Higher Education and Teaching Commons^™

Ekg Technology: It Is Time For A Change!, Megan Carroll

Research Days

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Background: Technology for obtaining pediatric EKGs has not changed in over 70 years. Current guidelines recommend a 12-lead EKG, which takes approximately 7 minutes to complete. Newer adult technology utilizes between 1-6 leads for EKG analysis. There has not been a study in pediatrics to assess the minimum number of leads required to attain diagnostic accuracy.

Objectives/Goal: To determine the appropriate number of leads needed to read pediatric EKGs safely and accurately.

Methods/Design: This is a single center systematic review that included randomly selected EKGs from our hospital database (2017-2020) read by two independent pediatric …

Increased Prevalence Of Parenteral Nutrition-Associated Liver Disease In Neonates With Congenital Heart Disease, Yasasvhinie Santharam

Research Days

Background: A life-sustaining therapy, use of total parenteral nutrition (TPN) allows for meeting nutritional needs of low birth weight, premature, or otherwise complex infants with conditions that prevent feeding through the GI tract. However, 40-60% of infants on long-term TPN have been shown to develop parenteral nutrition-associated liver disease (PNALD)1 , a serious condition characterized by cholestatic jaundice, steatosis, and hepatic fibrosis. Given these risks, providers must account for risk of hepatic injury when prescribing TPN, including attributes of gestational age, infection, surgical and diagnosis history2-6 . Yet with a multifactorial pathogenesis, significant heterogeneity in PNALD incidence still occurs. Looking …

Pharmacometabolomics Profiling Of Preterm Infants Validates Patterns Of Metabolism Associated With Response To Dexamethasone Treatment For Bronchopulmonary Dysplasia, Bradley C. Stockard

Research Days

Background: Bronchopulmonary dysplasia (BPD) is one of the most common health complications of premature birth. Corticosteroids are commonly used for treatment of BPD, but their use is challenging due to variability in treatment response.

Objectives/Goal: Previous pharmacometabolomics study has established patterns of metabolite levels with response to dexamethasone. We obtained additional patient samples for metabolomics analysis to find associations between the metabolome and dexamethasone response in a validation cohort.

Methods/Design: 14 infants provided 15 plasma and 12 urine samples. The measure of treatment response was the calculated change in respiratory severity score (deltaRSS) from pre-to-post treatment. Each metabolite was assessed …

Association Of Patient Demographics, Code Characteristics, And Survival To Discharge After In-Hospital Cardiac Arrests In The Pediatric Intensive Care Unit, Nathan Lavoy

Research Days

Background: Lower socioeconomic status and minority background have been linked to worse outcomes after out-ofhospital and in-hospital cardiac arrests (IHCA). Despite this, there has not been a focus on IHCA within a pediatric intensive care unit (PICU) evaluating patient demographics and code characteristics.

Objectives/Goal: The primary objective is to describe patient demographics, code characteristics, and survival to discharge of patients that suffer IHCA in a quaternary PICU. The goal of this descriptive, retrospective study is to identify possible differences in outcomes related to patient demographics, laying the foundation for further QI initiatives.

Methods/Design: Participants included patients between 24 hours and …

Neonatal Hypoxia Due To Pulmonary Artery Thrombus, Bianca Cherestal

Research Days

Background: Pulmonary artery thrombus is rare and should be considered in neonates with refractory hypoxia.

Case: Preterm female neonate had persistent hypoxia after birth despite intubation, high-frequency oscillatory ventilation (FiO2 100%), and inhaled nitric oxide. Delivery was via c-section at 33 weeks 4 days for new onset hydrops and poor biophysical profile. Echocardiogram revealed echo brightness in the lumen of the left pulmonary artery (LPA) with no color flow (figure 1a), concerning for occlusive thrombus. Chest CT angiogram confirmed the diagnosis (figure 1b, c). Hematology was consulted and recommended systemic thrombolysis (tissue plasminogen activator, tPA) with concomitant anticoagulation (Bivalirudin). Imaging …

The Effects Of Necrotizing Enterocolitis And Short Chain Fatty Acids On The Developing Brain In Mice, Maribel Martinez, Venkatesh Sampath, Paula Nichols, Wei Yu, Suban Burale, Tianhua Lei

Research Days

Background: Necrotizing enterocolitis (NEC) is a devastating disease in premature infants characterized by acute intestinal inflammation and necrosis with a mortality of 15%-30%. Approximately 50% of infants that survive NEC will develop neurodevelopmental defects[1]. Studies on the effects of NEC on the neonatal brain are limited, however it’s postulated that neurodevelopmental damage is induced via cytokine activation of toll-like-receptor 4 (TLR4) by high mobility group box protein 1 (HMGB1) on the microglia Accumulation of reactive oxygen and demyelination contribute to neuronal damage. Therapies that limit the development of NEC can potentially also limit the neuroinflammatory changes seen in NEC[2]. We …

Identifying Predictive Factors For Patients Transferred From Floor To Picu Within 24 Hours Of Admission By A Pediatric Critical Care Transport Team, Gina Patel

Research Days

Background: Appropriate triage and disposition during transport can reduce the need for unplanned transfers to the pediatric intensive care unit (PICU) within 24 hours of admission. We sought to determine predictive factors of patients admitted to the inpatient ward that required PICU transfer within 24 hours following transport by Children’s Mercy Critical Care Transport (CMCCT) team. The pediatric early warning score (PEWS) is used to monitor changes in the level of acuity for inpatients at our hospital and has been utilized to measure acuity during transport. We hypothesized patients with respiratory illness and PEWS > 4 during interfacility transport are at …

Repeat Tracheal Aspirates In Pediatric Intensive Care Patients: Understanding Clinical Application, Edward Lyon

Research Days

Background: Tracheal aspirate cultures (TA) are regularly obtained in the pediatric intensive care unit (PICU) when clinical changes in intubated or tracheostomy dependent children occur. Positive TA results are often unable to distinguish infection from colonization. There is no data describing the frequency and impact of repeated TAs on patients in the PICU.

Goal: Our objectives were to describe the frequency of repeated TAs in PICU children and emergence of multidrug resistant organisms (MDRO), identify bacterial profile of TAs, and examine antibiotic prescribing patterns related to these cultures.

Methods: A retrospective chart review occurred on 15 patients in the PICU …

Rates Of Physical Abuse Screening And Detection In Infants With Brief Resolved Unexplained Events (Brues), Angela Doswell

Research Days

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Background: “Apparent Life-Threatening Events” (ALTEs) have been associated with child physical abuse (CPA). In 2016, “Brief Resolved Unexplained Event” (BRUE) and development of its clinical guidelines and risk-stratification replaced ALTE. It is unknown if there is a similar association between BRUEs and CPA.

Objectives: To determine the rate of CPA in infants presenting with a BRUE, examine differences between infants with/without CPA, and examine rates of diagnostic testing used to detect CPA.

Methods/Design: This study was part of the BRUE Research and Quality Improvement Network, composed of 15 academic and community hospitals. Subjects were infants …

Healthcare Utilization Of Victims Of Commercial Sexual Exploitation Compared To Non-Victims, Cree Kachelski

Research Days

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Background: Approximately 17,000 US children are victims of Commercial Sexual Exploitation of Children (CSEC) annually. Nearly 75% of adolescent CSEC victims received medical care within 6 months prior to identification. Screening tools have been developed based on known characteristics of CSEC victims; however, little is known about how CSEC victims compare to non-CSEC adolescents in healthcare utilization. Thus, appropriate medical CSEC screening settings are unknown.

Objectives/Goal: We aimed to identify where and how often adolescents presented to medical care in the 12 months prior to CSEC identification. We hypothesized that compared to controls, CSEC positive …

Cvst As A Rare Complication Of Acute Pediatric Covid-19, Erin Bolen

Research Days

Background: A previously healthy 13-year-old male was admitted to the hospital for a bacterial superinfection in the setting of recent COVID-19, including orbital cellulitis and pansinusitis with subgaleal, epidural, and subdural empyema. Further workup identified an occult, non-occlusive cerebral venous sinus thrombosis (CVST) along the length of the superior sagittal sinus.

Objectives/Goal: To evaluate the reported cases of CVST as a potential complication of COVID-19 in the pediatric population and identify meaningful trends in demographics, presentation, and diagnostic course.

Methods/Design: A literature search was run with various combinations of the following terms, always including “COVID”: “pediatric,” “adolescent,” “CVST,” “cerebral venous …

Evaluation Of A Hirschsprung Disease Systemwide Enterocolitis De-Escalation Strategy, Albert Aickareth

Research Days

Problem Statement/Question: Components of systems that identify, treat and prevent enterocolitis are not well described. In addition, for patients with HSCR both pre and post pull-through, questions regarding a child’s clinical status occur through several different medical access points and may occur outside of colorectal center clinic hours.

Background/Project Intent (Aim Statement): Hirschsprung associated enterocolitis (HAEC) is a severe and potentially life-threatening complication of Hirschsprung Disease (HSCR) that can present with a variety of symptoms from mild abdominal pain to fulminant colitis. We evaluated our system-wide enterocolitis de-escalation strategy for both hospital staff and patient caregivers. Our primary analysis was …

Impact Of A Mental Health Screening Process In A Pediatric Ed, Bryan Stocker Do, Shobhit Jain Md, Kathryn Worland Msw, Celeste Tarantino Md, Lina Patel Md, Shayla Sullivant Md

Research Days

Background: Up to 20% of children in the United States experience a mental health disorder and suicide is the second leading cause of death among adolescents. Children presenting with mental health concerns to the Emergency Department (ED) can be challenging due to lack of access to trained professionals and long lengths of stay. Specialized teams have shown to be beneficial, but little is known about their impact in the ED.

Objectives/Goal: This study explored the impact of specialized social workers partnering with emergency medicine providers to provide care during an acute mental health crisis.

Methods/Design: We performed this work at …

X-Linked Nephrogenic Syndrome Of Inappropriate Antidiuresis Secondary To Vasopressin Receptor 2 Mutation, Erica Zarse

Research Days

Background: X-linked nephrogenic syndrome of inappropriate antidiuresis (NSIAD) is a rare cause of hyponatremia with a similar biochemical evaluation to the syndrome of inappropriate antidiuretic hormone secretion but with suppressed vasopressin (AVP) levels.

Objectives: We present a case of hyponatremia due to NSIAD.

Results: A 25-month-old male with developmental delay became unresponsive 30 minutes after falling off a couch onto a hardwood floor. He presented with tonic-clonic movements and eye deviation requiring antiepileptics. Serum laboratories noted hyponatremia (123 mmol/L), hypoosmolality (262 mOsm/kg) and hypochloremia (90 mmol/L) prompting endocrine consult. Head imaging normal. Urine dilute with specific gravity 1.004, osmolality 160 …

Covid-19: Perspectives From Youth In Detention, April Mcneill-Johnson

Research Days

Background: The COVID-19 pandemic amplified health disparities among youth in detention. Understanding perspectives of these youth on the pandemic and COVID-19 vaccination may identify strategies to mitigate pandemic-related health disparities in this group.

Objectives/Goal: To explore perspectives on the COVID-19 pandemic, effect on detention experience and the COVID vaccine among youth in detention.

Methods/Design: This is a secondary analysis of a study examining healthcare needs and experiences of youth in detention. We recruited a convenience sample of youth (14-17 years) detained in urban midwestern juvenile detention centers from January-November 2021. We conducted semistructured individual interviews & used a thematic analysis …

Gastrointestinal Fibromatosis: A Case Of Successful Oral Tyrosine Kinase Inhibitor Delivery To An Infant With Proximal Duodenal Obstruction, Darius Blanding

Research Days

Background: Infantile myofibromatosis (IM) is a rare disorder characterized by the fibrous proliferation of the skin, bone, muscle, and viscera that usually presents at birth, or soon after. Although IM is a benign condition, significantly higher morbidity and mortality have been reported when the viscera is involved. This case report is of a 6-week-old female who presented with poor feeding along with subcutaneous nodules that were diagnosed as IM. Upper and lower endoscopy were performed for worsening feeding intolerance showing marked nodularity throughout the gastrointestinal (GI) tract, including partial obstruction of the proximal duodenum by biopsy-proven myofibromas, confirming visceral IM …

Subclinical Status Epilepticus In The Setting Of An Acute Covid-19 Infection, Thomas Rieth

Research Days

Background: While COVID-19 commonly presents as an upper respiratory infection, acute COVID infections has the potential to have multisystem involvement. Neurological symptoms, which have mainly been reported in adults, are rare in children and are not well recognized. Better understanding of the neurological manifestations of COVID-19 in children can lead to earlier detection of COVID-19 and help with medical decision making and treatment.

Objectives/Goal: To describe an unusual presentation of COVID-19 in a previously healthy female and explore the neurological presentations of COVID-19.

Results: A 10 year old previously healthy female presented with a 1 day history of altered mental …

A Case Of Fibrous Hamartoma In Term Neonate, Elizabeth Perry

Research Days

Case report abstract: Fibrous hamartoma of infancy (FHI) is a rare, benign lesion characterized as a tumor of myofibroblastic origin that has characteristic features of triphasic histology. FHI was first described in 1956 by Reye and formally named by Enzinger in 1965 (1, 2). The lesion is defined as a hamartoma due to the histologic presentation of disorganized mesenchymal, fibrous, and adipose tissue with absence of mitotic figures; this combination of derived tissue without evidence of anaplasia is diagnostic for FHI. These lesions typically arise as a single, solitary mass, are most commonly located on the extremities, trunk, sacrum, or …

Early Onset Obesity In A 4-Year-Old Female Found To Have Variants In Both The Single-Minded Homolog 1 And Sh2b Adaptor Protein 1 Genes, Erica Zarse

Research Days

No abstract provided.

Special Education Teacher Burnout: Examining The Role Of Educator Preparation Programs In Prevention, Brittany L. Straub

Dissertations

Teacher burnout is increasingly problematic, especially for special education teachers who have a unique set of job responsibilities. Survey and interview data was used in this phenomenological study to examine how the educator preparation program (EPP) experience and self-authorship journey of early career special education teachers impact their potential to experience burnout. Data findings regarding level of self-perceived burnout, recollections of being or not being taught stress management and coping strategies in their EPPs, recollections of the self-authorship journey, and intentions for remaining in the career are shared in this dissertation. The essence of this phenomenon can be summed up …

Covid Anxiety And Stress In Higher Ed (Cash), Letitia Bergantz, Christopher E. Curtis

Journal on Empowering Teaching Excellence

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College is a time of increased stress and anxiety. The current changes in attendance and methods of instruction due to COVID-19 have demonstrated even higher levels of stress, anxiety, and mental health issues. Tailoring interventions to the specific needs of a campus community has been proposed as an appropriate means to the current crisis. This study identifies the mental health needs of students at a rural college as they pertain to the effects of the pandemic.

Questionnaires collected data from college students (N=33) at Athens State University, a rural university in …

Implementation Of Strategic Supports Into Coursework To Improve Notetaking Abilities And Overall Ota Student Success, Cheyenne M. Murphy

Department of Occupational Therapy Entry-Level Capstone Projects

Notetaking is a widespread practice utilized by students to capture valuable information mentioned throughout lectures, readings, and other supplementary instruction. Practices of notetaking can vary based on educational level and the student’s ability to take notes throughout their educational career. More specifically, the ability to take strategic notes is recognized as an important skill needed in a higher educational setting in relation to a students’ overall success (Salame & Thompson, 2020). When examining the effect of notetaking, earlier studies focused solely on the practice and utilization of notetaking (Rahmani & Sadeghi, 2011). The objective of this culminating project is research …

Use Of Standardized Test Results By Faculty And Students For Advanced Practice Nurse Certification Success, Dinorah Martinez-Anderson

Nursing Theses and Dissertations

The utilization of standardized testing as a recognized educational strategy to measure pre-professional readiness in Advanced Practice Nursing (APN) graduate programs has increased. Research supports such use for predicting licensure success for undergraduate education, however when related to the use in graduate nursing education, it is limited. Teaching and learning practices of APN faculty and students have not been comprehensively explored. This study examined the use of standardized testing results by faculty and students in APN graduate education that contributes to student national certification success. The Reconceptualization of Vygotsky’s Theory of Zone of Proximal Development (RVZPD) underpins the study. An …

Leader Development Of The Health Information Management (Him) Professional, Theresa Jones

Dissertations

This study contributes to the body of knowledge in leader development by examining how higher education programs in a female dominated profession assist learners in developing person-related characteristics that support leader development. A ten-part online survey was sent to directors of health information management (HIM) programs accredited by the Commission on Accreditation for Health Informatics and Information Management (CAHIIM). Results suggest an opportunity for improvement in the curriculum for development of person-related characteristics critical for leadership positions. In the interest of the progression of women these results should be taken into consideration.

Use Of Artificial Intelligence To Identify Predictors Of Functional Outcomes In Patients With Facioscapulohumeral Muscular Dystrophy, Natalie K. Katz

Research Days

Background: Facioscapulohumeral muscular dystrophy (FSHD) is one of the most common forms of muscular dystrophy characterized by slowly progressive muscle weakness. Symptoms initially involve the facial and shoulder girdle muscles, with later involvement of the distal lower extremities, pelvic girdle and proximal lower extremities. FSHD type 1 (FHSD1) is the most common form (~95% of individuals) and is caused by deletion of microsatellite repeats in the D4Z4 region on chromosome 4 (4q35). Normal individuals have >10 repeats whereas individuals with FSHD1 have 1-10 repeats. There is significant variability in regards to disease severity, rates of progression and functional outcomes, but …

Prevalence Of Adolescent Sexual Health Outcomes At Children’S Hospitals During Covid-19, Margarita Abella

Research Days

Background: The Coronavirus Disease 2019 (COVID-19) pandemic mitigation strategies, including social distancing, decreased structured environments, and decreased sexual and reproductive health (SRH) care access, could negatively impact adolescent SRH behaviors and related outcomes. To date, little is known regarding changes in adolescent SRH outcomes during COVID-19.

Objectives/Goal: Our goals were to assess changes in adolescent SRH outcomes, including sexually transmitted infections (STIs), pregnancy, and sexual assault in the hospital (emergency department [ED] and inpatient [IP]) during COVID-19 compared to pre-COVID-19.

Methods/Design: We conducted a retrospective cohort study of adolescent (11-18 years old) IP or ED hospital visits using the Pediatric …

Characterization Of Comorbidities In Patients With A Dual Diagnosis Of Down Syndrome And Autism Spectrum Disorder Using Cerner Health Facts, Michael Slogic

Research Days

Background: Up to 19% of patients with Down syndrome (DS) meet diagnostic criteria for autism spectrum disorder (ASD) (Channell, et al, 2019). While the medical and psychological comorbidities for patients with DS or ASD are well characterized, comorbidities and outcomes for patients with a dual diagnosis (DS-ASD) are poorly understood. A large cohort of patients with DS-ASD, as well as those with ASD and DS alone, are needed to better understand this. Methods for grouping and analyzing complex diagnostic phenotypes are also needed.

Objectives/Goal: Our objective is to utilize Cerner Health Facts, a multi-institutional healthcare database, to identify large populations …

Effectiveness And Safety Of Repeat Dexamethasone For Bronchopulmonary Dysplasia, Christian Oliveros

Research Days

Background: Although a short course of steroids maybe beneficial in infants at high risk for bronchopulmonary dysplasia, response to treatment is variable. In infants with persistent lung disease despite initial treatment, repeat courses of steroids have been described but not well-studied. This 10-year observational study from a single tertiary referral center evaluates the effectiveness and safety of repeat steroid treatment for bronchopulmonary dysplasia.

Objectives/Goal: To describe effectiveness of repeat dexamethasone treatment for bronchopulmonary dysplasia (BPD) and to evaluate potential detrimental effects on growth and neurodevelopment.

Methods/Design: This was a 10-year single-center observational study of infants <30 >weeks’ gestational age at birth …

A Study Examining The Safety And Efficacy Of Ferric Carboxymaltose In A Large Pediatric Cohort, Chandni Dargan Md, David Simon Do

Research Days

Background: Iron deficiency anemia (IDA) is common in the pediatric population with varying high-risk factors. Intravenous (IV) iron supplementation has become more desirable in patients with moderate to severe anemia and in patients who are either unresponsive to or have adverse side-effects secondary to oral iron. Iron sucrose and Iron dextran have been traditionally used in pediatrics while ferric carboxymaltose (FCM) has only been FDA approved in adults. One of the major advantages of FCM is the ease of dosing and efficacy. Though FCM was approved for adults in 2013 and there have been no safety concerns, it is not …

Attitudes Of Pediatric Residents In The Care Of Transgender Youth, Michelle Knoll

Research Days

Background: Transgender individuals have health disparities compared to the general population and face several barriers to medical care. Prior studies indicate physician knowledge on transgender topics is poor and that transphobia is associated with poor knowledge even after educational interventions. Objectives/Goal: We sought to examine pediatric residents’ attitudes about transgender individuals and assess concerns related to the treatment of transgender youth. Methods: A survey was sent to 89 US Pediatric and combined (e.g. Med-Peds) residency programs and advertised on social media. Approximately 32 programs forwarded the survey to an estimated 1325 residents; 138 residents completed it. The survey consisted of …