Higher Education and Teaching Commons^™

Bowel Clean Out Prior To Intrathecal Baclofen Pump Implantation: Effects On Acute Post-Operative Gastrointestinal Complications, Amanda Lindenberg, Sathya Vadivelu, Brittni Walton, Matthew J. Mclaughlin

Research Days

Background: Intrathecal baclofen (ITB) pumps have been used for management of spasticity and dystonia There is limited data on immediate post-operative complications such as GI adverse events after surgery for ITB pump related procedures. This study aimed to compare patients who underwent a pre-operative bowel cleanout to those who did not and the relationship with post-operative nausea, vomiting and constipation requiring an escalation of their bowel regimen.

Design: Retrospective cohort study.

Setting: Pediatric acute care hospital.

Participants: All patients who underwent new ITB pump and/or catheter placement from January 2015-December 2022.

Interventions: Preoperative bowel clean out. Main

Outcome Measure: Quantity …

Therapeutic Efficacy Of B7-H3 Car T Cell Therapy In Pediatric High-Grade Gliomas With H3g34r/V Mutation., Monika Yadav, Siddharth Subham, John Szarejko, Douglas Myers, David Akhavan, Viveka Nand Yadav

Research Days

Background: Pediatric high-grade gliomas (pHGGs) are aggressive brain tumors responsible for significant childhood mortality. These tumors often carry mutations in the H3F3A gene, which encodes histone H3.3 proteins. However, current treatment options are limited, underscoring the need for innovative approaches. Chimeric antigen receptor (CAR) therapy, which was successful in treating certain childhood cancers, holds promise for pHGGs with H3G34R/V mutations. This study aims to assess the potential of anti-B7-H3 CAR T cell therapy in treating the challenging pHGG tumors.

Method and Results: Here, we examined the expression of B7-H3 in various pHGG cell lines, encompassing those with H3G34V/R and H3K27M …

Central Venous Catheter-Associated Complications In Pediatric Patients With Acute Myeloid Leukemia, J Allyson Hays, Maggie Ziegler

Research Days

Background

Central venous catheters (CVCs) are a mainstay of pediatric cancer treatment for but have risks. CVCs can cause local site infections and systemic infections, known as central-line-associated bloodstream infections (CLABSIs). Analyzing rates of complications associated with different CVCs may inform future decisions about CVC choice. Hypotheses We hypothesized that tunneled cuffed (tunneled) catheters will have higher rates of CLABSIs compared to implanted ports (port) and ports will have higher rates of local site infections compared to tunneled.

Methods

Retrospective chart review of patients with acute myeloid leukemia (AML) at Children’s Mercy Hospital (CMH) identified patients treated from 2010 to …

Increasing Feedback From Endocrinology Faculty To Fellows: A Quality Improvement Initiative, Emily Metzinger, Emily Griffing, Michelle Knoll

Research Days

Feedback is essential in medical training. Our aim is to increase the frequency of feedback that CMH endocrinology fellows receive in both the inpatient and outpatient settings. We noted initial success of increasing feedback in the inpatient setting however later decreased to below goal. Frequency of feedback in the outpatient setting has remained below goal. Tracking feedback has been challenging, but a recent survey showed that fellows perceive that they receive more feedback.

Standardizing Clinical Ethics Consultation Documentation, Yoo Sun (Sunny) Jeong, Stephanie Kukora, Ásdís Finnsdóttir Wagner, Dawn Hood Patterson

Research Days

Background:

Clinical ethics consultations (CECs) require documentation. There is a paucity of literature and resources to guide clinical ethicists in documenting consults. High quality documentation encourages transparency between patients and clinicians, while keeping interdisciplinary team members knowledgeable about evolving care plans. However, there are discrepancies in the details captured in the CEC notes and accompanying recommendations.

Objectives/Goal:

To identify how CECs are documented in the medical record and assess whether there is consistent inclusion of relevant information.

Methods/Design:

Retrospective review of CECs conducted at a free-standing children’s hospital from January 2018- June 2023 was conducted. CECs were captured by cross-referencing …

To Bpd Or Not To Bpd: A Comparison Of The 2022 Versus 2011 Nichd Web-Based Risk Estimator For Bronchopulmonary Dysplasia, Mitch Kinkor, Jake Schneider, Farhath Sulthana, Janelle R. Noel-Macdonnell Phd, Alain Cuna

Research Days

This study compares the performance of the 2022 National Institute of Child Health and Human Development (NICHD) Bronchopulmonary Dysplasia (BPD) Outcome Estimator and its original 2011 version in identifying high-risk infants.

Pediatric Readiness In The Ambulatory Care Setting, Mary Haywood, Chris Kennedy, Robert D. Schremmer Md, Emily Cramer, Kevin Meilak Md

Research Days

Background: Emergent presentations are a relatively uncommon occurrence in the ambulatory care setting. However, when they do occur, they can be life threatening. Given their uncommon occurrence, many clinicians believe that emergencies do not present or do not occur in these settings. However, there can be up to 42 emergent presentations per office site per year, depending on location. Most commonly pediatric patients present with respiratory distress, but seizures, anaphylaxis, dehydration, and psychological/behavioral complaints can also present emergently to these clinics. Despite this, most offices are not prepared to handle these presentations. According to various studies, this is typically due …

Oscillometry In Term Neonates Without Respiratory Disease, Anna Nelson, Cheri Gauldin, Brooke Smith, Venkatesh Sampath, Winston Manimtim

Research Days

This feasibility study aims to determine normative values of oscillometry for neonates without respiratory disease.

Increasing The Rate Of Infants Rooming In With Their Mothers With Low-Acuity Congenital Heart Disease, Anna Nelson, Amy Marks, Ekta Patel

Research Days

This quality improvement study aimed to increase the number of infants with low-acuity congenital heart disease that could room-in with their mothers in a high-risk delivery center.

Automate Isolation Infection-Prevention Precautions (Aid-Ip): Improving The Efficiency Of Hospital Isolation With Viral Respiratory Infections, Timothy Burchard, Michael Platt, La'sonya Buford

Research Days

The AID-IP project is a QI study working to improve the process of isolation and de-isolation regarding respiratory viruses at Children's Mercy Hospital. Specifically, we aim to improve adherence to proper isolation precautions, minimize cognitive workload regarding the maintenance of isolation for staff, and improve family satisfaction with isolation practice.

Nrp, Pals, And Their Utilization During Code Events In A Pediatric Quaternary Hospital: A 'Compressed' Analysis, Mitch Kinkor, Deepa Kumar, Allison Taber, Stephen Pfeiffer, Jessica Brunkhorst, Danielle Reed

Research Days

Both the Pediatric Advanced Life Support (PALS) and Neonatal Resuscitation Program (NRP) algorithms are utilized for resuscitation during pediatric codes. The optimal time period to transition from NRP to PALS is not well studied. This study describes the utilization of chest compressions, prescribed medications, and patient outcomes during and after code events organized by the algorithm used to direct resuscitation (PALS or NRP) in a similarly aged patient population.

Improving Awareness And Utilization Of Safety Net Resources After Extremity Firearm Injury, Colleen M. Moreland, Caleb W. Grote, Richard M. Schwend, Julia G. Harris

Research Days

The orthopaedic surgery department can improve follow-on care for pediatric survivors of extremity firearm injuries by creating and implementing a checklist of defined safety net resources.

A Quality Improvement Project To Improve Antibiotic Choice For Children Admitted With Urinary Tract Infections (Utis), Philip Jurasinski Do, Pgy-3, Adrienne Deporre Md, Kathleen Berg Md, Allison Hadley Md, Viktoriya Stoycheva Mha, Rn, Cpn, Rana El Feghaly Md

Research Days

This is an antibiotic stewardship quality improvement project focused on improving antibiotic choices for children with urinary tract infections who are in the Children's Mercy Kansas City system. This project aims to improve the rates of cefazolin or cephalexin for treatment from 27% to 60%. 96% of urinary tract infections in our system are caused by E. Coli that are susceptible to these first generation cephalosporins.

More Of Less: Optimizing Opioid Prescriptions For Acute Fractures In The Emergency Department At A Children’S Hospital, Colton Schwarz, Spencer Wittmeyer, Mitch Kinkor, Michelle Dephillips, Elizabeth Edmundson, Ryan Mcdonough, Warren Teachout, Nicholas Clark

Research Days

Quality improvement project that aims to improve opioid stewardship in acute fracture management.

Characterization Of Nationally Reported Pediatric Deaths Involving Fentanyl Ingestions In Missouri, Margaret Campbell, Mary Moffatt, Emily Killough, Terra Frazier

Research Days

There has been a dramatic rise in pediatric deaths associated with synthetic opioid use, with the most prominent being Fentanyl. This is a retrospective cohort study using data from the National Center for Fatality Review and Prevention with the goal of identifying risk factors that increase the vulnerability of children to Fentanyl ingestion. Ultimately this research may help lead to improved identification of at risk children with the goal of implementation of targeted prevention programming.

How Neonates Die: Mortality Trends And Associations In A Level Iv Neonatal Intensive Care Unit, Erin Bolen, Ashley K. Sherman, Julie Weiner, Jotishna Sharma

Research Days

Background

Modes of neonatal mortality include withdrawal of life-sustaining interventions, non-escalation of interventions, and secondary to a code event. Mortality trends have been examined broadly, but the impact of clinical and demographic factors on the mode of neonatal mortality has yet to be evaluated. A greater understanding of this information would help guide medical decision-making and identify potential inequities. The aim is to evaluate the impact of clinical and demographic factors on the mode of neonatal death in a level IV neonatal intensive care unit (NICU).

Study Design/Methods

Data were collected via retrospective chart review of patients who died at …

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

Research Days

We utilized the Pediatric Health Information System to perform a retrospective cohort study of hospitalized children across 45 hospitals 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.

Coping Strategies And Stress Of The Undergraduate Nursing Student In The Clinical Setting: An Evidence Based Practice Quantitative Study, Ashley Calverley

Electronic Theses and Dissertations

The assessment of perceived stress and coping behaviors related to first-semester clinical might benefit students in nursing education. The assessment of most common coping behaviors and perceived stress related to the clinical setting is essential due to difference in personalities, learning abilities, and coping behaviors among nursing students today. Previous research has suggested the initial clinical period results in adverse outcomes, such as poor academic performance, elevated burnout levels, and diminished personal well-being. These factors are detrimental to academic success in nursing programs. Evidence supports that helping students develop positive stress/coping abilities will aid in adapting in both the academic …

Digital Storytelling As An Innovative Approach To Prehospital Education: The Experiences Of Teaching Academics., Andrew Van Noordenburg, Georgina Seaman

Health Professions Education

Purpose. To explore teaching academics' experiences of utilising digital storytelling as an innovative approach to prehospital education.

Method. This study describes an innovative learning activity, digital storytelling, developed for an undergraduate paramedicine program. The experiences of teaching academics were then explored through semi-structured interviews. Thematic analysis was used to evaluate the data.

Results. Three themes were identified through thematic analysis. The first theme was ‘the impact of friction on learning’ which describes how a learning activity’s design can negatively impact learning. The second theme ‘connecting with the teaching resources’ outlines how having access to sufficient resources is necessary to facilitate …

Incorporating Sex-Diverse And Gender-Inclusive Perspectives In Higher Education Biology Courses, Breanne N. Harris, A Kelsey Lewis, Sam L. Sharpe, Teri J. Orr, Christopher T. Martine, Chloe C. Josefson

Faculty Journal Articles

Inclusive teaching is teaching in a way that reaches all students in the classroom; this is beneficial for everyone, particularly for those with minoritized identities. Instructors play a critical role in scaffolding how students are exposed to and learn science content in the classroom. In this manuscript, we discuss how biology instructors can make their classrooms more inclusive with regard to sex and gender diversity content. Many topics in biology are based on androcentric, heteronormative, and oppressive framing, even though those lenses are more reflective of our own history and culture than they are of the diversity we see in …

Steps On Establishing A Faculty Development Curriculum For Health Science Educators In A New Medical School, Beatriz Tapia, Karina Madrigal, Robert Nelson

Research Colloquium

Purpose: New Medical Schools need health science educators, to teach throughout the medical education continuum from basic science to clinical years. The need to establish a defined faculty development curriculum for health science educators will aid in standardizing best teaching practices and build a potential master teacher to move the curriculum toward active learning and innovation. The UTRGV SoM is a distributed campus, to achieve increase outreach we will offer synchronous and asynchronous online faculty development during the pandemic. This poster will share our progress to date.

Methods: A pilot, faculty development program, was established from faculty needs assessment data, …

Magnetic Resonance Image-Based Estimates Of Hepatic Blood Flow In Children With And Without Obesity; Implications For Physiologically-Based Pharmacokinetic Models, Yoon Cho, Sherwin S. Chan, Chance S. Friesen, Valentina Shakhnovich

Research Days

Background: Physiologically based pharmacokinetic models for simulating drug pharmacokinetics are useful to guide drug dosing for pediatric patients. Hepatic blood flow could be a useful variable to use in these models.

Objectives/Goal: In this study, we explored 2-D phase contrast non-invasive magnetic resonance imaging (MRI) to measure hepatic blood flow in children with and without obesity.

Methods/Design: In this IRB-approved study, we imaged pediatric patients with abdominal MRI with 2D phase contrast imaging of the descending aorta (AO) at the diaphragm, the inferior vena cava (IVC) at the right atrium, and inferior to hepatic drainage above the renal vein confluence …

Persistent Pediatric Breast Abscesses Following Initial Treatment At Tertiary And Community Centers, Derek Marlor, Kayla Briggs-Groves, Shai Stewart Md, Nelimar Cruz-Centeno, Charlene Dekonenko, Jason D. Fraser

Research Days

Introduction: Little data exist on the management of pediatric breast abscesses that fail initial treatment. Therefore, this study aimed to evaluate and report outcomes in these patients.

Methods: All patients <18-years-old treated for a breast abscess between January 2008 and December 2018 were included. Patients were divided into 2 groups: initial treatment at our institution (Group 1) and initial treatment at referring centers (Group 2). The primary outcome was disease persistence following treatment at our institution. Secondary outcomes included treatment modalities and patient characteristics.

Results: In total, 145 patients were identified: 111 in Group 1 and 34 in Group 2. Antibiotics alone were the initial treatment in 52.3% (n=58) of Group 1 patients and 64.7% (n=22) of Group 2 patients. Invasive treatment was more common in Group 1 (45.9% vs 5.8%; p<0.00001). Patients with persistent disease in Group 1 were treated with aspiration (n=7, 50%), I&D (n=5, 35.7%), antibiotics (n=1, 7.14%), and manual expression (n=1, 7.14%.), while Group 2 patients were treated with antibiotics (50%, n=17), aspiration (26.47%, n=9), I&D (17.65%, n=6), and manual expression (5.88%, n=2). Group 2 patients with persistent disease were more likely to be treated with antibiotics or a change in antibiotics (50% vs 7.14%; p=0.005). Following treatment at our institution, the rate of persistent disease was similar between groups (12.6% vs 11.8%).

Conclusions: Persistent breast abscesses may be treated with antibiotics in appropriate cases. Damage to the developing breast bud should be minimized. Disease …

Respiratory Pathogen Panel Use In Hospitalized Infants <2 Months Of Age And Impact On Patient Management., Edward Lyon

Research Days

Background: Respiratory pathogen panels (RPP) are multiplex PCR platforms able to simultaneously detect several respiratory viruses. RPP utilization is not well described in infants < 2 months of age, who frequently require hospitalization for management of acute respiratory illness (ARI) and/or fever. Detection of a viral pathogen in this age group could impact the clinician’s decision to perform additional evaluation and administer antimicrobials.

Objectives/Goal: We sought to understand predictive features and clinical management impact of RPP use in infants < 2 months of age.

Methods/Design: Between October 2017 to September 2021, participants, aged < 18 years, hospitalized with an acute respiratory infection (ARI) were enrolled in Kansas City’s New Vaccine Surveillance Network (NVSN). Eligible patients were residents of Jackson County, had symptoms consistent with ARI (e.g., cough, fever, nasal congestion) lasting < 14 days, and enrolled within 48 hours of admission. For this study, only participants < 2 months of age were included. All participants had a research RPP, but results were not available to the clinician. Per provider discretion, some infants also received a clinical RPP (cRPP). Demographic characteristics, laboratory evaluations, and antimicrobial management were compared between infants with and without a cRPP.

Results: Of the 139 participants < 2 months of age, 57 (41%) had a cRPP (table 1). A cRPP was more frequently obtained in infants < 1 month of age (n=34 [47%]) compared with infants 1-2 months of age (n=23 [35%]; p=0.17). 35 (61%) participants with a cRPP had a parental report of fever while 41 (50%) of those without a cRPP had one reported. Only 20 (35.1%) of White, non-hispanic participants had a cRPP compared to 42 (51.2%) p=0.082 who did not have a cRPP. Participants who had blood or CSF culture collected were more likely to have a cRPP obtained, 47 (82.5%) p=

Conclusions: Overall, < 50% of infants < 2 months of age hospitalized with ARI received cRPP testing. Obtaining a blood or CSF culture was associated with increased cRPP usage. The length of stay was not different between the two groups. 35 viral infections went undetected in participants without a cRPP even with accounting for positive rapid NAAT testing, further investigation is needed to understand how this may influence clinical care.

Association Between Remote Monitoring And Interstage Morbidity And Mortality In Single Ventricle Patients Across Socioeconomic Groups, Bianca Cherestal

Research Days

Background: Despite improvements in outcomes over time, morbidity and mortality for infants with single ventricle (SV) heart disease remains high. Among other risk factors for mortality, infants of low socioeconomic status (SES) are known to be particularly vulnerable following stage 1 palliation.

Objectives/Goal: We sought to determine whether use of a novel remote monitoring program, CHAMP (Cardiac High Acuity Monitoring Program), mitigates differences in outcomes by SES for infants with SV during the interstage period.

Methods/Design: Using the CHAMP database, we identified 610 infants across 11 institutions enrolled in the program between 2014–2021. All enrolled patients’ families were provided with …

Pilot Study Using Sideline Hand-Grip Dynamometry To Assess Strength Changes In A High School Baseball Season: A Feasibility Study, Thomas Munro, Jason D. Yoderq, Brian R. Lee, Brian S. Harvey

Research Days

Background: Upper extremity injuries are common in baseball players. Objective measurements could assist in determining early signs of fatigue before injury occurs. Using HGD to measure strength changes may help identify early signs in the injury process. To our knowledge, HGD has not been tested on high school baseball players in the sideline setting. It is feasible to perform hand-grip dynamometry on-site at the high school level and HGD measurements will change throughout the season in varsity baseball athletes. Secondary aim: Asses HGD measurement in the context of injury/pain/fatigue/pitching.

Objectives/Goal: It is feasible to perform hand-grip dynamometry on-site at the …

Therapeutic Plasma Exchange To Alleviate Ventricular Tachycardia After Diphenhydramine Ingestion, Kaushal Dosani, Lejla Music Aplenc, Stephen Pfeiffer

Research Days

Background: The Covid-19 pandemic has adversely affected the mental health of children causing an increased incidence of suicide attempts. Diphenhydramine is a common household medication and is frequently ingested by children. Toxic doses of diphenhydramine can affect the cardiovascular and central nervous system. In the heart, diphenhydramine blocks fast sodium channels and potassium channels which can result in conduction abnormalities including sinus tachycardia, widening of QRS duration, ventricular tachycardia and torsades de pointes. Massive ingestion can cause severe cardiovascular collapse which may require ECMO support

Objectives/Goal: To describe a novel method of clearing highly protein-bound diphenhydramine molecules from circulation after …

Genes Predictive Of Aggressive Infant Acute Lymphoblastic Leukemia, Meghana Bhumireddy

Research Days

Background: Acute Lymphoblastic Leukemia (ALL) is a rapidly progressive cancer in which the bone marrow makes too many immature leukocytes that divide uncontrollably. KMT2A, or MLL, is a methyltransferase found in many types of leukemia, whose rearrangement (KMT2A-r) is present in approximately 2/3 of infants with ALL. KMT2A-r is associated with a very poor prognosis: roughly ⅔ of patients relapse within 1 year of diagnosis, and the relapsed KMT2A-r ALL is resistant to treatment (having nearly 100% morality). We explored gene expression in patient samples from three groups at diagnosis: KMT2A-r patients who relapsed, KMT2A-r patients who did not relapse, …

Drug Metabolizing Enzymes And Transporters May Help Determineeffective Budesonide Dosing In Eoe, Laurie Mccann, Lisa Harvey, Norah Almahbub, Wendy Y. Wang, Erin C. Boone, Janelle R. Noel-Macdonnell Phd, Rachel Chevalier

Research Days

Background: Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder diagnosed in children with painful or difficult swallowing, vomiting, or poor weight gain. Current treatment models adopt a trial-and-error approach in regard EoE treatment, including restrictive elimination diets, proton pump inhibitors, and topical budesonide. This approach can delay effective treatment which increases risk of disease progression and increases medical costs to families for frequent clinic visits and endoscopy.

Objectives/Goal: The objective of this study is to determine the CYP3A5 genotype and expression of patients with eosinophilic esophagitis to discover which patients will respond to standard dosing of topical budesonide treatment (1, …

Degree Of Uncertainty In Reporting Imaging Findings For Necrotizing Enterocolitis: A Secondary Analysis From A Pilot Randomized Diagnostic Trial, Disa Rathore, Kira Bourrett, Sherwin S. Chan, Erin Opfer, Alain Cuna

Research Days

Background: Uncertainty in reporting of imaging findings for necrotizing enterocolitis (NEC) can be challenging for clinicians and result in ambiguity, miscommunication, and potential diagnostic errors. The degree to which uncertainty complicates diagnostic imaging for NEC has not been characterized.

Objective: To determine the degree of uncertainty in diagnostic imaging for NEC.

Methods: We conducted a retrospective study using data from a previously completed pilot diagnostic randomized clinical trial (RCT). The study population comprised of preterm infants with suspected NEC who were randomized to either standard imaging with abdominal radiographs (AXR) alone or experimental imaging with AXR + add-on bowel ultrasound …