Medicine and Health Sciences Commons^™

Degree Of Twisting And Duration Of Symptoms Are Prognostic Factors Of Testis Salvage During Episodes Of Testicular Torsion, Adam S. Howe, Vinaya Vasudevan, Michael Kongnyuy, Kevin Rychik, Lisa A. Thomas, Maria Matuskova, Steven C. Friedman, Jordan S. Gitlin, Edward F. Reda, Lane S. Palmer

Publications and Research

Background: Testicular torsion is surgical emergency. Prompt diagnosis and treatment of testicular torsion is essential for testicular viability. At surgical exploration, the spermatic cord is seen twisted a variable number of times around its longitudinal axis. There is scant data regarding the degree of twisting and its association with testis outcomes. The purpose of our study is to explore how the degree of torsion factors into testicular outcome using follow-up data.

Methods: We retrospectively reviewed the records of adolescent males who presented with testicular torsion to our institution, looking at duration of pain symptoms, degree of torsion documented in the …

Teen, Parent, And Clinician Expectations About Obesity And Related Conditions During The Annual Well-Child Visit, Andrew S. Bossick, Charles Barone, Gwen L. Alexander, Heather A. Olden, Tanya Troy, Andrea E. Cassidy-Bushrow

Journal of Patient-Centered Research and Reviews

Purpose: This study aimed to examine family (patient, parent/guardian) and clinician preferences for identification and management of obesity and obesity-related conditions during the well-child visit.

Methods: Four focus groups with teen patients (n = 16), four focus groups with parents (n = 15) and one focus group with providers (n = 12) were conducted using a structured moderator guide tailored to each population. Eligible patients had a well-child visit during the past 12 months and a diagnosis of overweight, obesity, hyperlipidemia or elevated blood pressure. Parents who attended their child’s well-child visit and whose child met the diagnostic …

Risk Of Respiratory Syncytial Virus Hospitalization In The First And Second Years Of Life In Pediatric Patients With Congenital Heart Disease, Deborah Friedman, Pierre Wong

NYMC Faculty Publications

No abstract provided.

The Effect Of Occupational Therapy Play-Based Interventions On Cooperative Behavior In Elementary School Aged Children With Autism Spectrum Disorder, Shaunna Kelder, Jennifer E. Langill, Carol A. Reiss, Nicole F. Socia

Pediatrics

The purpose of this study was to explore the perceptions of occupational therapy practitioners regarding the effect play-based interventions have on cooperative behaviors in elementary school aged children with autism spectrum disorder (ASD). While occupational therapy practitioners use a variety of interventions involving play to enhance skills related to social, self-regulation and communication, the concept of how play affects cooperative behavior, specifically in children with ASD, has not been readily identified. This qualitative research project utilized an anonymous survey to collect the perceptions of occupational therapists (OT) and certified occupational therapy assistants (COTA). The intent of the survey was to …

Health Care Transitions For Adolescents And Young Adults With Special Health Care Needs: Where Are We Now?, Nicole Mubanga, Dennis J. Baumgardner, Jessica J. F. Kram

Dennis J. Baumgardner, MD

Eventually, all adolescents must “graduate” from pediatric-oriented to adult-oriented health care. This transition, most often occurring during young adulthood, is especially important for adolescents with special health care needs and involves not only primary care physicians, but also both pediatric and adult subspecialists. Several studies support the benefit of transitional programs for adolescents and young adults with special health care needs. Additionally, the American Academy of Pediatrics named transitional care as one of its top priorities. However, transitional programs have yet to become an established norm among hospitals and providers, specifically outside of children’s hospitals. This topic synopsis aims to …

The Use Of Sensory Spaces In Schools, Syeda S. Mahmood, Erin E. Mallekoote, Ashley Rister

Pediatrics

Objective: This mixed methods continuing line of inquiry was conducted in order to identify how occupational therapists (OTs) report that sensory spaces are being used in Michigan public school settings. This includes who uses the spaces, what purpose the space serves, and the training that individuals utilizing the spaces have received.

Methods: A link to a survey, which was adapted from Abbot, Wills, and Hanert (2015), was posted on the Michigan Alliance of School Physical and Occupational Therapists’ (MASPOT) listServ and Michigan Occupational Therapy Association’s (MiOTA) facebook page in June of 2016 in order to recruit participations. The …

Health Care Transitions For Adolescents And Young Adults With Special Health Care Needs: Where Are We Now?, Nicole Mubanga, Dennis J. Baumgardner, Jessica J. F. Kram

Journal of Patient-Centered Research and Reviews

Eventually, all adolescents must “graduate” from pediatric-oriented to adult-oriented health care. This transition, most often occurring during young adulthood, is especially important for adolescents with special health care needs and involves not only primary care physicians, but also both pediatric and adult subspecialists. Several studies support the benefit of transitional programs for adolescents and young adults with special health care needs. Additionally, the American Academy of Pediatrics named transitional care as one of its top priorities. However, transitional programs have yet to become an established norm among hospitals and providers, specifically outside of children’s hospitals. This topic synopsis aims to …

Duty Hours: More Rest? More Sleep? Less Learning?, Enrique Gomez-Pomar

Pediatrics Faculty Publications

No abstract provided.

Removing Barriers To Care For The Underserved: Provider And Patient Perception Of Direct To Consumer Telemedicine, Robert M. Grell, Rachel Hatcliffe, Sean M. Gillen, Craig Sable, Vanessa Grant, Matthew Ledda, Mary Fuska, Shireen Atabaki

GW Research Days 2016 - 2020

Purpose of Study: Lack of access to pediatric subspecialty care is a major barrier to pediatric health for underserved populations in the Washington DC, Virginia and Maryland area. Lack of access to transportation, long office wait times, and missed school and work are barriers that prevent access to subspecialty care. Direct to consumer (DTC) telemedicine provides this service to our underserved population by bringing care into their own home through use of computers, tablets, and smart phones.

Methods Used: Structured interviews of parents and providers were performed prior to implementation of a subspecialty DTC telemedicine program for underserved children in …

Needs Assessment Of Pediatric Radiological Equipment And Cross-Cultural Investigation Into Parental Empowerment In Pediatric Radiology Program Development In The Kingdom Of Bhutan, Danielle Canter

GW Research Days 2016 - 2020

Background:

Bhutan is a magnificent mountainous country hugged by India to the east and west and by China to the North and South. This peaceful nestled country faces challenges in combating non-communicable diseases due to the lack of radiological equipment necessary for early diagnosis. Prior to implementation of these medical devices, it is imperative to investigate the cultural attitudes, beliefs, and infrastructure, to ensure successful integration. Bhutan is beginning to implement a pediatric radiology program for the nation with the assistance of ABAH Foundation and RAD-AID International, both of whom partnered with graduate students at George Washington University School of …

Physician Satisfaction With Integrated Behavioral Health In Pediatric Primary Care., Jeffrey F. Hine, Allison Q. Grennan, Kathryn M. Menousek, Gail Robertson, Rachel J. Valleley, Joseph H. Evans

Manuscripts, Articles, Book Chapters and Other Papers

As the benefits of integrated behavioral health care services are becoming more widely recognized, this study investigated physician satisfaction with ongoing integrated psychology services in pediatric primary care clinics. Data were collected across 5 urban and 6 rural clinics and demonstrated the specific factors that physicians view as assets to having efficient access to a pediatric behavioral health practitioner. Results indicated significant satisfaction related to quality and continuity of care and improved access to services. Such models of care may increase access to care and reduce other service barriers encountered by individuals and their families with behavioral health concerns (ie, …

Expectations For Treatment In Pediatric Weight Management And Relationship To Attrition., Erinn T. Rhodes, Richard E. Boles, Kimberly Chin, Amy Christison, Elizabeth Getzoff Testa, Kimberly Guion, Mary Jane Hawkins, Carter R. Petty, Bethany Sallinen Gaffka, Melissa Santos, Laura Shaffer, Jared Tucker, Sarah Hampl

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Attrition in pediatric weight management negatively impacts treatment outcomes. A potentially modifiable contributor to attrition is unmet family expectations. This study aimed to evaluate the association between adolescent and parent/guardian treatment expectations and attrition.

PATIENTS AND METHODS: A prospective, nonrandomized, uncontrolled, single-arm pilot trial was conducted among 12 pediatric weight management programs in the Children's Hospital Association's FOCUS on a Fitter Future collaborative. Parents/guardians and adolescents completed an expectations/goals survey at their initial visit, with categories including healthier food/drinks, physical activity/exercise, family support/behavior, and weight management goals. Attrition was assessed at 3 months.

RESULTS: From January to August 2013, …

Mortality Associated With Gastrointestinal Bleeding In Children: A Retrospective Cohort Study., Thomas M. Attard, Mikaela Miller, Chaitanya Pant, Ashwath Kumar, Mike Thomson

Manuscripts, Articles, Book Chapters and Other Papers

AIM: To determine the clinical characteristics of children with gastrointestinal bleeding (GIB) who died during the course of their admission.

METHODS: We interrogated the Pediatric Hospital Information System database, including International Classification of Diseases, Current Procedural Terminology and Clinical Transaction Classification coding from 47 pediatric tertiary centers extracting the population of patients (1-21 years of age) admitted (inpatient or observation) with acute, upper or indeterminate GIB (1/2007-9/2015). Descriptive statistics, unadjusted univariate and adjusted multivariate analysis of the associations between patient characteristics and treatment course with mortality was performed with mortality as primary and endoscopy a secondary outcome of interest. All …

Outpatient Parenteral Antimicrobial Therapy In Pediatric Medicaid Enrollees., Jennifer Goldman, Troy Richardson, Jason G. Newland, Brian R. Lee, Jeffrey S. Gerber, Matt Hall, Matthew Kronman, Adam L. Hersh

Manuscripts, Articles, Book Chapters and Other Papers

Background: Outpatient parenteral antimicrobial therapy (OPAT) is overused in cases where highly bioavailable oral alternatives would be equally effective. However, the scope of OPAT use for children nationwide is poorly understood. Our objective was to characterize OPAT use and clinical outcomes for a large population of pediatric Medicaid enrollees treated with OPAT.

Methods: We analyzed the Truven MarketScan Medicaid claims database between 2009 and 2012. An OPAT episode was identified by capturing children with claims data indicating home infusion therapy for an intravenous antimicrobial. We characterized OPAT use by describing patient demographics, diagnoses, and antimicrobials prescribed. We categorized an antimicrobial …

Using A Multifaceted Approach To Working With Children Who Have Differences In Sensory Processing And Integration, Stacey Reynolds, Tara J. Glennon, Karla Ausderau, Roxanna M. Bendixen, Heather Miller-Kuhaneck, Beth Pfeiffer, Renee Watling, Kimberly Wilkinson, Stefanie C. Bodison

Occupational Therapy Faculty Publications

Pediatric occupational therapy practitioners frequently provide interventions for children with differences in sensory processing and integration. Confusion exists regarding how best to intervene with these children and about how to describe and document methods. Some practitioners hold the misconception that Ayres Sensory Integration intervention is the only approach that can and should be used with this population. The issue is that occupational therapy practitioners must treat the whole client in varied environments; to do so effectively, multiple approaches to intervention often are required. This article presents a framework for conceptualizing interventions for children with differences in sensory processing and integration …

The Art And Skill Of Delivering Culturally Responsive Trauma-Focused Cognitive Behavioral Therapy In Tanzania And Kenya., Briana Woods-Jaeger, Christine M. Kava, Christopher F. Akiba, Leah Lucid, Shannon Dorsey

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: This study explored the facilitators, barriers, and strategies used to deliver a child mental health evidence-based treatment (EBT), trauma-focused cognitive behavioral therapy (TF-CBT), in a culturally responsive manner. In low- and middle-income countries most individuals with mental health problems do not receive treatment due to a shortage of mental health professionals. One approach to addressing this problem is task-sharing, in which lay counselors are trained to deliver mental health treatment. Combining this approach with a focus on EBT provides a strategy for bridging the mental health treatment gap. However, little is known about how western-developed EBTs are delivered in …

Vitamin D Status In Pediatric Irritable Bowel Syndrome, Benjamin U. Nwosu, Louise Maranda, Ninfa Candela

Benjamin U. Nwosu

IMPORTANCE: Irritable bowel syndrome (IBS) is associated with significant morbidity in children and adolescents, and the therapeutic efficacy of available treatment options is limited. The role of vitamin D supplementation in pediatric IBS is unclear as the vitamin D status of pediatric patients with IBS is unknown. Equally, the relationship of vitamin D status with psychosomatic symptoms in children and adolescents is unclear. AIM: To characterize the vitamin D status of pediatric patients with IBS using a case-control study design. HYPOTHESIS: Serum 25-hydroxyvitamin D [25(OH)D] concentration will be similar between patients with IBS and controls. SUBJECTS AND METHODS: A retrospective …

Using Quality Improvement Methods To Increase Use Of Pain Prevention Strategies For Childhood Vaccination., Jennifer Verrill Schurman, Amanda D. Deacy, Rebecca J. Johnson, Jolynn Parker, Kristi Williams, Dustin Wallace, Mark Connelly, Lynn Anson, Kevin Mroczka

Manuscripts, Articles, Book Chapters and Other Papers

AIM: To increase evidence-based pain prevention strategy use during routine vaccinations in a pediatric primary care clinic using quality improvement methodology.

METHODS: Specific intervention strategies (i.e., comfort positioning, nonnutritive sucking and sucrose analgesia, distraction) were identified, selected and introduced in three waves, using a Plan-Do-Study-Act framework. System-wide change was measured from baseline to post-intervention by: (1) percent of vaccination visits during which an evidence-based pain prevention strategy was reported as being used; and (2) caregiver satisfaction ratings following the visit. Additionally, self-reported staff and caregiver attitudes and beliefs about pain prevention were measured at baseline and 1-year post-intervention …

Use Of Management Pathways Or Algorithms In Children With Chronic Cough Chest Guideline And Expert Panel Report, Anne B. Chang, John J. Oppenheimer, Miles M. Weinberger, Bruce K. Rubin, Kelly Weir, Cameron C. Grant, Richard S. Irwin, Chest Expert Cough Panel

Pediatrics Publications

BACKGROUND: Using management algorithms or pathways potentially improves clinical outcomes. We undertook systematic reviews to examine various aspects in the generic approach (use of cough algorithms and tests) to the management of chronic cough in children (aged ≤ 14 years) based on key questions (KQs) using the Population, Intervention, Comparison, Outcome format.

METHODS: We used the CHEST Expert Cough Panel's protocol for the systematic reviews and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development and Evaluation framework. Data from the systematic reviews in conjunction with patients' values and preferences and the clinical context …

Pilot Study Investigating The Use Of 3d Printing In Designing Upper-Extremity Prosthetics For Children: A Progress Report, Lauren Long, Christina Salas, Deana M. Mercer, Selina R. Silva, Jared Knigge

UNM Orthopaedic Research Journal

The availability and cost-effectiveness of functional prototypes and designs has increased considerably over the last decade because of 3D printing. The growing field of biomedical engineering is expanding on 3D-printing technology to make low-cost, upper-extremity prosthetics. This pilot study reports on the potential use of 3D printing for low-cost, upper-extremity prosthetics, specifically prosthetic hands for children. We start by characterizing existing open-source, 3D-printed upper-extremity prosthetics to determine their mechanical strength, statically and dynamically. Based on outcomes from these early tests, we optimize the existing designs to develop a new prosthetic. The prosthetic design, fabricated in The University of New Mexico …

When Crrt On Ecmo Is Not Enough For Potassium Clearance: A Case Report, Janice A. Tijssen, Guido Filler

Paediatrics Publications

Background: Continuous renal replacement therapy (CRRT) is an excellent method used to remove fluid and solutes. It may also reduce the systemic inflammatory response for patients on extracorporeal membrane oxygenation (ECMO) support. Theobjective of this report is to describe a case where CRRT in combination with ECMO was insufficient to control hyperkalemia. Methods: We report the case of an adolescent patient with refractory symptomatic hyperkalemia due to substantial rhabdomyolysis in which CRRT insufficiently cleared the patient's excess potassium. Results: Intermittent hemodialysis (IHD) was added and proved successful. The patient was weaned off ECMO, CRRT, and IHD, and his cardiac and …

Graduate Medical Education 2016-2017 Annual Report, Children's Mercy Hospital

GME Annual Reports

Annual report of the Children's Mercy Hospital Graduate Medical Education department, including pediatric residency, internal medicine/pediatrics residency, fellowship programs, medical students, continuing medical education, and library services.

Promotion Of Skin Protection In Children In Waterbury, Vt, Kelsey M. Sullivan

Family Medicine Clerkship Student Projects

Background: Vermont has among the highest rates of skin cancer in the nation. Between 2001 and 2005, Vermont had the highest incidence of melanoma of any state, 63% higher than the national average. It is also estimated that if children under 18 regularly used sunscreen of at least SPF 15, the incidence of squamous and basal cell carcinomas would decrease by 78%. Modeling by the EPA and CDC suggests that recommended sun protection measures could prevent 11,000 cases of skin cancer, 50 deaths, and $30 million in cancer treatment costs nationwide. Intervention: To create an information sheet on skin protection …

Predictors Of Loss To Follow-Up Among Children With Type 2 Diabetes., Ashley Shoemaker, Peiyao Cheng, Robin L. Gal, Craig Kollman, William V. Tamborlane, Georgeanna J. Klingensmith, Mark A. Clements, Tamara S. Hannon, Rubina Heptulla, Joane Less, Jamie Wood, Pediatric Diabetes Consortium

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND/AIMS: Youth with type 2 diabetes (T2D) have poor compliance with medical care. This study aimed to determine which demographic and clinical factors differ between youth with T2D who receive care in a pediatric diabetes center versus youth lost to follow-up for >18 months.

METHODS: Data were analyzed from 496 subjects in the Pe-diatric Diabetes Consortium registry. Enrollment variables were selected a priori and analyzed with univariable and multivariable logistic regression models.

RESULTS: After a median of 1.3 years from enrollment, 55% of patients were lost to follow-up. The final model included age, race/ethnicity, parent education, and estimated distance to …

Cancer Care Annual Report 2016-2017, Children's Mercy Hospital

Cancer Center Annual Reports

Annual report of cancer care and oncology services at the Children's Mercy Hospital, Kansas City MO, a pediatric medical center. This report has a focus on sarcomas.

A Month In Manila, Robin M. Lund

Posters

Describes a global health learning experience at Philippines Children's Medical Center in Manila.