Medicine and Health Sciences Commons^™

Development Of A Gme Wellness Program At One Sponsoring Institution: One Year’S Journey, Despina Tsarouhis Bs, Margaret A. Hadinger Edd, Joseph E. Patruno Md, Carmine Pellosie Do, Mph, Mba, Daniel Relles Md, Kevin M. Correll Mdiv, Mapc, Richard Drabic Lcsw, Johnathon Dallarosa Md, Lekha Racharla Do

Department of Education

No abstract provided.

Local Implementation And Standardization Of The Pediatric Severe Traumatic Brain Injury Guidelines, Michelle Brown

Research Days

Problem Statement/Question: Severe pediatric Traumatic Brain Injury (TBI) remains a significant cause of morbidity and mortality. Evidence-based guidelines leave gaps in how to best implement and deliver standardized care on the local hospital level.

Background/Project Intent (Aim Statement): We aim to improve clinical outcomes for severe TBI patients (Glasgow Coma Scale ≤8) with standardization of care according to updated evidence-based guidelines. We will target early guideline adherence (initial 72 hours of PICU admission) with a focus on 1) targeted temperature management (TTM40mmHg).

Methods (include PDSA cycles): The Children’s Mercy Hospital Pediatric ICU Severe TBI Guidelines were updated after the 3rd …

Simulation Based Clinical Systems Testing Of A Pediatric Ed To Improve Staff And Process Readiness For Pediatric Hypoglycemia, Kevin Meilak Md

Research Days

Background/Project Intent (Aim Statement): Hypoglycemia is the most common metabolic disorder in children in pediatric emergency department (ED) settings 1 . Children may present with nonspecific symptoms, or asymptomatically2 . So identification/treatment is very challenging. There is evidence in the adult literature that there is wide variability in the treatment of hypoglycemia3 . Currently Children’s Mercy does not have a standardized approach to the treatment of hypoglycemia not associated with diabetes mellitus. From observation in the clinical setting we believe there are gaps regarding the identification and treatment of hypoglycemia not associated with diabetes mellitus. Delayed recognition and under treatment …

Optimization Of Perioperative Prophylaxis In Penicillin-Allergic Labeled Patients, Katie A. Vandervelde

Research Days

Problem Statement/Question: A penicillin (PCN)-allergy label is life-long and has been shown to result in more costly, less effective, and broader-spectrum antibiotics being utilized for surgical prophylaxis. At CMH, 6.6% of surgical patients receiving perioperative antibiotics are labeled PCN-allergic. A common myth is that approximately 10% of patients with a PCN-allergy history will experience an allergic reaction if administered a cephalosporin, whereas recent observational studies have found crossreactivity rates between 0.17-0.7%. Most of these patients receive a cefazolin alternative unnecessarily. Currently, no process exists to identify and clarify PCN-allergic patients preoperatively. Data from November 2018-December 2019 found ~2.33 patients per …

A Case Of Metabolic Genetic Emergency, Elizabeth Loughman

Research Days

Background: Newborn screening (NBS) is one of the largest public health initiatives to improve infant morbidity and mortality, and this has been shown to detect and lead to prompt treatment of uncommon but rapidly fatal conditions. While NBS has changed outcomes of diseases, it is still imperative that prompt and early recognition of abnormal results and medical interventions remain the mainstay of care.

Objective: To describe a case of inborn error of metabolism in a 4-day old asymptomatic infant, where early recognition and treatment affected outcome.

Design/Methods: This case is a 4-day old female, former 36-week gestational age infant who …

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 …

Bivalirudin And Thrombolytic Therapy: A Novel Successful Treatment Of Severe Aortic Arch Thrombosis In A Term Neonate, Amjad Taha

Research Days

SUMMARY An early term infant with uncomplicated perinatal history was found to have a large thrombus in the aortic arch after he failed regular newborn critical congenital heart defect (CCHD) screen. He responded well to Bivalirudin thrombolytic and tissue-Plasminogen activator (tPA) combination therapy, with a significant resolution of the thrombus. The infant tolerated hospital admission well with no significant complications. He was discharged home on daily aspirin at two weeks of life. To our knowledge, the combination therapy approach with Bivalirudin and tPA is the first one reported in the literature in the neonatal age group.

BACKGROUND Aortic arch thrombosis …

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 …

Diagnosis And Management Of Otitis Media With Effusion In Pediatric Urgent Care Clinics, Ashley Deschepper

Research Days

Background: Otitis media with effusion (OME)’s clinical presentation is often confused with acute otitis media (AOM) by providers. Despite OME guidelines recommending watchful waiting with no antibiotics, rates of antibiotic use remain elevated. In our pediatric urgent care clinics (UCCs), an estimated 50% of patients diagnosed with OME receive antibiotic prescriptions.

Objectives/Goal: To determine the provider diagnosis validity and the rates of antibiotics prescribed among pediatric OME patients evaluated in 3 UCCs within a pediatric healthcare system.

Methods/Design: We randomly selected 75% of encounters for children age 0-18 years who had a billing diagnosis of OME in 2019. Charts were …

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 …

Coronavirus Update 5/11/2021: Raffle Winners Announced, The Coronavirus Planning Team

University Briefings & Virtual Events

Yesterday, Dr. Petillo drew the names for the winners of our first vaccination raffle.

Occupational Therapist Role In Post-Secondary Education Transition Program: Emphasis On Self-Advocacy Skills, Nikki K. Voorhees

Student Capstone Papers

It is becoming increasingly important for individuals to obtain post-secondary education in order to gain employment (Alverson et al., 2019; Chandroo et al., 2018). This increased importance to attend post-secondary education makes it imperative for students who are graduating from high school to be fully prepared for the transition to post-secondary education (Rothman et al., 2008). The transition from high school to post-secondary education is difficult for any individual. However, it is even more difficult for students with learning differences, as they tend to have problems in the areas of social skills, communication, problem solving, self-advocacy, and executive functioning (Alverson …

Teaching Philippine Literature And Illness: Finding Cure In Humanities, John Paolo Sarce

English Faculty Publications

Health and illness as themes are uncommonly being touched in literature classrooms. Other than the lack of interdisciplinary studies or specialists in this field in the Philippines; often teachers are also confronted with tons of materials that they are either overwhelmed to teach or find it difficult to deliver on their classes. This is the goal of this paper; help teachers gain confidence and basic knowledge of teaching literature that discusses health and illness especially at this time of history. Helping both teachers and students to understand and appreciate literature as a space for developing empathy while also honing their …

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 …

Physician Advocacy: Defining And Implementing Into Practice, Laura Kantor

Research Days

Background: Physicians are perceived by society to have a duty to both improve the health of their individual patients and the wellbeing of society as a whole. The perceived social and professional obligation of physicians to engage in advocacy work is often implied yet illdefined with little formal training or official supports. Many physicians feel their training and practice environment do not support increased engagement in advocacy. In order to promote the idea that advocacy is an integral aspect of modern practice, it is necessary to further characterize its definition and scope.

Objectives/Goal: We aim to gain insight into the …

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 …

A National Study On The Relationship Between Programmatic Factors And Athletic Training Education Board Of Certification Pass Rates, Leslie Rippon

Seton Hall University Dissertations and Theses (ETDs)

In athletic training (AT) education, the first-time BOC pass rate is a significant marker of a program’s success, and the Commission on Accreditation of Athletic Training Education (CAATE) requires programs to maintain a first-time 3-year aggregate BOC examination pass rate over 70%. There is limited published research on BOC pass rates on Professional Masters’ (PM) programs. Therefore, it is essential to identify modifiable factors that have a relationship with first-time pass rates. This study's aim was to investigate the relationships between programmatic factors and the first-time BOC pass rate for PM AT students while controlling for student and institutional factors. …

Integrating Ethics And The Opioid Crisis Via Simulation: An Ethical Debriefing For Nursing Students, Raigan A. J. Shackelford

Senior Honors Projects, 2020-current

Over the past three decades, opioid medication misuse and abuse has skyrocketed. The increase in improper use has created the need for more frequent exercise of ethical reasoning skills in practice. This study was designed to determine the effect of an ethics-centered debriefing exercise following a standardized simulation scenario concerning opioid misuse/abuse on nursing students’ value of and perceived confidence in ethical reasoning skills. 18 senior level BSN students at James Madison University in Harrisonburg, VA, participated in an ethics- focused debriefing exercise following the simulated scenario. The debriefing was constructed using the ANA Code of Ethics and James Madison …