Science and Mathematics Education Commons^™

Association Between Blood Pressure And Esa Dose In Pediatric Patients On Dialysis, Heather A. Morgans

Research Days

Background: Hypertension is a reported side effect of Erythropoiesis Stimulating Agents (ESAs), with a mechanism of action related to elevated hematocrit levels and direct vasopressor effects. Limited information exists on the relationship between ESA dosage and hypertension in children receiving maintenance dialysis.

Objectives/Goal: The primary aim of this study was to determine whether there is a significant association between ESA dose and blood pressure (BP) in pediatric patients on dialysis. The secondary aim was to determine covariates in relation to ESA dose.

Methods/Design: Data from the International Pediatric Dialysis Network (IPDN) database was used to retrospectively analyze the association between …

Functional Outcomes Of Infants With Chiari Ii Malformation With Tracheostomy And Home Ventilator Dependence, Abbigayle Carlson

Research Days

Background: Chiari II malformation is relatively common with an incidence of about 1 in 1000 live birth and is associated with reduced life expectancy. Characteristic features are beaked midbrain, downward displacement of the tonsils, and cerebellar vermis, and spinal myelomeningocele that can be associated with hydrocephalus needing ventriculoperitoneal shunt (VP shunt). Mortality is about 50-70% if not recognized early. Survivors have high morbidity and develop neurologic abnormalities and significant developmental delays. Long-term outcome is poorly understood.

Objective: Not much has been published that describes the outcome of infant with Chiari II malformation that received tracheostomy for long-term ventilator support. Our …

Evaluation Of A Symptom-Based Algorithm For Managing Battery Ingestions In Children, James Fraser

Research Days

Background/Objectives/Goal: Complications from battery ingestion in the pediatric population are becoming more severe due to the emergence of stronger and smaller batteries. We previously established a symptom-focused, evidence-based algorithm for battery ingestion and seek to evaluate this protocol to investigate its safety and potential cost benefit. (Figure 1)

Methods/Design: Following IRB approval, all radiographs performed for foreign body ingestion between 2017-2020 were reviewed. All button battery ingestions were included to evaluate an institutional symptom-based algorithm emphasizing observation over intervention.

Results: Review of 2,237 foreign bodies series demonstrated 44 button battery ingestions. Median age at ingestion was 3.8 years [2.5,5.2]. Locations …

Phenotypic Characterization Of Jarid2-Related Intellectual Disability: A Case Series, Maxime Cadieux-Dion

Research Days

Background: In recent years, wide implementation of research and clinical next generation sequencing has led to an astonishing number of novel disease-gene assertions. Recently, loss of function variants in JARID2 were reported in 16 patients with a clinically distinct neurodevelopmental phenotype that consisted of neurodevelopmental delay, intellectual disability (ID), learning disability, autism and behavioral abnormalities. Dysmorphic features were seen in most patients and included high anterior hairline, deep-set eyes, full lips, broad forehead, bulbous nasal tip, or depressed nasal bridge. Cleft lip/palate was observed in only 1/16 patients. Most cases were de novo, with only one inherited case from an …

Educational Impact Of Supervising Fellow Visits In The Emergency Department, Grace E. Arends Md

Research Days

Problem Statement/Question: After meeting certain criteria, pediatric emergency medicine (PEM) fellows were previously permitted to independently manage and discharge patients. These encounters anecdotally fostered autonomy but missed educational opportunities. We have previously reported that fellow positive perception of education and autonomy was low (22% and 11%). Additionally, the absence of an attending’s attestation on these patient charts prevented the collection of a professional service fee, an average potential billed amount of $125.67 per unit of service or total of $620,307 in 2019.

Background/Project Intent (Aim Statement): After key stakeholder involvement, we recognized attending supervision for all fellow patients as an …

Smart Rounding: Development Of A Nurse-Driven Rounding Checklist As A Sustainable Intervention For Improved Care Communication, Charles I. Maloy

Research Days

Background/Project Intent: Use of checklists in the healthcare setting is increasingly common and is important to the development of high reliability and standard avenues for communication. At our tertiary care freestanding pediatric hospital, there was no widely used rounding checklist that discussed items important to quality care and patient safety outside of the intensive care unit. The development and implementation of medical checklists for the standard patient floor are inadequately described. We will develop and implement a rounding checklist with at least 80% daily checklist use sustained over 6 months. Team members will report improved multidisciplinary discussion of patient safety …

Educating Providers: Timely Post-Operative Pain Management In A Level Iv Neonatal Intensive Care Unit (Nicu), Jamesia Donato, Jamesia Donato

Research Days

Background/Project Intent (Aim Statement): NICU patients often encounter painful procedures and can have significant short and long-term consequences from inadequately treated pain. Ensuring adequate pharmacological and nonpharmacological pain management while minimizing associated risks is paramount. Our NICU is part of the Children’s Hospitals Neonatal Consortium “Erase Pain” collaborative to improve management of postop pain in neonates. SMART Aim: Increase the percentage of patients receiving acetaminophen within one hour after surgery to greater than 70% by July 2020.

Methods (include PDSA cycles): A multidisciplinary team developed pain treatment algorithms and postop order plans to standardize the approach to postop pain management. …

Improving The Approach To Fellowship Trainee Feedback, Katie A. Vandervelde

Research Days

Problem Statement/Question: Giving and receiving feedback are difficult but necessary skills in medical training. We identified a need for improved feedback based on decreased learner satisfaction on our annual ACGME survey. In an anonymous survey, 2018-19 infectious disease fellows reported receiving formal feedback from 52.4% of their inpatient clinical experiences with faculty.

Background/Project Intent (Aim Statement): Increase the occurrence of feedback to fellows by faculty during clinical service rotations from 52.4% to >90.0% in 6 months utilizing a standardized method.

Methods (include PDSA cycles): A Feedback Card (Figure 1), was developed by fellows and faculty. Both parties were instructed to …

Does Access To Care Influence A Child’S Presentation With Appendicitis?, Neal Talukdar

Research Days

Background + Objectives/Goal: Racial demographic and health care coverage impact how and when patients seek care. Previous studies have documented that minority children present with higher rates of perforated appendicitis. We aimed to identify if racial and coverage disparities were associated with the timing and mechanism of appendicitis presentation.

Methods/Design: We performed a prospective study of children (≤ 18 years old) who underwent laparoscopic appendectomy from May 2018 - September 2020. Prior to discharge, the patient’s parent/guardian completed a survey focused on health care encounters within the past year. Surveys were collected using RedCap®; data were analyzed using STATA®.

Results: …

Standardization Of Fertility Preservation Discussion Amongst Pediatric Oncology And Bone Marrow Transplant Patients: A Single Institution Experience, Chandni Dargan, Sarah E. Mc Dermott, Shelby Chesbro

Research Days

Background/Project Intent (Aim Statement): As treatment for pediatric malignancies improves long term survival, physicians are shifting focus to late effects of therapy such as infertility. Currently, options for fertility preservation include cryopreservation of mature oocytes, sperm, and gonadal tissue, although barriers remain present. Within our division, we lacked a standard approach to discussing fertility preservation options prior to initiation of treatment.

Methods (include PDSA cycles): Records from 474 pediatric patients with new oncologic diagnoses at CMH from 2014- 2020 were retrospectively reviewed. We evaluated the frequency that reproductive health discussions were documented in pubertal males and females requiring chemotherapy or …

Esophageal, Gastric, And Duodenal Histologic Findings In Patients With Feeding Difficulties, Amy Issa

Research Days

Background: The etiology of feeding difficulties in children is often multifactorial including medical, oral motor, and behavioral. Gastrointestinal etiologies have been identified as the primary medical component in children with feeding difficulties, however, there is not substantial information to predict which children will have a particular gastrointestinal disorder. The general consensus has been that children with feeding difficulties should have symptoms such as vomiting or abdominal pain to warrant performing esophagogastroduodenoscopy (EGD), but the validity of this approach has not been established.

Objectives/Goal: The aims of the current study were to describe EGD findings of patients presenting to a large …

Efficacy Of Pediatric Surgery Mobile Application For General Surgery Residents, James Fraser

Research Days

Background/Objectives/Goal: Integration of pediatric surgery content into the general surgery curriculum poses unique challenges as the patient population, pathophysiology, and management of surgical disease is distinctive from other subspecialties. Pediatric surgery represents approximately 2% of content on the in-training exam for residents (ABSITE) and is often underemphasized in didactic material, contributing to difficulty with preparation for these clinical rotations. We hypothesize that implementation of a mobile-based application with pertinent clinical algorithms and resources for pediatric surgical education will improve resident performance and enhance learning experiences in the management of pediatric surgery patients.

Methods/Design: Seventeen residents rotating on the pediatric surgery …

Learning From The Past: A Novel Approach To Reducing Unplanned Extubations In The Neonatal Icu, Yonatan Kurland

Research Days

Background/Project Intent (Aim Statement): The objective of this quality improvement project is to decrease unplanned extubations in a Level IV NICU to an annual rate of2020.

Methods (include PDSA cycles): We hypothesized that increased awareness of historical ETT position would both prevent unnecessary ETT position adjustments and encourage prophylactic adjustments to adjust for significant weight gain or loss. In December 2019, we implemented a novel intervention to provide readily accessible graphs of historical ETT tube position in each neonate with corrected gestational agecycles, we provided education to all members of the multidisciplinary team, we enlisted the Information Technologies Department to …

Improving The Rate Of Ppsv-23 Vaccination In Children With Type I Diabetes, Henry S. Jeng Dr

Research Days

Background/Project Intent (Aim Statement): The routine use of PCV-13 has resulted in a dramatic reduction in the incidence of pneumococcal infections among young children. However, serious pneumococcal infections caused by additional vaccine serotypes continue to occur in older children with high-risk conditions.1 As per the CDC, children with Diabetes should receive the PPSV-23 vaccine beginning at 2 years of age and at least 8 weeks after their last indicated dose of PCV-13.2 A review of division data from March 2016 to November 2018 revealed that only 2.6% of the eligible patient population with Diabetes have received the PPSV-23 vaccine. More …

Instagram As A Tool To Enhance Virtual Recruitment In The Era Of Covid-19, Sophia Hackman, Zuri Hudson, Christian Oliveros, Kyra Mccarty

Research Days

Problem Statement/Question: Due to the COVID-19 pandemic, resident recruitment will be virtual for the first time. Interviewees will be unable to visit Children’s Mercy for a tour, will spend less time engaging with current residents, and will be unable to visit Kansas City. The Recruitment Committee sought to understand if social media could be utilized to spread awareness of our pediatric residency program and provide insight into the culture of Children’s Mercy and Kansas City.

Background/Project Intent (Aim Statement): Prior to COVID-19, in person interviews would consist of dinner with current residents the day before the interview and a tour …

Addressing Hpv And Hbv Immunizations In Pediatric Acute Sexual Assault Care, Katie A. Vandervelde

Research Days

Problem Statement/Question: Victims of sexual assault are at increased risk for acquiring sexually transmitted infections (STIs), including Hepatitis B virus (HBV) and Human papillomavirus (HPV). These immunizations are not curative, but each are >95% effective at preventing infections by the included viruses. The Center for Disease Control and Prevention recommends that children who are victims of sexual abuse/assault, receive the HPV and HBV immunizations at the time of their initial medical evaluation for sexual abuse/assault. Knowing that child sexual assault victims are at increased risk for repeat assault, number of lifetime sex partners, and of being lostto-follow-up, in addition to …

Comparison Of Nasal Swab And Saliva Specimen For Detection Of Sars-Cov-2 In Children, Aaron Shaw

Research Days

Background: Stemming from the rapid need for COVID-19 testing when supplies were limited, we investigated alternate sample processing methods and sample types for SARS-CoV-2 detection. Respiratory specimen processing using an automated nucleic acid extraction system (easyMAG) provides highly quality of nucleic acid for amplification. Reagents and supplies for easyMAG were on short supply during the pandemic, so alternative sample processing methods were investigated. Due to COVID-19 quarantine and isolation, a home kit for specimen collection was desired, particularly one that was less invasive than nasopharyngeal swabs. We investigated the sensitivity and parent/ child satisfaction of home collection kits evaluating saliva …

Supporting Students In Elementary Statistics, J. Christopher Tweddle, Maxwell Luetkemeier

Research Days

General Education mathematics requirements can present a significant hurdle for student progress towards attaining a degree. Nationally, students enrolled in introductory college-level mathematics classes successfully earn credit towards a degree about 65% of attempts. GSU is no exception. Since we began admitting first-year undergraduate students in 2014, we have offered different support opportunities to promote student success. In this paper, we will provide an overview of the interventions and the data on student success in Elementary Statistics. Additionally, we'll provide preliminary information on pilot offering of a corequisite support model.

Indomethacin Exposure Is Associated With Birthweight In Extremely Preterm Infants: Non-Standard Exposure With Standard Weight-Based Dosing, Bradley C. Stockard

Research Days

No abstract provided.

Iv Amiodarone Vs Iv Sotalol For The Use In Postoperative Junctional Ectopic Tachycardia (Jet): A Randomized Study, Tanner Isaacson

Research Days

No abstract provided.

Justice System Involvement Among Adolescents In The Emergency Department, Vivek Dubey

Research Days

No abstract provided.

Incidental Diagnosis Of Dual Arterial Supply Of The Right Lower Lobe, Christopher Mathis

Research Days

No abstract provided.

Isolated Polymorphic Ventricular Tachycardia: An Unusual Presentation Of Acute Myocarditis, Natalie S. Shwaish

Research Days

No abstract provided.

Risk Of Brain Abscess In The Nonfenestrated Fontan Circulation, Bethany Runkel

Research Days

No abstract provided.

Race And Ethnicity Is Associated With Pediatric Unintentional Injuries Requiring Hospitalization, Kristyn Jeffries

Research Days

No abstract provided.

Heart Rate Recovery Following Exercise Testing In Pediatric Patients With Acyanotic Repaired Congenital Heart Disease, Natalie S. Shwaish

Research Days

No abstract provided.

Provider Education And Rapid Antigen Detection Test Use In Private And Academic Pediatric Clinics, Steven Dahl

Research Days

No abstract provided.

Neurally Adjusted Ventilatory Assist In Neonates With Congenital Diaphragmatic Hernia, Yonatan Kurland

Research Days

No abstract provided.

Characteristics Of Low Acuity Unscheduled Transfers To The Pediatric Intensive Care Unit, Ashley Daniel

Research Days

No abstract provided.

Novel Prenatal Diagnosis Of Protein C Deficiency And Primary Prophylaxis With Protein C Concentrate: A Case Series, Alexandra Prosser

Research Days

No abstract provided.