrate utilization by measuring gas exchange in exhaled air and urinary nitrogen. The use of indirect calorimetry in critically ill patients requires precise equipment to obtain accurate measurements. The most recent guidelines suggested that measured energy expenditure by indirect calorimetry be used to determine energy requirements. This article reviews the methodological and clinical use of indirect calorimetry in critically ill pediatric patients.

The Use Of Virtual Tools In Narrowing The Impact Of Health Disparities In Neurology., Jean-Baptist Lepichon, Stephanie Horton, Omar Abdelmoity, Mark A. Hoffman, Emily Cramer, Nirmeen Kishk, Salah Hamada, Ahmed Abdelmoity

Manuscripts, Articles, Book Chapters and Other Papers

The concept of Epilepsy Treatment Gap (ETG) refers to the proportion of people with epilepsy who are not being appropriately treated. The ETG in the USA approaches 10%, with historically underserved populations and rural populations disproportionately affected. The ETG in Low-and Middle-Income Countries (LMIC) is reported to be 5-10 times higher than in high-income countries. The growing availability of reliable internet access offers a unique opportunity to provide better care to children and adults with epilepsy. In this paper we explore various telehealth (TH) initiatives that have leveraged the availability of easy and free access to an internet connection in …

Acute Otitis Media: Low Dose Versus High Dose Amoxicillin, Children's Mercy Kansas City

Clinical Critically Appraised Topics

No abstract provided.

Diabetic Ketoacidosis Intravenous Fluids, Children's Mercy Kansas City

Clinical Critically Appraised Topics

No abstract provided.

Croup: Observation Time Post Racemic Epinephrine Dosing In Children With Croup, Children's Mercy Kansas City

Clinical Critically Appraised Topics

No abstract provided.

Acute Otitis Media, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Care Process Models)

No abstract provided.

Stewardship Opportunities For Cervical Lymphadenitis And Deep Neck Space Infections, Aaron Shaw, Brian R. Lee, Lauren Kazmaier, Emily Baker, Tina Dao, Sandra Arnold, Angela Myers

Posters

Background: Cervical lymphadenitis (LAD) and deep neck space abscesses (DNSA) are common pediatric infections caused by similar bacteria. We sought to determine differences in presentation, diagnosis, and treatment between LAD and DNSA to identify antimicrobial and diagnostic stewardship opportunities. Methods: Charts were obtained using ICD9/10 codes for retropharyngeal and parapharyngeal abscessed (DNSA), and LAD between 1/1/10-12/31/20 from two pediatric centers. 1981 charts were identified. Charts were excluded if the diagnosis was not a bacterial infection (e.g. Kawasaki disease), if the LAD was not in the neck, or if caused by less common bacteria (e.g. tuberculosis). Data on presenting signs, symptoms, …

Screening Considerations For Patients With Sexually Transmitted Infections, Children's Mercy Kansas City

Clinical Critically Appraised Topics

No abstract provided.

Pharmacokinetic Evaluation Of Intravenous Vitamin C: A Classic Pharmacokinetic Study., Ping Chen, Greg Reed, Joyce Jiang, Yaohui Wang, Jean Sunega, Ruochen Dong, Yan Ma, Anna E. Esparham, Ryan Ferrell, Mark Levine, Jeanne Drisko, Qi Chen

Manuscripts, Articles, Book Chapters and Other Papers

Purpose: Intravenous vitamin C (IVC) is used in a variety of disorders with limited supporting pharmacokinetic data. Herein we report a pharmacokinetic study in healthy volunteers and cancer participants with IVC doses in the range of 1-100 g.

Methods: A pharmacokinetic study was conducted in 21 healthy volunteers and 12 oncology participants. Healthy participants received IVC infusions of 1-100 g; oncology participants received IVC infusions of 25-100 g. Serial blood and complete urine samples were collected pre-infusion and for 24 h post-infusion. Pharmacokinetic parameters were computed using noncompartmental methods. Adverse events were monitored during the study.

Results: In both cohorts, …

Croup: Predictors Of Admission For Patients With Croup, Children's Mercy Kansas City

Clinical Critically Appraised Topics

No abstract provided.

Characterization Of The Mucosally-Adherent Duodenal Microbiome In Children With And Without Crohn's Disease., Kenneth Schmidt, Janelle R. Noel-Macdonnell Phd, Carrie Vyhlidal, Daniel P. Heruth, Vivekanand Singh, Atif A. Ahmed, Taina Hudson, Veronica Williams, Valentina Shakhnovich

Manuscripts, Articles, Book Chapters and Other Papers

Manipulation of the microbiome is a rational treatment strategy for inflammatory bowel disease (IBD). Compared to the colon and terminal ileum (TI), understanding of the microbial composition in the duodenum is sparse. This gap in knowledge is especially significant for children with Crohn's disease (CD) because the prevalence of duodenal CD is higher in children than in adults. Our aim was to characterize the bacterial composition of the mucosally-adherent duodenal microbiome in children with and without CD as a first step toward development of targeted IBD treatment strategies at this disease location. Fresh-frozen mucosal biopsies were obtained from the duodenum …

Gluten-Free Diet In Childhood Difficult-To-Treat Nephrotic Syndrome: A Pilot Feasibility Study., Tarak Srivastava, Katherine M. Dell, Kevin V. Lemley, Debbie S. Gipson, Frederick J. Kaskel, Kevin Edward Meyers, Christian Faul, Ayelet Goldhaber, Laurajane Pehrson, Howard Trachtman

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: Minimal change disease in childhood can follow a frequently relapsing or steroid-dependent course in up to 40% of cases. Second-line immunosuppressive medications that are used to manage these patients are associated with significant adverse effects. There is a need for safer alternative treatments for difficult-to-treat nephrotic syndrome. Therefore, we conducted an open-label feasibility study to assess the safety and efficacy of a gluten-free diet as treatment for pediatric patients with difficult-to-treat nephrotic syndrome. As a second aim, we sought to determine if the plasma zonulin concentration can identify those who are more likely to respond to this intervention.

METHODS: …

Acute Otitis Media: Antibiotic Length, Children's Mercy Kansas City

Clinical Critically Appraised Topics

No abstract provided.

Who Is My Child’S Main Doctor? Assessing Caregiver Perceptions Of Teaching Teams At A Pediatric Tertiary Care Center., Jonathan Ermer

Research Days

Background: The size and structure of large academic teaching teams can create a barrier to communication and relationship-building with caregivers. Studies have shown that from a patient perspective, being able to name their doctor and identify their role is important. Benefits include increased patient satisfaction, improved relationships in line with the family-centered care movement, and improved patient safety. Although important, studies in both adults and pediatrics have shown that patients and caregivers do not know who their doctors are. Acknowledging the hierarchy present on family-centered rounds is not only burdensome and confusing to patients and caregivers, but it can also …

Evaluation Of A Modified Pre-Medication Algorithm For Non-Emergent Intubation In A Neonatal Intensive Care Unit, Lilah Melzer

Research Days

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Background: The use of pre-medication for elective non-emergent intubation in neonates and infants has been suggested to minimize physiologic instability, decrease oral/pharyngeal trauma and decrease time and attempts to successful intubation. A pre-medication algorithm including the use of Fentanyl + Atropine was modified to include a higher dose of fentanyl with addition of muscle relaxant and benzodiazepine in a level IV neonatal intensive care unit.

Objective: The objective of this study was to compare first attempt success of intubation pre- vs post-modification of the pre-medication algorithm.

Methods: This is a single site retrospective chart review. …

Primary Venous Thromboprophylaxis In Pediatric Oncology Patients, Kyra Mccarty

Research Days

Background: The Virchow’s Triad principles of venous stasis, endothelial damage, and hypercoagulability are all features of malignancy and contribute to the increased risk venous thromboembolism (VTE) seen in oncology patients. Additionally, certain chemotherapy treatments, presence of a central venous catheter and immobility are also intrinsically associated with malignancy diagnoses and exacerbate this risk. However, much debate exists over the use of thromboprophylaxis in the pediatric population, primarily due to lack of evidence regarding safety and efficacy, primarily the risk of major bleeding. Multiple retrospective studies have attempted to identify the primary risk factors for VTE in this pediatric oncology patient …

Diagnosis, Management, And Treatment Of Lymphadenitis And Deep Neck Space Infections At A Children’S Hospital, Aaron Shaw

Research Days

Background: Although cervical lymphadenitis and deep neck space abscesses (DNSA) are relatively common pediatric diagnoses, no standardized approach exists for management of these infections.

Objectives/Goal: To assess variability in diagnosis and treatment of cervical lymphadenitis and DNSA in a children’s hospital.

Methods/Design: Charts were obtained using ICD9/10 codes for diagnoses of retropharyngeal and parapharyngeal abscess, and lymphadenitis between 1/1/10-12/31/20. 1,237 charts were identified. Patients with a retropharyngeal and/or parapharyngeal abscess were defined as DNSA. Charts were excluded if the diagnosis was not a bacterial infection (e.g. Kawasaki disease), if the lymphadenitis was not in the neck, or if caused by …

Burnout In Pediatric Nephrology Fellows And Faculty: Lessons From The Sustainable Pediatric Nephrology Workforce Project (Superpower)., Susan M. Halbach, Kartik Pillutla, Patricia Seo-Mayer, Alan Schwartz, Darcy K. Weidemann, John D. Mahan

Manuscripts, Articles, Book Chapters and Other Papers

Physician well-being is an important contributor to both job satisfaction and patient outcomes. Rates of burnout among physicians vary by specialty, ranging from 35 to 70%. Among pediatric residents, longitudinal data demonstrates consistent rates of burnout around 50-60%, although little is known about burnout among pediatric subspecialty fellows. Specifically, the degree of burnout among pediatric nephrologists remains unknown, as does the impact faculty burnout may have on trainee burnout. We sought to evaluate prevalence and predictors of burnout among US pediatric nephrology fellows and faculty, and assess for interactions between groups. In this multi-center pilot survey of all United States …

Association Of Patient Demographics, Code Characteristics, And Survival To Discharge After In-Hospital Cardiac Arrests In The Pediatric Intensive Care Unit, Nathan Lavoy

Research Days

Background: Lower socioeconomic status and minority background have been linked to worse outcomes after out-ofhospital and in-hospital cardiac arrests (IHCA). Despite this, there has not been a focus on IHCA within a pediatric intensive care unit (PICU) evaluating patient demographics and code characteristics.

Objectives/Goal: The primary objective is to describe patient demographics, code characteristics, and survival to discharge of patients that suffer IHCA in a quaternary PICU. The goal of this descriptive, retrospective study is to identify possible differences in outcomes related to patient demographics, laying the foundation for further QI initiatives.

Methods/Design: Participants included patients between 24 hours and …

A Mixed-Methods Examination Of Transgender Youth Desistence, Mirae J. Fornander

Research Days

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Background: Access to gender-affirming medical care (GAMC) for transgender/gender diverse (TGD) individuals is one of the most pressing social justice issues of our time. Research has begun to identify the benefits of GAMC. However, little is known about the healthcare needs of TGD youth, especially those who discontinue GAMC. Available literature lacks clear and consistent terms to define TGD youth who stop care. Further, a significant criticism of current research is the assumption that discontinuing care is equivalent to detransitioning. There are no studies, to our knowledge, that differentiate between TGD youth who choose to …

Healthcare Utilization Of Victims Of Commercial Sexual Exploitation Compared To Non-Victims, Cree Kachelski

Research Days

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Background: Approximately 17,000 US children are victims of Commercial Sexual Exploitation of Children (CSEC) annually. Nearly 75% of adolescent CSEC victims received medical care within 6 months prior to identification. Screening tools have been developed based on known characteristics of CSEC victims; however, little is known about how CSEC victims compare to non-CSEC adolescents in healthcare utilization. Thus, appropriate medical CSEC screening settings are unknown.

Objectives/Goal: We aimed to identify where and how often adolescents presented to medical care in the 12 months prior to CSEC identification. We hypothesized that compared to controls, CSEC positive …

Self-Reported Sexual Behavior In A Pediatric Gender Clinic Sample, Mirae J. Fornander

Research Days

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Background: Previous studies of transgender/gender diverse (TGD) youth indicate differences in rates of sexual behaviors between TGD youth and their cisgender peers. However, few studies have reported the sexual behavior and preferences of TGD youth in a large clinic sample, and no studies, to our knowledge, have utilized questionnaires that do not assume the sex or gender of one’s sexual partner.

Objectives/Goal: The current study aims to explore the self-reported sexual behavior of TGD youth presenting for gender-affirming medical care.

Methods/Design: Retrospective chart review of 589 patients (ages 12-22, M= 15.92, SD= 1.54; 72.9% assigned …

Improving Adolescent Sexual And Mental Health Care Access Through Community Outreach, Anna Bitely

Research Days

Background: In the pandemic’s wake, marginalized adolescents face exacerbated barriers to accessing sexual and reproductive health (SRH) and mental health (MH) care. Telemedicine access for SRH/MH care has increased, but disparities remain.

Objectives/Goal: We assessed the impact of our intervention (AccessKCTeen) on care access.

Methods/Design: We trained four peer leaders to share SRH/MH information and mobilize their networks to attend AccessKCTeen outreach events. We partnered with community organizations to host events where we demonstrated telemedicine, shared resources for SRH/MH care, and discussed and distributed free health items (e.g. emergency contraception (EC), condoms, pregnancy tests, hand sanitizer). Teens completed surveys prior …

Urinary Tract Infection-Cystitis/Pyelonephritis, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Clinical Practice Guidelines)

No abstract provided.

Skin And Soft Tissue Infection, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Clinical Practice Guidelines)

No abstract provided.

Association Of Abnormal Findings On Neonatal Cranial Ultrasound With Neurobehavior At Neonatal Intensive Care Unit Discharge In Infants Born Before 30 Weeks' Gestation., Jennifer Helderman, T Michael O'Shea, Lynne Dansereau, Jennifer Check, Julie A. Hofheimer, Lynne M. Smith, Elisabeth Mcgowan, Charles R. Neal, Brian S. Carter, Steven L. Pastyrnak, Bradford Betz, Joseph Junewick, Heather L. Borders, Sheri A. Dellagrotta, Barry M. Lester

Manuscripts, Articles, Book Chapters and Other Papers

Importance: Cranial ultrasound (CUS) findings are routinely used to identify preterm infants at risk for impaired neurodevelopment, and neurobehavioral examinations provide information about early brain function. The associations of abnormal findings on early and late CUS with neurobehavior at neonatal intensive care unit (NICU) discharge have not been reported.

Objective: To examine the associations between early and late CUS findings and infant neurobehavior at NICU discharge.

Design, Setting, and Participants: This prospective cohort study included infants enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants Study between April 2014 and June 2016. Infants born before 30 weeks' gestational …

Trends In Proportions Of Female Representation At American Society Of Pediatric Nephrology Pediatric Academic Society Meetings 2012-2021, Bahar Barani Najafabadi, Dave Selewski, Danielle Soranno, Darcy Weidemann

Posters

No abstract provided.