Medicine and Health Sciences Commons^™

The Role Of Adverse Childhood Events On The Progression Of Chronic Kidney Disease In Children: A Ckid Study, Ana Cortez, Matthew Matheson, John Cowden, Bradley Warady, Darcy K. Weidemann

Posters

There is a paucity of research on the relationship between adverse childhood events (ACEs) and chronic kidney disease. The effect of ACEs on the long-term health outcomes of cardiovascular disease, cancer, and chronic lung disease first emerged in a paper published in 1998. The National Institutes of Health sponsored the ACE Study, which Kaiser Permanente carried out in California. The study used a 17-question survey addressing seven exposures: psychological, physical, contact-sexual abuse, substance abuse, mental illness, mother being treated violently, and criminal behavior in the household. The results revealed a strong relationship between childhood exposure to ACEs and health outcomes. …

Increasing Equitable Access To Pediatric Specialty Care In Maine Through Implementation Of Econsults, David Ireland, Rachel Rockers, Sarah M. Gabrielson, Anya K. Cutler, Laura J. Faherty, Genevieve Whiting

Costas T. Lambrew Research Retreat 2024

Introduction

•Barriers to accessing pediatric specialty care exist for many and are not experienced equally by all.

•eConsults are an asynchronous provider-provider referral modality to obtain low-barrier specialist input in place of some face-to-face (F2F) visits.

•We evaluated sociodemographic factors associated with referral to and receipt of specialist input before and after eConsult implementation at MaineHealth to examine equity implications.

Bal-A-Vis-X Intervention To Improve Upper Limb Coordination In Children With Disability: A Pilot Study, Marta Boot, Zoe Clark, Kyla Hill, Mckenzie Stefanoff, Betsy Donahoe Fillmore, Trisha Renner, Bo Slutz, Mary I. Fisher

University of Dayton Doctor of Physical Therapy Annual Research Symposium

Purpose/Hypothesis: Balance/Auditory/Vision exercises (Bal-A-Vis-X) consists of a series of exercises using sand-filled bags and racquet balls. Most of the exercises are completed while standing on a rocker board and heavily rooted in rhythm. The rhythmic patterns are utilized to facilitate focused concentration, crossing midline, motor planning, right/left awareness, eye-hand coordination, balance, bilateral coordination, body and spatial awareness. Only a few published studies have explored Bal-A-Vis-X as an intervention in therapy. The purpose of this study was to investigate the use of Bal-A-Vis-X to improve upper limb coordination in children with motor delays.

Number of Subjects: Fifteen children with motor delays …

Call Me Telephone Triage Skills For Pediatricians Across Multiple Settings, Cody Clary, Jonathan Ermer, Rebecca Callahan, Kayla Heller, Luke Stephens, Margaret Kirkpatrick, Nehal Parikh, Cody Tigges, Madhuradhar Chegondi

Presentations

Come explore current evidence surrounding telephone triage skills across a variety of settings and learn ways to teach these valuable skills while promoting best practices. Outpatient pediatricians, hospitalists, ICU physicians and ED providers all have telephone calls incorporated into their work. Often physicians are operating with very little training in this area, and methodology about teaching these skills to pediatric trainees is limited. We will highlight educational innovations at a variety of programs designed to improve resident and fellow education, sharing our results and providing opportunities for others to design their own content relevant to their own practice. Participants will …

Thyroid Dysfunction In Patients Receiving Immune Checkpoint Inhibitors, Emily Metzinger, Jennifer Boyd, Julia Broussard, Christopher Klockau

Posters

Objectives: The use of immune checkpoint inhibitors (ICIs) in cancer treatment is increasing. Literature about endocrinopathies associated with ICIs in children is limited. This study investigates ICIs and thyroid dysfunction in pediatric patients at one institution.

Methods: Retrospective chart review of patients ages 1 to 19 was completed who received any of the following ICIs between January 2000 and November 2023: PD-1 inhibitors (nivolumab or pembrolizumab), PD-L1 inhibitors (durvalumab or atezolizumab), and CTLA-4 inhibitors (ipilimumab or tremelimumab). Patients were excluded if thyroid function tests (TFTs) were not available to review or if patients passed away within 30 days of ICI …

Variation In Systemic Corticosteroid Prescribing During Asthma-Related Hospitalizations Across Children's Hospitals, Sian Best, Matt Hall, Jessica L. Bettenhausen, Shelby Chesbro, Nicholas Clark, Megan Collins, Adrienne G. Deporre, Jonathan Ermer, Bridgette Jones, Leah Jones, Jessica Markham, Elisha Mccoy, Maria Newmaster, Laura Plencner, Henry T. Puls, Smit Shah, Kathryn Kyler

Presentations

Asthma exacerbations are a leading cause of pediatric hospitalizations, and systemic corticosteroids remain a key component of inpatient treatment. Emergency department-focused studies have shown dexamethasone to be equivalent to prednisone/prednisolone in terms of outcomes such as readmission rates, but less is known about the trends in dexamethasone use versus other systemic corticosteroids, and associated outcomes in the inpatient setting. Objective (216) To describe variability and trends in inpatient systemic corticosteroid prescribing practices for acute asthma exacerbations, and to determine associations between the prescribed steroid and hospitalization outcomes. Design/Methods (949) This retrospective cross-sectional study utilized the PHIS database to examine patients …

Understanding Inpatient Diagnostic Imaging Use In Children’S Hospitals To Prioritize Stewardship Efforts, Megan Collins, Matt Hall, John R. Stephens, Jessica Markham

Posters

Background: Healthcare waste, including overuse of treatments or testing such as unnecessary diagnostic imaging, has estimated annual costs of over $760 billion in the United States. The most prevalent and costly imaging studies among hospitalized children are not known. Objective: To describe diagnostic imaging studies among hospitalized children with the highest prevalence, cost, rates of repetition, and hospital variation to help inform de-implementation efforts. Design/Methods: We performed a retrospective cohort study of children <18 years of age hospitalized from 1/1/2021 to 12/31/2022 across 45 hospitals in the Pediatric Health Information System. We identified all radiologic imaging for inpatient and observation encounters using billing codes. We grouped images by modality and body location, and excluded images classified as other/unspecified body location. The intraclass correlation coefficient was used to measure variation across hospitals in imaging use after adjusting for age and severity. Higher numbers indicate a higher degree of variation. Results: We identified 1,523,343 encounters; 59.1% had diagnostic imaging (Table 1). The most prevalent diagnostic imaging studies were chest x-ray (XR), abdominal XR, and echocardiogram. The images most frequently repeated were chest XR, echocardiogram, and abdominal XR. The costliest individual diagnostic imaging studies were echocardiogram, chest XR, and head/brain MRI (Table 2). Although chest XR was among the least expensive imaging modalities per unit cost, given the high prevalence of use and repeat use it was one of the costliest tests overall. Head US, interventional XR, and abdominal US had the highest variability of use between hospitals (Table 2, Figure). Conclusion(s): Chest XR and echocardiograms were among the most prevalent, costly, and frequently repeated imaging studies. Abdominal XR, abdominal ultrasound, bone/joint XR, head/brain CT, and head/brain MRI were high in both prevalence and cost among hospitalized children. Five of the 10 most commonly used imaging techniques and four of the 10 most commonly repeated imaging techniques expose children to ionizing radiation. These results could help identify areas that should be targeted to reduce radiation exposure, improve care, and decrease costs for hospitalized children.

The Impact Of Health-Related Social Needs On Health Outcomes Among Youth Presenting To A Midwest Pediatric Diabetes Clinic Network, Jasmine Roghair, Emily Dewit, Katelyn Evans, Mitchell Barnes, Heather Feingold, Samantha Jacob, Courtney M. Winterer, Jeffrey D. Colvin, Mark A. Clements, Shilpi Relan, Kelsee Halpin

Posters

Objective: Screening for health-related social needs (HRSNs) is recommended as part of routine diabetes care given the strong impact of social factors on health outcomes. Our objective was to compare diabetes-related health outcomes among youth presenting to a tertiary diabetes center based on whether they screened positive or negative for HRSNs at a routine clinic visit. Methods: Baseline data were collected from patients whose parent/guardian completed a HRSN screen as part of their child’s diabetes clinic intake from 9/1/21 to 8/30/22. The screen is a 6-item questionnaire adapted from the Accountable Health Communities HRSNs Screening Tool. Longitudinal data were analyzed …

How We Heal Little Hearts: The Piccolo Procedure Explained, Rania Habib, Toby A. Rockefeller

Transformational Pediatrics Podcast

The Piccolo device is an innovative and minimally invasive way to close the Patent ductus arteriosus (PDA) in pediatrics. Dr. Rockefeller talks about how the Piccolo came to fruition, the benefits, and what else is on the horizon for the PDA closure world.

Fine Motor Integration For Children With Special Needs And Low Tone, Iliana V. Blancas, Rebecca King

Spring 2024 Virtual OTD Capstone Symposium

The topic of focus will be a Fine Motor Integration Program for Children with Special Needs and Low Tone and provide students, parents, teachers, and therapists a resource to aid with the development of these skills. This program hopes to establish the development of the fine motor skills at an early age to reduce the issues that arise later within the school years that stem from lack of fine motor skills within this population.

A Program To Help At Home: Social Skill For Children With Autism Spectrum Disorder, Naomi Solomon, Mary Jan Greer, Justine Faghihifar

Spring 2024 Virtual OTD Capstone Symposium

The Autism spectrum disorder (ASD) typically presents in early childhood with delayed or abnormal functioning and according to the CDC (2022), 1 in 44 children have been diagnosed across all demographics. With these high prevalence rates, occupational therapy can be an asset in ASD through a client-centered approach. The problem is the lack of generalization of skills used in the clinic to the home environment to develop and maintain social skills in children with ASD for social participation. This capstone used program development to demonstrate the impact group sessions have on social skills for a child diagnosed with autism by …

Every Moment Counts (Emc): Understanding School Stakeholder Perceptions Of Positive Mental Health Promotion In The Elementary School Setting. A Preliminary Report., Madeline Malooly, Angela Blackwell, Lauren Thomas

Spring 2024 Virtual OTD Capstone Symposium

For children and adolescents, the prevalence of psychological disorders associated with mental illness continues to rise in North America and is now considered to be the leading cause of disability for this population (Bitsko et al., 2022). It was estimated that between 25 and 50% of adult mental illnesses could be prevented through early intervention and preventative measures in childhood (Kim-Cohen et al., 2003). In an effort to address mental health promotion in schools, Dr. Susan Bazyk founded and created EMC, which is a “multi-pronged mental health promotion initiative to help all children to be mentally healthy in order to …

Occupational Impact Of Caregivers In Pediatric Palliative Care, Lezlye Ramos, Karen Park, Jazminne O. Arteaga

Spring 2024 Virtual OTD Capstone Symposium

The purpose of this study is to understand the occupational impact for caregivers who had a child with a life-limiting or life-threatening condition who had received pediatric palliative care. A lack of understanding of occupational therapy’s role in end-of-life care ultimately underutilizes and under-prepares occupational therapists to work in this practice area. Becoming a medical family caregiver, neglecting personal needs and desires becomes a norm having a in-direct effect on physical and psychological health and well-being. Findings from this study suggest that it is reasonable to infer that occupational participation among caregivers is influenced by finding time for self and …

Occupational Therapists' Perception Of Children With Neurodevelopmental Disorders & Sleep In Pediatric Outpatient Settings, Carina Jimenez, Susan Macdermott, Jazminne Orozco Arteaga

Spring 2024 Virtual OTD Capstone Symposium

The capstone investigates pediatric occupational therapists' views on managing sleep issues in children with neurodevelopmental disorders. It highlights gaps in education and resources and emphasizes the need for evidence-based interventions. Findings emphasize the importance of enhancing occupational therapists' role in addressing sleep challenges for improved family well-being, advocating for more comprehensive education and support systems.

The Role Of Occupational Therapy For Mothers With Children Who Have Had A Neonatal Intensive Care Unit (Nicu) Stay, Reagan Mclendon, Cynthia Haynes

Spring 2024 Virtual OTD Capstone Symposium

This study examined the occupational needs of mothers with a child who required a NICU stay and illustrates the potential roles of occupational therapy for this population.

Promoting Parental Competence When Transitioning From The Nicu To Home: A Coaching Intervention, Vanessa Chavez, Angela Labrie Blackwell

Spring 2024 Virtual OTD Capstone Symposium

This handbook aims to improve the support system for families in the Neonatal Intensive Care Unit (NICU) by developing a coaching intervention that empowers parents, improves their confidence, and provides necessary home care skills.

Single Center Retrospective Comparison Of Bivalirudin And Heparin For Therapeutic Anticoagulation In Pediatric Patients, Clayton Habiger, Shannon L. Carpenter

Posters

Background: The pharmacological choice for continuous anticoagulation therapy in pediatric patients has classically been unfractionated heparin. However, with heparin there are risks of treatment resistance in pediatrics given differences in developmental hemostasis, and contemporary medications such as bivalirudin offer a valuable alternative. Bivalirudin binds to thrombin and has shown encouraging results compared to heparin in pediatric patients receiving ECMO, but no comparison has been made in patients receiving therapeutic anticoagulation. Three years ago, Children’s Mercy Pediatric Hematology department encouraged bivalirudin use over heparin use for therapeutic anticoagulation requiring a continuous infusion. Objectives: Compare clinical and laboratory outcomes in patients receiving …

Comparing Universal Versus Targeted School Screenings For Depression Among Teens, Research Research Dissemination Committee, Maine, Usa

REACH: Research Evidence-to-Action for Community Health

The US Preventive Services Task Force endorses universal adolescent major depressive disorder (MDD) screening in primary care; however, most adolescents lack preventive health care, resulting in worsening disparities in MDD screening and treatment.

Anterior Hip Pain In Adolescent Female Wrestler, Melanie Kennedy

Posters

No abstract provided.

Self-Regulation And Sensory Processing Education Program For Educators, Julianne Mendivil, Tina G. Bhakta, Angela Blackwell

Spring 2024 Virtual OTD Capstone Symposium

Children with low self-regulation skills may face many challenges in the classroom environment that can impact their performance in school-based activities. As teachers play a vital role in the development of young children, this educational program aims to improve teacher competence (knowledge, skills, and attitudes) in applying sensory processing and self-regulating concepts to the school environment.

The Ci-Asd Program: Implementation Of Contextual Interventions For Autism Spectrum Disorder (Ci-Asd) With Latino Families (Preliminary Report), Gabriel Gonzalez, Erik Pérez, Angela Blackwell

Spring 2024 Virtual OTD Capstone Symposium

Children diagnosed with Autism Spectrum Disorder (ASD) experience sensory processing differences that affect their participation in daily activities and routines. Autism affects an estimated 1 in 36 children in the U.S. However, Latino children are diagnosed two years later than white children. Latino families still have the greatest disparities in accessing ASD resources throughout the U.S. compared to white families. The lack of ASD services and resources led to decreased parental self-efficacy, quality of life, and increased child behavioral problems.

Contextual Interventions Adapted for Autism Spectrum Disorder (CI-ASD) are an emerging intervention for occupational therapy (OT) practitioners. Recent literature shows …

Speeding Up Time: An Old Back In A Young Athlete, Carey Wagoner, Greg Canty

Posters

Case of a 16 year old female competitive dancer with chronic back pain. Previous diagnosis of mechanical low back pain being treated by PT without improvement. Further workup demonstrated bilateral spinal synovial cysts at L4/L5 facet joints. Patient underwent IR guided aspiration and steroid injection with resolution of her symptoms and ultimately returned to dance.

A Qualitative Study On Mother's Occupational Engagement After A Nicu Experience, Rachel Garcia, Mary Ann Smith, Julie Heftie Ms, Otr/L

Spring 2024 Virtual OTD Capstone Symposium

Mothers who are “at-risk” for complications during pregnancy have an increased probability for mental health conditions following delivery, adversely affecting their engagement in motherhood occupations. This qualitative study identifies how best to address the needs of “at-risk” pregnant women. Through the process of conducting semi-structured interviews with women who have experienced NICU with their babies, and interviews with healthcare practitioners working in the NICU, their narrative addresses what approaches would support women while they are going through their “at-risk” pregnancies to assist them with the transition to their occupational roles as mothers and promote bonding with their baby.

Improving Frequency Of Peer Review Of Abnormal Genital Exam Findings In Patients Undergoing Sexual Abuse Evaluation, Lyndsey Hultman, Terra N. Frazier, Jennifer Hansen

Presentations

Background/Objectives: 2023 Child Advocacy Center (CAC) accreditation standards require that “all medical professionals providing services to CAC clients must demonstrate that 100% of all findings deemed abnormal or “diagnostic” of trauma from sexual abuse have undergone expert review by an advanced medical consultant”. Prior to program implementation, scheduled Case Review occurred among the authors’ institution child abuse pediatricians (CAPs), but typical practice was to review cases upon CAP request. The authors’ institution faced practice standard implementation barriers of high case volumes and collaboration with multiple different CACs. Our primary aim was to increase peer review of abnormal exams from a …

Something's Gnawing At Me, Catharine Kral, Brian Harvey

Posters

17-year-old female presented to Sports Medicine clinic with a chief complaint of bilateral hip pain and difficulty walking who was found to have bilateral ovarian teratoma.

Telehealth Implementation Of A Young Adult Ibd Clinic: Uptake, Benefits To Patient Care, And Challenges, Angela Combs Ma, Alaina Linafelter, Jordan Sevart, Michele H. Maddux

Posters

Introduction: Since the COVID-19 pandemic, pediatric psychologists have been at the forefront of telemedicine expansion to ensure access for patients and families to needed mental health services. This has required adaptations across the care continuum – from scheduling to service delivery to documentation. This poster aims to summarize the telehealth (TH) application of a Young Adult IBD Clinic (YAC-IBD) that provides transition preparation to youth with Inflammatory Bowel Disease (IBD). Methods: In April 2020, the YAC-IBD was converted from in-person visits to a virtual visit format. Since then, 119 youth ages 17-21 (inclusive) have been seen in this clinic. This …

Transition Skills Lab: A Telehealth Intervention For Improving Healthcare Transition In Youth With Special Health Care Needs, Angela Combs Ma, Alaina Linafelter, Jordan Sevart, Michele H. Maddux

Posters

Introduction: Few interventions exist to provide hands-on practice of key health management tasks to youth with special health care needs (YSHCN). The Transition Skills Lab was adapted from Jerlym Porter’s work and piloted as a virtual intervention in YSHCN. Methods: Sixteen young adults participated in the virtual Transition Skills Lab, during which they practiced three key patient competencies pertaining to health care tasks: reading an insurance card, reading a pill bottle label, and scheduling an initial visit with an adult doctor. Participants were then asked to rate their confidence on skills taught within the intervention on a four-point scale from …

Congenital Heart Defects And Autism: Understanding The Breakdown Of Associated Risk Factors In A Clinically Referred Sample, Elizabeth Raines, Amanda Strasser, Amanda Manderfeld, Paul Glasier, Elizabeth J. Willen

Posters

Background: Children with Congenital Heart Disease (CHD) have higher odds of developing social difficulties and/or an Autism Spectrum Disorder (AuSD) than the general population (i.e., ~10% vs. ~1%). However, there is a paucity of nuanced understanding of specific drivers of the increased rates of AuSD in extant literature. The purpose of this study is to identify the rates of co-occurring cardiac, neurological, and genetic conditions to better understand associated risk factors in a patient sample from a medium-size children’s hospital. Methods: Our population includes a clinically referred sample of children (i.e., medical history of CHD and neurodevelopmental risk) under 18 …

Ovarian Torsion, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Antimicrobial Duration Stewardship Project: A Qi Approach, Joshua Saucedo, Rana El Feghaly, Amanda Nedved, Leslie Hueschen, Marsha Dannenburg, Tanis Stewart, Patty Philips, Jennifer Floyd

Presentations

A QI project aimed at increasing the percentage of children discharged home from the emergency department with a diagnosis of community acquired pneumonia (CAP) or acute bacterial rhinosinusitis (ABRS) treated with an optimal antibiotic duration (5 days or less for CAP, 7 days or less for ABRS) from 22% to 70% by July 2025. Additionally, assess for differences in care based on demographic and socioeconomic factors such as the area deprivation index. National guidelines and CMH clinical pathways recommend short antibiotic durations (5-7 days) for most infections (5 days for community acquired pneumonia, 5-7 days for acute bacterial rhinosinusitis). At …