Higher Education and Teaching Commons^™

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 …

Management Of Primary Spontaneous Pneumothorax In Children: A Single Institution Protocol Analysis, Shai Stewart Md, James Fraser, Nelimar Cruz-Centeno, Derek Marlor, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Tolulope A. Oyetunji, Shawn D. St.Peter

Research Days

Background: Primary spontaneous pneumothorax (PSP) affects 3.4 per 100,000 children in the United States. Regardless of the initial management, additional procedures, and prolonged hospital length of stay (LOS) may occur. There is currently no consensus in the pediatric surgical community on the optimal management of these patients, which has resulted in marked variability in management. The Midwest Pediatric Surgery Consortium (MWPSC), of which our site is a participant, suggested a management algorithm to include simple aspiration upon presentation, and if this fails, VATS should be considered.

Objectives/Goal: The purpose of this study was to evaluate the outcomes of instituting a …

Institutional Outcomes Of Blunt Liver & Splenic Injury In The Atomac Era, Shai Stewart Md, James Fraser, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Shawn D. St.Peter, Tolulope A. Oyetunji

Research Days

Background: The Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium (ATOMAC) practice management guideline (PMG) was created to standardize management of blunt liver or spleen injury (BLSI) across pediatric trauma centers. Evaluations of institutional outcomes after its adoption remain scarce. We describe our outcomes since PMG adoption at our institution.

Objectives/Goal: The purpose of this study was to assess patient outcomes and resource utilization after implementation of this protocol. We hypothesized there is no difference in length of stay (LOS) or complications regardless of grade of isolated injuries to the liver or spleen. In addition, there is limited guidance on the management of concurrent injuries to …

A Novel Approach For Laparoscopic Direct Inguinal Hernia Repair In Children, Shai Stewart Md, Charlene Dekonenko, Nelimar Cruz-Centeno, Derek Marlor, Jason D. Fraser

Research Days

Background: Inguinal hernia repair is one of the most common operations performed by pediatric surgeons, and the frequency of laparoscopy for repair is increasing. The vast majority of these are indirect hernias and therefore how to best repair a direct defect when seen during laparoscopy is still unknown. Simple high ligation of the hernia sac (as is done in an indirect hernia) does not repair the inguinal floor weakness/defect seen in a direct hernia.

Objectives/Goal: We therefore present a case of laparoscopic bilateral indirect and direct inguinal hernia repair, commonly known as pantaloon hernia, repaired without mesh and utilizing the …

Antibiotic Monotherapy Vs Dual-Drug Therapy In Perforated Appendicitis: Single Center Retrospective Review, Shai Stewart Md, Nelimar Cruz-Centeno, Derek Marlor, Dae H. Kim, Shawn D. St Peter, Tolulope A. Oyetunji Md Mph

Research Days

Background: The optimal antibiotic regimen in perforated appendicitis to reduce intraabdominal abscess (IAA) formation has not yet been agreed upon in the pediatric surgery community. We aimed to evaluate the outcomes of patients with perforated appendicitis when intravenous antibiotic monotherapy with Piperacillin-Tazobactam (PT) versus dual-drug therapy with Ceftriaxone and Metronidazole (CM) are administered. We hypothesized there is no difference in the rate of IAA formation with antibiotic monotherapy, as opposed to our once-daily dosed, institutional standard dual-drug therapy.

Objectives/Goal: The goal was to determine if our current management protocols for acute appendicitis were delivering the best possible results for our …

A Comparison Of Large Tbsa Scald Versus Flame Burns In Young Children, Ashley Daniel

Research Days

Background: It is generally accepted that of children with the same total body surface area of burns, those with flame burns seem to have longer lengths of stay and more complications than those with scald burns. Anecdotally we have seen the opposite to be true. Among a consortium of five US pediatric burn centers participating in the Pediatric Injury Quality Improvement Collaborative (PIQIC), young children with scald burns seem to experience disproportionately more frequent and severe complications compared to their older counterparts and compared to patients of a similar age with flame burns.

Objectives/Goal: In this multi-institutional study, we compared …

Relationship Between Rurality And Access To Care For Families Of Hospitalized Children, Zoetta L. Mcloughlin Md

Research Days

Background: At Children’s Mercy Hospital, greater than 1 in 5 hospitalized children are from rural areas. Rural families often travel long distances for hospitalization at free-standing children’s hospitals, a median of 70 miles according to recent work. Rural families are more likely than non-rural families to experience financial insecurity, and these baseline hardships may be intensified during hospitalization due to out-of-pocket costs, lost work, inability to meet family needs, and removal from social support. However, little is known about the differences in healthcare access and resulting burdens between rural and non-rural families.

Objectives/Goal: To describe differences in demographics, health care …

Rural And Urban Caregiver Experiences Of Financial Strain And Food Insecurity During Pediatric Hospitalizations, Rachel E. Granberg

Research Days

Background: Stress is common among caregivers of hospitalized children. In addition to stress related to their child’s illness, caregivers experience stress related to financial strain and food insecurity during their child’s hospitalization. The burden of financial strain and food insecurity related to pediatric hospitalizations may vary between rural and urban populations.

Objectives/Goal: To identify financial strain and food insecurity experienced by caregivers of hospitalized children and to describe differences between rural and urban populations.

Methods/Design: A prospective cross-sectional survey enrolled a random sample of caregivers of hospitalized children between 8/31/2021 and 12/2/2022 at a single children’s hospital. Demographic information was …

Female Authorship Concordance In Academic Pediatrics, Roxana Guggenmous, Jessica L. Bettenhausen, Jessica L. Markham

Research Days

Background: Gender disparities are well described in medicine and academia. Despite a catalyzed movement towards gender equity, female physician-scientists remain at risk for experiencing biases in hiring practices, compensation, promotion, appointment to leadership positions, and achievement of extramural funding through the National Institutes of Health. In pediatrics, the female workforce has grown consistently over time, with female physicians comprising 72.3% of the workforce as of 2021, yet prior work suggests that this growth is not fully reflected in academic publications. Achieving gender parity in academic publication may help reduce gender-based disparities impacting career advancement. Therefore, we sought to describe the …

Pediatric Educational Outreach To A Community Based Emergency Department: Clinical Management Of The Febrile Infant, Jess Parker, Frances Turcotte Benedict, Emily Hillman, Ryan C. Jacobsen, Ashley K. Sherman, Arjun Sarin

Research Days

Background: Multiple studies have shown variability in the approach to treatment of febrile infants ≤ 60 days of age in community emergency departments (EDs), and the American Academy of Pediatrics (AAP) recently published new guidelines on management of febrile infants. Therefore, an opportunity exists to provide evidence-based recommendations for the care of this patient population to providers in community EDs.

Objectives/Goal: To assess 1) alignment of community ED provider practices with an AAPinformed Clinical practice guideline (CPG) for management of febrile infants ≤ 60 days of age. 2) change in comfort level and degree of alignment after targeted education.

Methods/Design: …

Socioeconomic Factors And Picu Interventions In High Mortality Risk Asthmatics, Hanh Ho, Paul N. Bauer, Jade B. Tam-Williams

Research Days

Background: Asthma mortality rates are overall lower in children, but studies estimate 5-10% of asthmatics have refractory mortality prone asthma. Asthmatics with repeat pediatric intensive care unit (PICU) admissions are believed to be at high mortality risk with increased health care utilization and socio-economic challenges.

Objectives/Goal: We aim to identify patients with repeat PICU admissions for status asthmaticus and characterize the levels of interventions and socio-economic status.

Methods: A retrospective chart review was done on patients with the following inclusion criteria: age 0- 18, PICU admission between January 2010 to December 2015, and a diagnosis of status asthmaticus on admission. …

Supporting Families Impacted By Adverse Childhood Experiences (Aces), Jennifer Paumen, Laura Plencner, Jacqueline Kitchen

Research Days

Background: Adverse childhood experiences (ACEs) impact a majority of individuals, with approximately two-thirds of adults having experienced 1 or more ACE.1 The health consequences of ACEs are significant, including cardiovascular disease, cancer, autoimmune diseases, and mental illnesses.1 These health impacts can even start as early as childhood, leading to an increased risk of learning and behavioral concerns.2,3 Recent evidence has also identified the impact that parental ACEs may have on parenting and child development,4,5,6 which in turn may lead to an intergenerational transmission of ACEs.4,7 As a nurturing caregiver relationship is key for buffering adversity,2,8 it is imperative to address …

Influencing Influenza Immunization: Qi Project In A Pediatric Resident Continuity Clinic, Brittany Moore

Research Days

Problem Statement/Question: There have been a multitude of approaches to vaccine hesitancy in regard to childhood vaccinations. In light of the COVID-19 pandemic there was a noticeable decline in influenza vaccination among children aged 6 months to 18 years. The influenza vaccination rate in the pediatric resident continuity clinic at Children’s Mercy Hospital was below the national average for pediatric patients.

Background/Project Intent (Aim Statement): The aim of this study is to increase the percentage of patients aged 6 month and older currently enrolled in ROYAL clinic receiving at least one influenza vaccine from 38.6% to 55% by January 1, …

Increasing Utilization Of Gestational Age Based Table For Initial Intubation In A Level Iv Neonatal Intensive Care Unit, Maribel Martinez, Dianne Lee, Christopher R. Nitkin

Research Days

Problem Statement/Question: Most providers in our unit are not using the NRP recommended method to determine the initial ETT insertion depth in neonates.

Background/Project Intent (Aim Statement): Endotracheal tube (ETT) depth in neonates is of critical importance due to significant adverse events when malpositioned. While randomized trials comparing different methods have not shown superiority of any particular method, the weight-based method (weight (kg) +6) has been found to be highly inaccurate in extremely low birth weight neonates. Furthermore, the Neonatal Resuscitation Program (NRP) recommends using gestational age (GA)-based table (Kempley ST, et al, Resuscitation 2008) or nasal-tragal length for initial …

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

Research Days

Problem Statement/Question: Child Advocacy Centers (CACs) coordinate child abuse MDTs, and 2023 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.” Scheduled Case Review occurs among Children’s Mercy child abuse pediatricians (CAPs), but current practice is to review cases only upon CAP request.

Background/Project Intent (Aim Statement): Appropriate interpretation of sexual abuse exam findings is crucial for accurate diagnosis and provision of medical information to multidisciplinary child protection teams (MDTs). Medical …

Unique Endoscopic Retrieval Of A Large Rectal Foreign Body, Laurie Mccann, Jose Cocjin

Research Days

Introduction: Large rectal foreign bodies are usually difficult to extract, usually requiring operative management.

Case: A 14-year-old male presented to the ER for a rectal foreign body. Earlier in the day, he had rectal itching and inflammation. He used a cylindrical reusable ice stick (for water bottles) for topical relief, which did not work, so he placed the tube in his rectum, then he was unable to retrieve it and sought medical help. Physical exam was significant for lower abdominal pain and palpable mass just below his umbilicus, which was painful to palpate. CT abdomen/pelvis showed a large foreign body …

Improving Fluid Management Of Extreme Premature Infants By Providing A Restrictive Fluid Management Algorithm In The Nicu, Jacob S. Ward, Dena Hubbard, Nicholas Clark

Research Days

Problem Statement/Question: At our institution we found wide variability in and a lack of an evidence-based standard for fluid management in premature infants.

Background/Project Intent (Aim Statement): Excessive fluid intake in premature infants during the first week of life increases the risk of adverse events and overall mortality. Fluid restriction is recommended to help decrease morbidity and mortality in this patient population. We aimed to improve the fluid management of premature infants born < 29 weeks gestation admitted to our intensive care nursery (ICN) by implementing a fluid restriction protocol with the goal of >70% compliance over a 16-month period.

Methods (include PDSA cycles): Institution of daily weights started at beginning of baseline period. In April of 2021, we implemented a …

Hypereosinophilia With An Anterior Mediastinal Mass, Sonya Parashar, Aarti Pandya

Research Days

Background: Hypereosinophilia is defined as 1500 eosinophils/mL or above with evidence of end-organ damage due to the eosinophils at least 4 weeks apart.

Objectives/Goal: We describe a case of steroid resistant hypereosinophilia.

Methods/Design: A 3-year-old male was admitted for newly found anterior mediastinal mass and left pleural effusion. About 6 weeks prior to admission, he was seen in his primary care office for difficulty breathing. Despite the appropriate treatment for his symptoms, the patient continued to have significant respiratory symptoms and a chest x-ray showed a large left pleural effusion. He was immediately transferred to a tertiary care center and …

Bone Marrow Transplant For Macrophage Activation Syndrome In Systemic Juvenile Idiopathic Arthritis, Shailly Gaur, Michael J. Holland, J Allyson Hays, Ibrahim A. Ahmed

Research Days

Background

The recognition of macrophage-activation-syndrome (MAS) in the setting of systemic-juvenileidiopathic-arthritis (sJIA) is complex, but a necessary distinction given emerging treatment options. With overlapping clinical manifestations including fever, end-organ involvement and lymphadenopathy, there is a focus on laboratory values to differentiate MAS from a sJIA flare. Once parameters are met, multiple treatment modalities can be considered, as monotherapy or in combination, including steroids, immunosuppression, chemotherapy, intravenous immunoglobulin, and cytokine-directed biologics. Given the long-term morbidity and mortality associated with progressive inflammation and immune dysregulation due to MAS with sJIA, it is imperative to regain control over this complication. However, these treatments …

Impact Of Personalized Interactive Storytelling On Suspension Of Disbelief In Clinical Simulation, Audra Renee-Smith Xenakis

Electronic Theses and Dissertations

The literature review found suspension of disbelief (SOD) in clinical simulation heavily weighted on educators alone within high-fidelity environments. The project examined a co-created narrative background story applied to a simulated patient’s clinical profile to determine achieving an improved connectedness toward the simulated patient leading to enhanced SOD and enhanced levels of learning and reaction. The studied population was third-semester associate degree nursing students over 18 years of age with prior clinical simulation experience who were not repeating the semester. The research methodology used a quantitative experimental design with cluster sampling, randomization, and post-Likert-scored questionnaires. The intervention group co-created personalized …

The Invisible Epidemic: A Concussion Assessment Among University Faculty And Staff, Emily R. Brown, Jacqueline D. Villanueva Arevalo

Student Scholar Showcase

Background: The present body of research is deficient, and institutions frequently lack defined return-to-learn policies for students who have incurred or been diagnosed with a mild traumatic brain injury (mTBI)/concussion.

Purpose: This research study aims to determine the level of knowledge and awareness university faculty and staff currently have at a private university in the Mid-Atlantic Region.

Participants: 64 collegiate faculty and academic staff

Methods: A Cross-sectional, web-based Faculty and Staff Concussion Awareness and Knowledge survey was completed by participants, consisting of 9 demographic, 21 Likert Scale, and 1 multiple-option question.

Results: Initial descriptive and frequency statistics of the 64 …

Nursing Faculty Perceptions Of Stress, Coping, And Intent To Leave The Profession In The Ongoing Covid-19 Pandemic: A Quantitative Study, Lynlee Morgan

Dissertations

The COVID-19 pandemic impacted all of society to varying degrees; this impact was especially true in higher education due to an overnight transition to distance learning and incessant pivots to meet new guidelines and overcome obstacles. Nursing faculty were significantly impacted due to the responsibility of producing safe, qualified, competent practitioners to provide care in the clinical setting. The limitations in or exclusions from clinical experiences combined with the fact that faculty were managing personal concerns and had never encountered these unprecedented conditions exacerbated the challenge of preparing new nurses. This study was critical due to the faculty role and …

Inclusion Of Sexual Orientation And Gender Identity (Sogi) Cultural Competence In Higher Education Healthcare Programs: A Scoping Review, Kristin Willey, Jennifer K. Fortuna, Jessica Guerra, Amanda Gross, Samantha Turner, Tara Grant, Betsy Williams

Internet Journal of Allied Health Sciences and Practice

Purpose: Lack of sexual orientation and gender identity (SOGI) cultural competence in healthcare providers contributes to poor health outcomes in individuals who are lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and more (LGBTQIA+). However, SOGI is often overlooked in healthcare education. Existing research shows educational programs in the nursing, medical, and pharmacy professions are incorporating cultural competence training into the curricula. Few studies have explored how SOGI cultural competence is incorporated into occupational therapy (OT), physical therapy (PT), and speech-language pathology (SLP) curricula. Clear guidelines for training on SOGI cultural competence are lacking in these professions. It is …

Moving Forward Together: Reflections Of A National Survey Of Ot/Ota Students’ Perceptions Of Culturally Aware Educational Content Delivery, Adair M. Sanchez, Iris W. Burns, Tina M. Deangelis, Maclain Capron, Abigail Mills, Taylor Kligerman

Journal of Occupational Therapy Education

In June of 2020 in response to the murder of George Floyd and the additional atrocities against historically marginalized people and communities across the United States, the Commission on Education (COE) of the American Occupational Therapy Association (AOTA) sought to act within its scope. A retrospective survey (N= 1,692) was developed, deployed, and analyzed in accordance with the COE’s standard operating procedures relating specifically to monitoring trends that impact the education of occupational therapy (OT) and occupational therapy assistant (OTA) students. This survey aimed to capture perspectives from OT/OTA students regarding the delivery of culturally aware educational content in curricula …

A Framework For Creating And Using Teaching Philosophy Statements To Guide Reflective And Inclusive Instruction, Steven D. Taff

Journal of Occupational Therapy Education

A teaching philosophy statement (TPS) is a brief, deeply personal narrative that gives insight into an educator’s perspective on the teaching enterprise. A TPS is typically comprised of a reflection on the educator’s values and beliefs, a description of what happens during the learning process, and statements about how teachers and learners ideally interact. Use of a TPS clarifies the bridge between theory/philosophy and practice which strengthens education as an interactive phenomenon and in so doing evokes an ethical purpose for the teaching-learning dynamic. This article describes the theoretical underpinnings of, and process for, an innovative framework occupational therapy educators …

An Exploration Of The Causes And Effects Of Interpersonal Conflict Related Stress Among A Self-Selected Cohort Of Second Level Teachers In Ireland, Patrick Bruce

Theses

Teaching has been classified by researchers as a high stress profession. Stress in teaching has been reported to have many negative health outcomes and also affects productivity. The literature also reports that stress in teaching is a difficult matter to resolve satisfactorily, with mixed outcomes from interventions. An emergent cause of work-related stress in education is IPC and this study sets out to investigate the prevalence of this underreported phenomena.

A sample of 25 teachers working in Irish second level schools were recruited. Semi structured interviews were conducted to report on the experiences of stress, it’s causes and effects both …

Understanding The Role Of Faculty Advising In Graduate Allied Healthcare Profession Programs As Practitioners Transition To Professor, Lillie Marie Barnett Thomas

Electronic Theses and Dissertations

Individuals in allied healthcare professions continue to see growth in all areas, including clinical practice and higher education. Leaders at the university level, alongside leadership within allied healthcare accreditation bodies for disciplines like athletic training, occupational therapy, physical therapy, and speech-language pathology, maintain the need to grow the professions through master’s and doctoral degree programs. With the growth, many working practitioners move from clinical practice to academia with little to no experience or understanding of higher education and all the responsibilities of the job. This quantitative research study used a purposive sampling of allied healthcare professionals across the United States …

Science, Technology, Engineering, And Mathematics (Stem) Project-Based Learning (Pbl) Education: A New Mexico Case Study For Equity And Inclusion, Kimberly A. Scheerer

Teacher Education, Educational Leadership & Policy ETDs

This research addresses how student participation in Science, Technology, Engineering, and Mathematics (STEM) project-based learning (PBL) education activities encourages underrepresented minority student achievement in STEM career field trajectories. Seven New Mexico high school counselors and 12 STEM organization personnel were interviewed during this study. Their responses represent the nuanced professional voices where New Mexico public education intersects with STEM student interest and cultural influence.

For students, STEM PBL can foster deep integration across educational disciplines and enhance STEM career trajectory interest and readiness. STEM education converged with PBL methodologies has the ability to leverage community support while broadening student networks. …

The Power Of Conflict Or Rhetoric And Poetry, Suzanne Riskin

be Still

I am grateful for the opportunity to write this piece, share my thoughts and give a moment of gratitude for the grace that medical students show to others, their attending physicians, patients and most importantly themselves Effective writing, speaking, and expression is easily born from a struggle with others. Our own internal battles emote themselves as prolific poetry.

This piece was inspired by the quote by Yeats.