Medicine and Health Sciences Commons^™

Incidence Of Initial Renal Replacement Therapy Over The Course Of Kidney Disease In Children., Derek K. Ng, Matthew B. Matheson, Bradley A. Warady, Susan R. Mendley, Susan L. Furth, Alvaro Muñoz

Manuscripts, Articles, Book Chapters and Other Papers

The Chronic Kidney Disease in Children Study, a prospective cohort study with data collected from 2003 to 2018, provided the first opportunity to characterize the incidence of renal replacement therapy (RRT) initiation over the life course of pediatric kidney diseases. In the current analysis, parametric generalized gamma models were fitted and extrapolated for RRT overall and by specific treatment modality (dialysis or preemptive kidney transplant). Children were stratified by type of diagnosis: nonglomerular (mostly congenital; n = 650), glomerular-hemolytic uremic syndrome (HUS; n = 49), or glomerular-non-HUS (heterogeneous childhood onset; n = 216). Estimated durations of time to RRT after …

Caregiver Perspectives On Telehealth: A Service Delivery For Occupational Therapy, Rebecca Johnston

Student Capstone Papers

Telehealth; also known as telerehabilitation, telecare, telemedicine, teletherapy, and telepractice; is an emerging healthcare service that is utilized in various healthcare facilities with a span of ages, conditions, and locations (World Federation of Occupational Therapy [WFOT], 2014). Telehealth utilizes information and communication technologies to deliver services to a patient when the healthcare provider is not in the same location (WFOT, 2014). Telehealth can provide an online platform for evaluations, consultations, monitoring, supervision, and intervention with patients and other professionals (WFOT, 2014).

Telehealth is an emerging method of delivering occupational therapy (OT) services to various populations, including: children and youth; productive …

Standardization Of Postoperative Care Guidelines For Pediatric Cleft Palate Patients, Tatyana Grib, Macy Therese G. Andrada, Julie C. Barragan, Amanda K. Dailor, Samantha T. Gerber, Mercedes S. Greenberg

Master's Projects and Capstones

At a large, community-based pediatric hospital in Southern California, a quality improvement project commenced with a goal to improve patient outcomes by decreasing length of stay and pain levels, while increasing toleration of feeds. Implementing a standardized guideline would ensure safe practice across the continuum and allow providers to use a systematic tool for postoperative care, including nursing care interventions and medications. The Root-Cause- Analysis tool was used to assess the microsystem and determine the contributing factors to the identified problem. A SWOT analysis was then performed, followed by a plan to collect data from all pediatric cleft palate procedures …

The Early "Unnatural" History Following Surgical Repair Of Ventricular Septal Defects., Sathish M. Chikkabyrappa, Justin T. Tretter, Arpan R. Doshi, Sujatha Buddhe, Puneet Bhatla, Achi Ludomirsky

Manuscripts, Articles, Book Chapters and Other Papers

Introduction: Surgical outcomes for simple ventricular septal defects (VSD) have been excellent in the past three decades. For this project, the timing of resolution of left-sided dilation and mitral regurgitation (MR) following VSD repair was assessed.

Methods: Echocardiographic data surrounding surgery of 42 consecutive children who underwent surgical patch repair of a VSD were reviewed. The echocardiograms were reviewed up to a mean of 12 months post-operatively (range 9 - 14 months). Quantitative data indexed to body surface area including left atrial (LA) volume, mitral valve annulus diameter, and left ventricular end-diastolic dimension (LVEDD) was analyzed.

Results: The majority of …

Are You My Doctor? Utilizing Personalized Provider Cards To Improve Patient/Doctor Connections, Jessica Colyer, Tina Halley, Melissa Winter, Jennifer Coldren, Martha Parra

Patient Experience Journal

In the setting of large, multidisciplinary medical care teams, it can be difficult for patients and families to identify their primary providers in the inpatient hospital setting. A review of our institutional patient satisfaction scores reflected a low rating with respect to families identifying their provider. We sought to improve patient and family connections with front line providers using personalized provider cards. We developed trading cards with pictures and biographies of the doctors on each card as well as an explanation of provider roles. The cards were piloted on a single inpatient unit without trainees. We had great provider engagement …

Failure To Rescue As An Outcome Metric For Pediatric And Congenital Cardiac Catheterization Laboratory Programs: Analysis Of Data From The Impact Registry., Michael L. O'Byrne, Kevin F. Kennedy, Natalie Jayaram, Lisa J. Bergersen, Matthew J. Gillespie, Yoav Dori, Jeffrey H. Silber, Steven M. Kawut, Jonathan J. Rome, Andrew C. Glatz

Manuscripts, Articles, Book Chapters and Other Papers

Background Risk-adjusted adverse event (AE) rates have been used to measure the quality of pediatric and congenital cardiac catheterization laboratories. In other settings, failure to rescue (FTR) has demonstrated utility as a quality metric. Methods and Results A multicenter retrospective cohort study was performed using data from the IMPACT (Improving Adult and Congenital Treatment) Registry between January 2010 and December 2016. A modified FTR metric was developed for pediatric and congenital cardiac catheterization laboratories and then compared with pooled AEs. The associations between patient- and hospital-level factors and outcomes were evaluated using hierarchical logistic regression models. Hospital risk standardized ratios …

Special Considerations In Pediatric Burn Patients Regarding Drug Dosage And Administration, Kelsey Lindsley, Maureen Moynihan, Angela Chu, Kristen Yaeger, Karen L. Kier

Pharmacy and Wellness Review

Pediatric burn patients are a high-risk patient population to treat. These patients have altered physiologic function as a result of the burn injury, in addition to their smaller size and developing bodies. This creates unique challenges during treatment. Accommodations for these patients are made through unique drug dosages and routes of administration. When treating pediatric burn patients, properly assessing and treating pain promptly and effectively is of utmost importance. Nurses who utilize accurate and appropriate pain assessment scales will provide the best treatment of pain. Proper assessment allows the patient to receive the correct analgesic regime, ensuring a faster and …

Which Student Characteristics Are Most Important In Determining Clinical Honors In Clerkships? A Teaching Ward Attending Perspective., Lauren Nicholas Herrera, Ryan Khodadadi, Erinn Schmit, James Willig, Andrew Hoellein, Christopher Knudson, Karen Law, Nina Mingioni, Katherine Walsh, Carlos Estrada, Winter Williams

Division of Internal Medicine Faculty Papers & Presentations

PURPOSE: To explore faculty perspectives on which characteristics of high-performing clerkship students are most important when determining an honors or top grade designation for clinical performance.

METHOD: In 2016-2017, the authors surveyed faculty (teaching ward attendings) for internal medicine clerkships and 1 pediatrics clerkship in inpatient settings at 5 U.S. academic medical centers. Survey items were framed around competencies, 24 student characteristics, and attitudes toward evaluation. Factor analysis examined constructs defining high-performing students.

RESULTS: Of 516 faculty invited, 319 (62%) responded. The top 5 characteristics as rated by respondents were taking ownership, clinical reasoning, curiosity, dependability, and high ethical standards …

Acetaminophen Protein Adducts In Hospitalized Children Receiving Multiple Doses Of Acetaminophen., Sibo Jiang, Valvanera Vozmediano, Susan M. Abdel-Rahman, Stephan Schmidt, Laura P. James

Manuscripts, Articles, Book Chapters and Other Papers

Previous reports have questioned the safety of multiple doses of acetaminophen administered to ill children. Acetaminophen protein adducts (adducts) are a biomarker of acetaminophen-induced liver injury and reflect the oxidative metabolism of acetaminophen, a known mechanism in acetaminophen toxicity. In this prospective observational study, we analyzed adduct concentrations in 1034 blood samples obtained from 181 hospitalized children (1 to 18 years inclusive) who received 2 or more doses of acetaminophen. Linear regression analysis showed that serum adduct concentrations increased as a function of the cumulative acetaminophen dose, which could be attributed, in part, to a long half-life of adducts (2.17 …

The Meaning And Motivation Of Children Participating In Animal-Assisted Therapy: A Pilot Study, Beth Laskowski, Melissa Y. Winkle, Whitney Lucas Molitor

People and Animals: The International Journal of Research and Practice

Background: Despite claims that animal-assisted therapy is beneficial, there is limited empirical evidence supporting this. Current literature supports the physical, emotional, and psychological benefits an animal can provide, but few studies have explored the outcomes of incorporating an animal into skilled treatment facilitated by a healthcare professional. This study seeks to explore the effects of animal-assisted therapy in outpatient pediatric occupational therapy practice.

Purpose: The purpose of this research is to explore the meaningfulness and motivation animal-assisted therapy interventions provide for pediatric clients when compared with traditional occupational therapy treatment.

Methods: Researchers utilized a within-participants repeated-measures design for this study. …

Identifying Pediatric Obesity In The Retail Health Setting And Implications For Quality, Jodie Nicole Guardi

College of Science and Health Theses and Dissertations

Pediatric obesity has reached an epidemic status. The purpose of this study was to examine the prevalence of overweight and obese patients, as well as how often and how accurately a diagnosis was coded. The population for this study included children ages 3-18. This cohort presented to retail health clinics in a large urban health system for school or sports physicals from June 1, 2017 to November 30, 2017. Method. A retrospective chart review was conducted. Statistical analysis was performed to determine if there was a relationship between obesity and age, ethnicity, race, and gender. Results. The study identified 15.9% …

Executive Abilities And Academic Achievement In Children With Sickle Cell Disease, Erika Wesonga

Arts & Sciences Electronic Theses and Dissertations

Academic achievement is crucial to a child’s psychosocial and occupational success (Davaoudzadeh et al., 2015; Margari et al., 2013). In children with sickle cell disease (SCD), a genetic disorder resulting in abnormal hemoglobin and significant neurologic sequelae, poor academic achievement is common (e.g. Wang et al., 2001). Studies of typically-developing children have revealed links between academic achievement and neuropsychological abilities, particularly higher-order executive abilities that are mediated primarily by frontal brain regions (Altemeier et al., 2006; Bull & Scerri, 2001). In children with SCD, there is a wealth of evidence that executive abilities are impaired (Berkelhammer et al., 2007), but …

Neurodevelopmental Outcomes Of Infantile Hydrocephalus: An Fmri Case Study, Ikhlas Ahmed Hashi

Electronic Thesis and Dissertation Repository

Ventricle dilatation caused by infantile hydrocephalus may result in extensive damage of the posterior cortex (parietal and occipital lobes). We hypothesize that pathological changes in the development of the posterior cortex can be linked to non-verbal learning disabilities in children with previous infantile hydrocephalus. This case study will investigate the neurodevelopmental outcomes of 3 treated hydrocephalus patients, when compared to a group of healthy control children (n = 12). Within the hydrocephalus group, patients displayed differences in non-verbal test performance as well as parietal brain activation during an fMRI number comparison task. We associated these differences with clinical variables such …

Prescribing Probiotics In Tandem With Antibiotics In A Pediatric Setting., Allyson Riggs

Doctor of Nursing Practice Papers

Gastrointestinal (GI) discomfort including antibiotic associated diarrhea (AAD) is a common side effect of antibiotic therapy. As antibiotic use continues to increase, more patients are affected by AAD. Significant evidence has been found on using probiotics for the treatment and prevention of GI distress and AAD. Provider education is needed in the clinical setting to share evidence and make recommendations on best practice. The goal of this intervention was to increase the rate at which providers prescribe probiotics in tandem with antibiotics, via increased provider education. A retrospective Electronic Health Record (EHR) review was conducted once before and once after …

Hear Me Out: An Evaluation Of The Services Provided To Parents Prior To A Diagnosis Of Hearing Loss, Amber Wagster

McNair Scholars Research

This study seeks to identify and evaluate the services provided to parents of children who did not pass their newborn hearing screening. This study will determine what educational services were offered and if they effectively-prepared parents for navigating the process of their child's potential hearing loss diagnosis. A questionnaire was distributed to parents through the offices of audiologists and through Hands & Voices, a parental advocacy organization.

Be On Traq – Cross-Cultural Adaptation Of The Transition Readiness Assessment Questionnaire (Traq 5.0) And Pilot Testing Of The German Version (Traq-Gv-15)., Caroline Culen, Marion Herle, Marianne Konig, Kiana Johnson, David L. Wood, Gabriele Hausler

ETSU Faculty Works

Objective: Transfer from pediatric care into the adult health care system is known to be a vulnerable phase in the lives of youth with special health care needs (YSHCN). Recommendations from the literature favor assessment of transition readiness rather than simply pass over YSHCN from pediatric to adult-centered care by the age of 18. Nevertheless, no validated and disease neutral assessment instrument in German exists to date. Hence, our aim was to cross-culturally adapt and to pilot-test a German version of the Transition Readiness Assessment Questionnaire (TRAQ 5.0). We wanted to provide a tool that can be applied broadly during …

Clinical Assessment Of 4th Year Osteopathic Medical Students: Outdoor Medicine Rotation, Erik E. Langenau, Sarah Blazovic, Ashley Cochran, Sarah Corcoran, Elisa Guisto, Austin Sorchik, Cameron Williams

Erik E. Langenau

Introduction: Securing clinical training sites remains a challenge for medical educators who often resort to paying preceptors or searching for new clinical training sites which haven’t traditionally taken students. We describe a unique partnership between the Boy Scouts of America and PCOM, providing a clinical training opportunity for OMS4 students at PCOM: Outdoor Clinical rotation the Summit Bechtel Family National Boy Scout Reserve in rural West Virginia at the National Scout jamboree, serving 35,000 scouts.

Methods and Curricular Design: By the end of the rotation, each PCOM student was able to (1) provide urgent care for common outdoor injuries: …

Exploring The Connections Between The Presence Of Developmental Trauma And Clinical Reasoning: The Lived Experience Of Pediatric Occupational Therapists, Gwendolyn R. Blake, Briar E. Plantinga, Julie Shafer

Pediatrics

Background: Developmental trauma is a current issue facing the nation. It adversely affects participation in occupations across the lifespan. This paper examines how the clinical reasoning of practicing pediatric occupational therapists changes when treating clients who have experienced developmental trauma.

Methods: A phenomenological approach was applied using multiple cases. Four individuals, who identified as working with clients with developmental trauma, were interviewed using a series of semi-structured and open-ended questions on their experience treating these clients.

Results: Narrative transcripts were reviewed by the authors and organized into themes of performance patterns of the therapist and the context of developmental trauma …

Use Of The Who Access, Watch, And Reserve Classification To Define Patterns Of Hospital Antibiotic Use (Aware): An Analysis Of Paediatric Survey Data From 56 Countries., Yingfen Hsia, Brian R. Lee, Ann Versporten, Yonghong Yang, Julia Bielicki, Charlotte Jackson, Jason Newland, Herman Goossens, Nicola Magrini, Mike Sharland, Garpec And Global-Pps Networks

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Improving the quality of hospital antibiotic use is a major goal of WHO's global action plan to combat antimicrobial resistance. The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate simple stewardship interventions that are widely applicable globally. We aimed to present data on patterns of paediatric AWaRe antibiotic use that could be used for local and national stewardship interventions.

METHODS: 1-day point prevalence survey antibiotic prescription data were combined from two independent global networks: the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children and the Global Point Prevalence Survey on Antimicrobial Consumption and …

Use Of A Radial Artery ‘Slender’ Sheath For Facilitating Transfemoral Arterial Access For Neuroendovascular Embolization In A Very Young Infant, Timothy L. Miao, Enriqueta Lucar Figueroa, Khalid Bajunaid, Michael Mayich, Sandrine De Ribaupierre, Sachin K. Pandey

Paediatrics Publications

Pediatric neuroendovascular procedures are increasingly performed as several studies have shown the safety of these interventions. In the literature, an upper limit of 4 French catheter size is conventionally used for femoral access in neuroangiography of very young infants. However, this constraint in luminal size may not allow for more complex procedures. We present the previously unreported use of a radial 5 French slender catheter with ultrathin walls for femoral access for aneurysm embolization in a 3-month-old boy presenting with left M2 aneurysm rupture.

Comparative Study Between Intrahemorrhoidal Diode Laser Treatment And Milligan-Morgan Hemorrhoidectomy, Alla A. Alsisy, Ibrahim Ei Salem, Yahia M. Alkhateep

Menoufia Medical Journal

Objective The aim of this study was to compare between intrahemorrhoidal diode laser coagulation with Milligan–Morgan (MM) hemorrhoidectomy. Background Because of the increased number of patients suffering from hemorrhoids and increased complications of MM hemorrhoidectomy, using intrahemorrhoidal diode laser therapy in this study was proved to be beneficial in terms of being easily used, noninvasive, nontoxic, painless, and highly effective. Patients and methods This study included 60 patients with symptomatic hemorrhoids of grades II and III. Thirty patients were treated with intrahemorrhoidal diode laser coagulation and the remaining were treated with MM hemorrhoidectomy. We measured operative time, postoperative pain, complications, …

Comparing The Corneal Biomechanical Stability After Small Incision Lenticule Extraction And Laser-Assisted In Situ Keratomileusis For Myopic Correction Using An Ultra-High-Speed Camera (Corvis St), Hossam F. El-Barbry, Khaled Es Ahmed, Sameh M. El-Gohary

Menoufia Medical Journal

Objectives The aim of this study was to invest igate the differences in corneal deformation parameters after femtosecond laser small incision lenticule extraction (SMILE) and laser-assisted in situ keratomileusis (LASIK). Background Applanation time and deformation amplitude [as measured with the CorVis ST (CST)] may be useful in assessing corneal biomechanical changes after corneal refractive surgery. The aim of this study was to evaluate the corneal biomechanical changes using the CST in eyes with LASIK and SMILE. Participants and methods This is a small prospective clinical interventional series study carried out from March 2016 to April 2017 on 50 eyes divided …

Evaluation Of Macular Changes During Pregnancy By Optical Coherence Tomography, Ahmed Abd Elhakiem Darrag, Hassan Gamal El Din Farahat, Motaz Fayez Elsawy

Menoufia Medical Journal

Objective The aim of the study was to evaluate macular changes during pregnancy by optical coherence tomography (OCT). Background The study included pregnant female individuals during the three trimesters. Patients and methods This prospective cohort study was carried out from October 2015 to August 2017 on a total number of 52 eyes (26 right eyes and 26 left eyes) of pregnant women of noncomplicated pregnancy recruited from the outpatient ophthalmology clinic at Menoufia University Hospital and Mansoura Ophthalmology Hospital. The certificate approval number is 886. The study was subdivided into three groups: group 1 includes pregnant women during the third …

The Effect Of Hypertension On Choroidal Thickness Measured By Optical Coherence Tomography, Amin F. Ellakwa, Asela N. Yousef, Asmaa M. Ibraheem

Menoufia Medical Journal

Objective The aim of the study was to investigate the effect of hypertension on choroidal thickness using the enhanced-depth imaging mode of spectralis Heidelberg optical coherence tomography. Background Hypertension is an important risk factor in developing systemic vascular disease and ocular vascular disease. The effect of hypertension on the retina and deeper retinal tissues is now a topic of great interest besides being a risk factor for ocular vascular disease. Recently, optical coherence tomography has been shown to be effective in evaluating choroidal thickness. Patients and methods We include in this study 100 participants (50 healthy normotensive and 50 hypertensive …

Corneal Wavefront-Guided Versus Aberration-Free Transepithelial Photorefractive Keratectomy In Patients With Myopia With High Pre-Existing Corneal Higher Order Aberrations, Amin F. El-Lakwa, Marwa A. Zaky, Rana M. Ashour Gebril

Menoufia Medical Journal

Objective The aim was to compare the efficacy, safety, and predictability of corneal wavefront-guided (WFG) and aberration-free ablation in single-step transepithelial photorefractive keratectomy (TransPRK) in patients with myopia with high pre-existing corneal higher order aberrations (HOAs). Background Corneal WFG and aberration-free treatments have been proposed as methods to achieve better visual, refractive, and optical outcomes. Patients and methods A prospective case series was conducted in El-Hekma Eye-LASIK Center, Menoufia Governorate, Egypt, during the period from January 2017 to December 2017. TransPRK was performed for eligible patients with myopia with or without astigmatism with corneal HOAs greater than or equal to …

Evaluation Of Aphakic Iris-Claw Intraocular Lens Implantation, Abdel-Khalik I. El-Saadany, Ahmed M. Shebl Fayed, Ghada Z. Rajab, Hany A. Khairy

Menoufia Medical Journal

Objectives To evaluate the technique of aphakic iris-claw (IC) intraocular lens (IOL) implantation, the visual outcome, and the incidence of postoperative complications. Background Several techniques are available for visual rehabilitation of eyes with inadequate capsular support following complicated cataract surgery or owing to lens subluxation or dislocation. IC-IOL is an effective option with several advantages over other techniques. Patients and methods Patients with inadequate capsular support underwent aphakic IC-IOL implantation. We used two techniques: anterior chamber (AC) and retropupillary fixation of IC lens. Eyes were evaluated for uncorrected and corrected distance visual acuity, intraocular pressure (IOP), and the incidence of …

Topography-Guided Photorefractive Keratectomy Combined With Accelerated Corneal Collagen Cross-Linking (The Athens Protocol) For Keratoconus, Hani A. Khairy, Hatem M. Marey, Wagih K. Makar

Menoufia Medical Journal

Objective The aim was to evaluate corneal changes after topography-guided partial photorefractive keratectomy (PRK) combined with accelerated corneal collagen cross-linking (CXL) (the Athens protocol) in progressive keratoconus with Pentacam Scheimpflug imaging. Background Keratoconus is a bilateral noninflammatory progressive corneal thinning that results in irregular astigmatism and progressive myopia. Topography-guided partial PRK combined with CXL (The Athens Protocol) has been developed not only to arrest progression of keratoconus but also to offer the patients functional vision. Patients and methods This prospective study included 20 eyes that underwent topography-guided partial PRK combined with accelerated CXL (The Athens Protocol). Preoperative and postoperative assessments …

Assessment Of Prognostic Factors In Patients Diagnosed With Acute Invasive Fungal Rhinosinusitis In Egypt, Abd Ellatif I. El-Rashidy, Ahmed M. Basha, Ibrahim A. Abd El-Shafy, Omar A. El-Banhawy

Menoufia Medical Journal

Objective To evaluate the prognostic factors in patients with invasive fungal rhinosinusitis and their effects on disease outcome. Background Invasive fungal sinusitis is a fatal disease and its relative rarity has made precise identification of treatment protocols and prognostic factors difficult. Patients and methods Twenty patients diagnosed with invasive fungal sinusitis were recruited for a descriptive study. All patients were treated with antifungal drugs with proper control of their underlying diseases. Surgical debridement of necrotic and gangrenous tissue was performed in 15 patients. We divided the patients into two groups (surviving and nonsurviving). Both the groups were compared regarding the …

Assessment Of The Role Of Cerebrolysin In Treatment Of Idiopathic Facial Nerve Paralysis, Tamer M. Attia

Menoufia Medical Journal

Objective The aim was to evaluate the role of Cerebrolysin in the treatment of Bell's palsy as a form of peripheral nerve disorder. Background Bell's palsy is a common facial nerve disorder with no available studies assessing the role of Cerebrolysin in its treatment. Patients and methods This is a single-blinded randomized clinical trial conducted on 52 patients with Bell's palsy who were distributed between two groups to receive the classical treatment for Bell's palsy. Group I received a placebo in the form of normal saline, whereas group II received Cerebrolysin. Both groups were compared regarding the overall rates of …

Deantigenicity Of Skin Homografts In Management Of Major Burn Cases, Ahmed Tt Nassar, Ezzat Am Allam, Mohamed Ahmed Megahed, Sherief M. Elkashty

Menoufia Medical Journal

Objective The aim was to assess the ability of deantigenicity of skin homograft to decrease its rejection and improve its survival in management of patients with major burns. Background Skin homograft is considered as a good skin substitute in major burn cases. The major problem of the skin homograft is rejection. So, many methods are used to decrease antigenicity of the skin homograft and prolong its survival. Patients and methods This clinical trial included 32 patients with burn who were managed in Plastic Surgery Department, Menoufia University Hospital, from October 2015 to October 2017. Four groups were formed: control group …