Medicine and Health Sciences Commons^™

Transition Skills Lab: A Telehealth Intervention For Improving Healthcare Transition In Youth With Special Health Care Needs, Angela Combs, Alaina Linafelter, Jordan Sevart, Michele H. Maddux

Research Days

The goal of this abstract is to evaluate youth skill-building and confidence across health care tasks through the virtual Transition Skills Lab.

Long-Term Physical And Emotional Functioning In Children Following Intensive Interdisciplinary Pain Treatment For Amplified Pain Syndrome, Sabrina Ung, Jacqueline Pabis Phd, Jenny Scheurich Phd, Dustin Wallace Phd

Research Days

The current study aimed to examine the efficacy of pediatric interdisciplinary pain treatment (IIPT) several years after treatment completion by exploring mean-level changes of physical and mental health functioning pre-intervention, post-intervention, and at follow-up 2 to 6 years after IIPT completion.

Reducing Sharps Disposal In The Operating Room, Kasey Brooks, Brandon Layton

Research Days

Used an education program to reduce the amount of sharps waste in the operating room within the anesthesia department.

Delirium On Admission To The Cicu, Spencer Wittmeyer, Jaime Silva-Gburek, Kelly S. Tieves

Research Days

Background: Delirium is increasingly recognized in the pediatric cardiac intensive care unit (CICU) with an incidence up to 67% and is associated with worse outcomes including increased mortality, prolonged hospitalization, and increased rates of intubation and mechanical circulatory support. The Cornell Assessment for Pediatric Delirium (CAPD) is the only validated tool for the diagnosis of delirium in the pediatric population. The CAPD may be limited in children with developmental disabilities as it does not account for baseline ability in scoring. Prior work has identified low specificity for the CAPD in children with developmental disabilities and those requiring mechanical ventilation. This …

Approach To Pivie In Pediatrics: Standardization For Early Detection, Jamie Green, Jill Gregory, Elizabeth Murphy, Jessica Miller, Nicole Manchester, Frank Harris, Meaghan Wildes, Cecilia Inman, Jenn Paradis, Faye Weir

Operations Transformation

PIVIE (Peripheral Intravenous Infiltration & Extravasation) can have devastating effects, especially in the pediatric population. The condition may disrupt vasculature severe enough for permanent skin and tissue loss that can lead to impaired limb function due to severe scarring. Problem: No standardized process existed either to prevent or review these events at Barbara Bush Children’s Hospital at Maine Medical Center prior to the study. PIVIEs were measured through the event reporting platform and only severe PIVIEs were being documented in this report. All infiltrations (1-4 on the infiltration scale) should be measured for accurate benchmarking. Occurrences in the electronic medical …

Transition To Adult Care For Bleeding Disorders: Building A Multidisciplinary Tool, Leslie Larson, Ekaterina Funk, Dana Grass, Felicia Munster, Eric Larsen, Louise Baca, Glen Roy, Sara Artinyan

Operations Transformation

Youth with chronic illnesses often have poorer health outcomes after transitioning to adult care. Maine Health Bleeding Disorders is a Health Resources and Services Administration (HRSA) grant funded Hemophilia Treatment Center (HTC) that serves patients with congenital bleeding disorders. We provide multidisciplinary specialty care throughout the lifespan which includes pediatric and adult hematologists, family nurse practitioners, nurses, physical therapists, social worker, dietitian, genetic counselor, and research coordinator. In 2022, HRSA mandated all federally funded HTCs increase by 25 percent from baseline the number of individuals ages 12 to 26 years seen in a comprehensive clinic that have a health care …

Application Of Lymphedema Education Toolkit For Nurse Coordinators, Julian K. Miranda

Master's Projects and Capstones

Problem: There is approximately one in five breast cancer survivors affected by breast cancer-related lymphedema (BCRL), a potentially debilitating condition affecting the physical, emotional, social, and financial well-being of individuals. Context: This Quality Improvement (QI) project was conducted at an outpatient facility of Hospital X’s Women’s Cancer Center. Within this microsystem, there are 24 permanent clinical nurse coordinators and advanced practice providers, with 15 nurse coordinators dedicated to care for patients with breast cancer or gynecological conditions. Intervention: The intervention aims to evaluate if a standardized educational tool improves early interventions for patients with lymphedema and knowledge among healthcare providers …

The Impact Of Childhood Opportunity Index On Treatment Outcomes Of Osteochondritis Dissecans Of The Knee, Colton Schwarz, Kennedy J. Morey, Brian R. Lee, Angie Vanderpool, Kevin Latz, Natalie C. Stork, Donna Pacicca, Brian Harvey

Research Days

This study aims to explore the relationship that Childhood Opportunity Index (COI), a validated measure of socioeconomic status, has on the outcomes of treatment of osteochondritis dissecans (OCD) of the medial femoral condyle (MFC) of the knee in pediatric patients age 0-18 years.

Thyroid Dysfunction In Patients Receiving Immune Checkpoint Inhibitors, Emily Metzinger, Jennifer Boyd, Julia Broussard, Christopher Klockau

Research Days

The use of immune checkpoint inhibitors (ICI) is increasing in the treatment of different cancers. This study investigates ICI and thyroid dysfunction in pediatric patients at Children's Mercy Kansas City. This is a retrospective chart review that looked at development of thyroid disorders in patients who received PD-1 inhibitors, PD-L1 inhibitors, or CTLA-4 inhibitors in 19 pediatric patients. Results showed that hypothyroidism developed in 3 patients who received any of these medications. Additionally, 2 patients had thyroid dysfunction prior to starting ICI therapy, and 1 of these patients developed hyperthyroidism shortly after beginning ICI therapy. Thyroid dysfunction can be seen …

Simultaneous Vertical Sleeve Gastrectomy And Deceased Donor Liver Transplant In A Pediatric Patient With Cirrhosis And Class 3 Obesity, Lakshmi Kunam, Voytek Slowik, Brooke Sweeney, Ryan T. Fischer, Jason D. Fraser, Bhargava Mullapudi, Richard J. Hendrickson

Research Days

Background: Liver transplantation is a life saving procedure for children with end-stage liver disease with the goal of returning to a normal healthy life. Obesity and weight gain can lead to post-transplant steatosis and contribute to patient morbidity and mortality. In patients with obesity, simultaneous bariatric surgery can lead to reduced body mass index (BMI) and decrease allograft steatosis and patient metabolic syndrome.

Methods: After obtaining patient and family assent/consent, patient records were reviewed and analyzed.

Results: The patient was initially evaluated at 8 years of age for right upper quadrant pain. Imaging consistent with cirrhosis and portal hypertension prompted …

Characteristics And Clinical Outcomes Of Iud Insertion Under Conscious Sedation In Pediatric And Adolescent Patients, Alleana Corpin, Madeline Ross, Anne-Marie Priebe, Ashli A. Lawson

Research Days

Intrauterine devices (IUDs) are a favorable option for adolescents for contraception and menstrual suppression. However, few choose this option citing anxiety and concern for pain related to insertion procedure. Our institution proposes utilizing conscious sedation techniques for anxiolysis and analgesia during IUD insertion. The objective of this study was to identify characteristics of teens choosing conscious sedation for this procedure and likelihood of successful insertion.

Key Words: Intrauterine device (IUD), adolescent, conscious sedation

An Increased Failure Rate Of Asparaginase Desensitization With Calaspargase Pegol, Jillian Fry, Erin Guest, Keith August

Research Days

BACKGROUND: Pegaspargase (SS-PEG) became unavailable to younger patients in 2022, leaving calaspargase pegol (SC-PEG) as the only available long-acting asparaginase formulation. SC-PEG has been compared to SS-PEG and found to have similar rates of adverse events and event-free survival. Our institution uses a desensitization protocol for those with asparaginase hypersensitivity reactions. Here we review our experience with desensitization since the transition to SC-PEG. OBJECTIVES: To compare the rate of hypersensitivity reactions, success of desensitization, and need for alternative asparaginase preparations between patients receiving SC-PEG and SS-PEG. METHOD: This is a retrospective, single center study of pediatric patients who received >2 …

Effects Of Drug Delivery On Ppi-Responsive Esophageal Eosinophilia, Alex Biller, Rachel Chevalier, Amornluck Krasaelap, Janelle R. Noel-Macdonnell

Research Days

Determine if formulation of proton pump inhibitory (pill/capsule vs liquid) affects eosinophilic infiltration of esophagus in patients with PPI-Responsive Esophageal Eosinophilia.

Development Of An Endometriosis Toolkit To Support Clinicians In Providing Quality Care For Women, Rachel Hasbun

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Endometriosis is the abnormal growth of endometrium-like tissue outside the uterine cavity, affecting approximately 11% of women in the United States during their reproductive years. Diagnostic challenges stem from its varied clinical presentations, reliance on laparoscopy for definitive diagnosis, and limited awareness among practitioners and patients, potentially leading to diagnostic delays of up to 13 years.

Problem: The complexities of diagnosing endometriosis in primary care and specialty settings, combined with limited provider awareness and a lack of comprehensive resources, hinder timely and accurate identification. This leads to suboptimal treatment and care for women affected by the condition.

Methods: …

Louisiana State University Health Sciences Center - 2024 - 150th Commencement, Office Of The Registrar, Lsu Health Sciences Center-No

Graduation & Commencement Programs

The program for the 151st Commencement of LSU Health Sciences Center - New Orleans held May 16, 2024.

Teaching Medical Procedural Skills For Performance, Kersi Taraporewalla, Paul Barach, André Van Zundert

College of Population Health Faculty Papers

Procedures are a core element of medical professional practice. Today's training approach was formulated in the mid-twentieth century based on a computer analogue of the brain. Despite minor modifications, the system has remained relatively unchanged for the past 70 years. It delivers competence. However, competence is not reliable performance. The inability to adapt to the variety of patients and variations in the performance environments, such as the operating room, results in patient morbidity and mortality. There is a need for changes in the development and training of medical procedural skills based on current theories of skill acquisition, movement theory, and …

Desvenlafaxine Induced Acute Angle-Closure Glaucoma - Case Report, Venkatesh Babu Dr, Priyankha Kothandaraman Dr, Megha Sadashiv Dr., Kishor M

Digital Journal of Clinical Medicine

The World Health Organization (WHO) estimates that Depressive disorder affects more than 264 million people worldwide. The global prevalence of depression among those who are aged 18 years and older was approximately 4.4%. According to a 2017 study by India's National Institute of Mental Health and Neuroscience s (NIMHANS), 7.5% of the population in the nation suffers from depression affecting one in 20 Indians_[1].

SSRIs ( Selective Serotonin Re uptake Inhibitors) and SNRIs ( serotonin-nor epinephrine re uptake inhibitors) are increasingly the first-line choices of anti-depressant because of their tolerable side-effect profile and low rate of lethality if …

Variation In Systemic Corticosteroid Prescribing During Asthma-Related Hospitalizations Across Children's Hospitals, Sian Best, Kathryn Kyler, Matt Hall, Jessica L. Bettenhausen, Shelby Chesbro, Nicholas Clark, Adrienne Deporre, Jonathan Ermer, Leah Jones, Jessica Markham, Maria Newmaster, Laura Plencner, Henry T. Puls, Smit Shah, Bridgette Jones, Megan Collins, Elisha Mccoy

Research Days

This abstract describes the variability and trends in inpatient systemic corticosteroid prescribing practices for acute asthma exacerbations in children's hospitals, and aims to determine associations between the prescribed steroid and hospitalization outcomes.

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.

Casar Auc Community Only Lecture: Men, Women’S Body Autonomy & Gbv Crimes In Egypt, Us & Canada: Why Men Need To Step Up For The Education Of Women's Body Autonomy, The Prince Alwaleed Center For American Studies And Research Casar

Performances, Events, and Presentations

This was a hybrid CASAR AUC community only lecture titled: ‘Men, Women’s Body Autonomy & GBV crimes in Egypt, US & Canada’: Why men need to step up for the education of women’s body autonomy.

This lecture featured Tadwein from Egypt, Women’s Advocates from the US & London Abused Women's Counseling Center from Canada (via Zoom). This lecture was part of course AMST 1091 ‘Exploring Feminist Perspectives in Egypt & the US’ (core curriculum pathways two- American studies) taught by Yasmeen El-Ghazaly, CASAR Assistant to Director & Adjunct Faculty - Wednesday May 15th, 2024

The lecture pondered on the following …

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.