Higher Education and Teaching Commons^™

Wilms Tumor Presenting With Spontaneous Necrosis And Clostridium Perfringens Co-Infection, Ronald Palmen, Abbey Elsbernd, Kristin Palmen

Research Days

Background: Wilm’s Tumor (WT) is the most common renal malignancy of childhood. The initial presentation of WT may mimic infection or other malignancies with nonspecific symptoms including fever, abdominal/flank pain, or hematuria. This poses a diagnostic challenge for providers, particularly when both infection and malignancy are observed. We describe a case of WT with spontaneous necrosis initially obscured by overlying Clostridium perfringens infection, making diagnosis of the cancer difficult.

Case Description: A previously healthy 5-year-old girl presented to the emergency department with a two-day history of left flank pain and fevers. In the emergency department, she was tachycardic (130 bpm), …

Acute Complications In Pediatric Patients With Diabetes Admitted With Isolated Diabetic Ketoacidosis, Isolated Hyperglycemic Hyperosmolar State, And Mixed Hyperosmolar Diabetic Ketoacidosis, Erica Zarse

Research Days

Background: Diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), and mixed DKA and HHS (hyperosmolar DKA) are hyperglycemic emergencies for which children with diabetes mellitus (DM) are admitted to the hospital. To date, there is little evidence to guide the management of pediatric diabetic patients with hyperosmolarity.

Objectives: The objective of this study is to compare the in-hospital complications at our institution in patients who have isolated DKA to those with a component of hyperosmolarity.

Methods: We reviewed medical records of patients from 01/2019 through 12/2020 admitted with DKA (serum bicarbonate ≤16 mEq/L) and/or HHS (blood glucose ≥600 mg/dL and osmolality …

Memory T Cell Populations In Human Leukemia, Sara Mcelroy

Research Days

Background: Incorporating the immune system into cancer management is an area of robust research. Treatment modalities aimed at activating cytotoxic T cells against malignancies include immune checkpoint inhibitors, bispecific T-cell engagers, and chimeric antigen receptor (CAR) tumor-specific T cells. Most anti-cancer T cell research is narrowly focused, but knowledge about the nature of diverse sub-populations of T cells in cancer, particularly memory T cells, is vital prior to potential incorporation into therapies. T memory stem cells (Tscm) are of interest due to their longevity and powerful abilities of self-renewal and creating the full spectrum of memory CD8+ T cells, including …

Quality Improvement Project To Improve Provider-To-Nursing Communication During Daily Rounds, Kayeleigh Higgerson Do, Sara Mcelroy Md

Research Days

Problem Statement/Question: We aim that by June 2021, our Heme/Onc resident service daily table rounds will include 80% of bedside nurses to improve communication between the provider team and bedside nurse.

Background/Project Intent (Aim Statement): Daily rounds on our Heme/Onc resident service include table rounds (discussion of overnight events and daily plan) and bedside rounds (team goes to see patients and relay daily plan). These rounds infrequently include the bedside nurse caring for the patient, leading to poor communication of the plan from the provider team. This is a problem, because it has the potential to lead to medical errors …

Acute Kidney Injury In Youth With Diabetes Admitted With Isolated Diabetic Ketoacidosis, Isolated Hyperglycemic Hyperosmolar State, And Hyperosmolar Diabetic Ketoacidosis: A Single Center Experience, Erica Zarse

Research Days

Background: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are hyperglycemic emergencies for which children are admitted to the hospital.

Objectives/Goal: Our objective was to compare acute kidney injury (AKI) between youth with isolated DKA to those with hyperosmolarity and explore associations to risk of AKI.

Methods/Design: Charts were reviewed from 01/2019 through 12/2020 for youth admitted with DKA (serum bicarbonate ≤16 mEq/L) and/or HHS (blood glucose ≥600 mg/dL and osmolality ≥320 mOsm/kg). Isolated HHS youth were combined with hyperosmolar DKA for analysis. AKI was defined as elevated creatinine level for age. The total amount of isotonic fluids administered was …

Engagement Strategies For Online Students: Use Of Technology To Enhance Learning, Jim Maddox

TFSC Publications and Presentations

Teaching students in an online program requires being intentional with how the course is constructed and how space is created for students to fully engage. Face-to-face courses provide the means of this interaction that creates a challenge for online learning. The following are some innovative and creative ways I am using technology to engage my online students and enhance their learning. I utilize Zoom to hold optional Live Chats via Zoom. These are also recorded for students to watch later as well. I use breakout rooms for small group discussions (pair-and-share, triads, and larger groups), we have Q & A …

Teaching Innovation Learned From The 2022 Amte Conference: Prepare Future Mathematics Educators, Yi-Jung Lee

TFSC Publications and Presentations

The role of mathematics has transformed from gatekeeper to launchpad in K-12 schools and been considered as a critical factor in career readiness in a diverse society (CDE, 2022). Therefore, teacher education programs must adopt effective teaching approaches with cultural awareness while preparing future mathematics teachers. I shared a revised teaching design framework (Rhodes, 2021) along with the Culturally Responsive Mathematical Modeling perspectives to help educators integrate a) productive disposition, b) the instructional design with modeling tasks, and c) equity-minded practice into their teaching preparation and practices.

Photovoice Gives Students A Voice, Lynne Meade

TFSC Publications and Presentations

Students often struggle with ways to turn their experiences into meaningful stories. Photovoice is a way to use photography for positive social change and to help people tell their stories. I used Photovoice to help students process the uncertainty of moving back home when the university switched to remote in Spring 2020. Since I teach public speaking, I used those stories to teach public speaking skills as well.
For example, one prompt I used was “an unexpected use of something.” I showed them a small hand weight that I used as a doorstop. I took creative pictures of the weight …

The Racial And Ethnic Makeup Of The Asthma Clinical Trials Informing The 2020 Nhlbi Asthma Guidelines Update, Esosa Adah

Research Days

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Rationale: Black/African American and Hispanic people in the United States are disproportionately impacted by asthma with increased prevalence, morbidity, and mortality. However, these groups are often under-represented in asthma clinical and translational research studies which is a barrier to achieving health equity. We describe the racial/ethnic makeup of participants included in clinical trials which informed the recent 2020 National Heart, Lung, and Blood Institute(NHLBI) asthma management guidelines focused update.

Methods: We identified clinical trials included within the 2020 NHLBI asthma management guidelines focused update. We determined the frequency (%) of studies reporting study participant racial/ethnic …

Improving Advanced Therapeutic Endoscopy Performance At An Academic Children's Hospital, Julia Snodgrass, Thomas M. Attard, Donna Ditsch, John Colgan, Amanda Weston, Jessica Koch, Nadia Ibrahimi, Pang Krasaelap, Voytek Slowick, Laura Shroyer

Research Days

Problem Statement/Question: Advanced therapeutic endoscopy is infrequently needed but critical in the management of children with complex gastroenterology disorders. Hands-on experience in specific advanced techniques, set up of endoscopy equipment and familiarity with new ancillary equipment for use during endoscopy have been intra-departmentally identified as potential areas for improvement.

Background/Project Intent: Our aim is to improve provider scoring on an endoscopy practice test based on technical aspects of therapeutic techniques, indications and set up of standard and new endoscopic equipment by 20% over pre-practice session testing.

Methods: The Model for Improvement framework was utilized. A multidisciplinary team was created including …

A Case Of An Elevated Tryptase, Sonya Parashar

Research Days

Introduction: Hereditary Alpha Tryptasemia (HαT) is an autosomal dominant disorder characterized by an elevated baseline tryptase that occurs up to 3% of the population and clinically resembles mast cell activation syndrome.

Case description: A full-term, 13-month-old female patient presented to Allergy and Immunology clinic for persistently elevated tryptase. Her initial symptom was non-bloody loose stools, but she later developed recurrent flushing, joint pain, constipation, and frequent nighttime awakenings. Her past medical history included gastroesophageal reflux disease. Family history was significant for an older sibling with history of flushing. At all visits, physical examination was normal. Tryptase ranged between 11.7 - …

Evaluating Caretaker Satisfaction With Same-Day Discharge After Gastrostomy Tube Placement, James A. Fraser Md, Shai Stewart Md, Kayla B. Briggs Md, Shawn D. St. Peter Md, Tolulope A. Oyetunji Md Mph

Research Days

Background: Same-day discharge (SDD) after outpatient laparoscopic gastrostomy tube (G-tube) placement has been our standard institutional practice since 2017, following written and video-based preoperative education regarding G-tube use, maintenance, and exchange at the time of consultation.

Objectives/Goal: We aim to evaluate caretaker satisfaction with our same day discharge protocol following laparoscopic gastrostomy tube placement.

Methods/Design: Following IRB approval, all patients planned for SDD after G-tube placement from FebruarySeptember 2021 at a tertiary care academic center were identified. Retrospective chart review was performed to identify demographic information, successful same-day discharge or reason for postoperative admission, time to first postoperative feed, length …

Ultrasound Guided Peripheral Iv Access Curriculum For The Pediatric Emergency Department: A Pilot Study., Samuel Dillman

Research Days

Background: Up to 50% of children have difficult venous access. Studies in the Pediatric Emergency department (PED) have shown that ultrasound guided peripheral IV (USGPIV) access has decreased IV access time and ED length of stay.  Barriers for use include lack of training and comfort with the procedure.

Objectives/Goal: Our objectives are to pilot and evaluate USGPIV training for Pediatric Emergency Medicine (PEM) physicians and nurses.

Methods/Design: The course included a 4-hour, hands-on session with US IV training using a blue phantom task trainer in conjunction with the Vascular Access Team (VAT) for PEM physicians and nurses.  Participants’ skills were …

Recurrent Primary Spontaneous Pneumothorax Masquerading As A Congenital Pulmonary Airway Malformation In A Young Female, Chandra Swanson

Research Days

Background: Spontaneous pneumothoraxes in children are uncommon, may be idiopathic or associated with underlying pulmonary disease, and can present management challenges.

Objectives/Goal: We present a 12-year-old female with recurrent right sided spontaneous pneumothorax in the setting of an asymptomatic SARS-Co-V2 (COVID) infection and imaging concerning for congenital lobar overinflation (CLO) versus congenital pulmonary airway malformation (CPAM), prompting surgical intervention.

Methods/Design: A literature review and chart review were completed for this case report.

Results: A 12-year-old pre-menstrual female with remote history of eczema, asthma, and environmental allergies presented from an outside facility with four-days of progressive chest pain and dyspnea on …

Factors Leading To Reduced Unscheduled Pediatric Asthma Visits During Covid-19, Sean Stout

Research Days

Background: Emergency Department (ED) and inpatient (IP) asthma visits were reduced during 2020 at a tertiary pediatric hospital. This was likely due to measures used to avoid exposure to the SARS-CoV2 virus which led to fewer viral upper respiratory infections (URIs). Other known asthma triggers include allergens, air pollution, and weather changes.

Objectives/Goal: To determine whether other factors could explain this reduction, we looked for changes in other asthma triggers such as pollen, air pollution, and weather.

Methods/Design: Monthly ED and IP asthma visits from 2010 to 2019 were compared to 2020 by time series analysis (TSA), controlling for total …

Virtual Free-Writing Journal Portfolios In An Intensive English Program In Iraq, Charles Mckinney

MA TESOL Collection

Middle-Eastern English language learners (ELLs), specifically Iraqi students, are often not well equipped to succeed in university settings where English is the medium of instruction (EMI) for their intended graduate and undergraduate studies. Oftentimes, they are weaker in their academic literacy skills, when compared to listening and speaking, and need extra scaffolding and/or remedial instruction to develop their reading and writing dexterity for overall academic success. One way to support their writing development is to implement free-writing journal projects that will enable them to cultivate an original writer voice, to think quickly and critically in the L2, and to integrate …

Feeding And Swallowing Disorders In 100 Children With 22q11.2 Syndrome, Jana Ghulmiyyah

Research Days

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Background: 22q11.2 deletion syndrome (22q11DS) is the most common microdeletion syndrome. The syndrome includes a wide range of variable features including congenital heart disease, palatal abnormalities, immune deficiency and learning difficulties. Otolaryngologic manifestations include hearing loss, characteristic facial features and laryngotracheal abnormalities. A few studies have reported dysphagia as a common feature of this syndrome however little is known about the specific feeding and swallowing difficulties that occur in children with 22q11DS.

Objectives/Goal: The aim of the study is to identify the frequency of feeding and swallowing disorders in a large cohort of pediatric patients …

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. …

Inpatient Outcomes For Children Receiving Empiric Methicillin-Resistant Staphylococcus Aureus Coverage For Complicated Pneumonia, Sophia Hackman

Research Days

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Background: Pediatric community acquired pneumonia is responsible for an estimated 124,000 hospitalizations annually in the United States, with up to 40% of hospitalized children subsequently developing a complicated pneumonia (i.e., effusion/empyema). Children with complicated pneumonia commonly require increased numbers of procedures, have exposure to broad-spectrum antibiotics, and have prolonged hospitalizations. While the prevalence of pneumonia has overall declined with childhood vaccination, the number of children with complicated pneumonia has remained stable. Current guidelines do not adequately address antibiotic management of pediatric complicated pneumonia specifically when to utilize methicillin-resistant Staphylococcus aureus (MRSA) coverage, likely contributing to …

Supraclavicular Neck Mass In A 14 Month Old Boy, Jana Ghulmiyyah

Research Days

Background: Lipoblastoma is a rare benign tumor arising from embryonic fat cells in children younger than 3 years of age. They rarely present in the neck and usually do not have spindle cell appearance. We therefore present a case of neck lipoblastoma with review of the literature.

Case Description: We present the case of a 14-month-old male who presented with 1 month history of a right supraclavicular neck mass that was enlarging gradually. On physical exam, it was non tender, mobile with no overlying skin changes. Patient did not have any respiratory distress. A fine needle aspirate (FNA) showed spindle …