Medicine and Health Sciences Commons^™

Uncovering The Burden Of Intentional Injuries Among Children And Adolescents In The Emergency Department, Uzma R. Khan, Butool Hisam, Nukhba Zia, Mohammed Umer Mir, Olakunle Alonge, Seemin Jamali, Adnan Hyder, Junaid Abdul Razzak

Department of Emergency Medicine

Introduction: In low- and middle-income countries, injuries are a leading cause of mortality in children. Much work has been done in the context of unintentional injuries but there is limited knowledge about intentional injuries among children. The objective of this paper was to understand the characteristics of children with intentional injuries presenting to emergency departments in Pakistan.
Methods: The data was from the Pakistan National Emergency Departments Surveillance (Pak-NEDS), conducted from November 2010 to March 2011 in seven major emergency departments of Pakistan. Data on 30,937 children under 18 years of age was collected. This paper reports frequency of intentional …

The Pediatric Disease Spectrum In Emergency Departments Across Pakistan: Data From A Pilot Surveillance System, Huba Atiq, Emaduddin Siddiqui, Surraya Bano, Asher Feroze, Sayyeda Ghazala Kazi, Jabeen Fayyaz, Shivam Gupta, Junaid A. Razzak, Adnan A Hyder, Asad Mian

Department of Emergency Medicine

Background: There is an increasing number of urgently ill and injured children being seen in emergency departments (ED) of developing countries. The pediatric disease burden in EDs across Pakistan is generally unknown. Our main objective was to determine the spectrum of disease and injury among children seen in EDs in Pakistan through a nationwide ED-based surveillance system.
Methods: Through the Pakistan National Emergency Department Surveillance (Pak-NEDS), data were collected from November 2010 to March 2011 in seven major tertiary care centers representing all provinces of Pakistan. These included five public and two private hospitals, with a collective annual census of …

Nurses’ Perceptions Of Best Practices To Assess Pediatric Patients And Educate Their Families Experiencing Effects Of Cancer Chemotherapy: “Chemo Brain” A Pilot Study, Jennifer A. Tapping

Senior Theses

With more advanced and more aggressive chemotherapy cancer treatment leading to higher survival rates, complications with quality of life are becoming more prominent. Of these complications, delayed cognitive processing, commonly known as “chemo brain,” is becoming a topic of interest. Cognitive changes are some of the most common as well as the most challenging complications associated with central nervous system (CNS) directed treatment, such as chemotherapy. The term “chemo brain” is often used to describe self-reported or observed cognitive processing delays in patients who receive chemotherapy as a form of cancer treatment (Raffa, 2009). Although these cognitive delays have the …

Prospective Testing And Redesign Of A Temporal Biomarker Based Risk Model For Patients With Septic Shock: Implications For Septic Shock Biology, Hector R. Wong, Natalie R. Cvijanovich, Nick Anas, Geoffrey L. Allen, Neal J. Thomas, Robert J. Freishtat, +17 Additional Authors

Pediatrics Faculty Publications

The temporal version of the pediatric sepsis biomarker risk model (tPERSEVERE) estimates the risk of a complicated course in children with septic shock based on biomarker changes from days 1 to 3 of septic shock. We validated tPERSEVERE performance in a prospective cohort, with an a priori plan to redesign tPERSEVERE if it did not perform well. Biomarkers were measured in the validation cohort (n = 168) and study subjects were classified according to tPERSEVERE. To redesign tPERSEVERE, the validation cohort and the original derivation cohort (n = 299) were combined and randomly allocated to training (n = 374) and …

Effect Of Kidney Function On Drug Kinetics And Dosing In Neonates, Infants, And Children., Frederique Rodieux, Melanie Wilbaux, Johannes N. Van Den Anker, Marc Pfister

Pediatrics Faculty Publications

Neonates, infants, and children differ from adults in many aspects, not just in age, weight, and body composition. Growth, maturation and environmental factors affect drug kinetics, response and dosing in pediatric patients. Almost 80 % of drugs have not been studied in children, and dosing of these drugs is derived from adult doses by adjusting for body weight/size. As developmental and maturational changes are complex processes, such simplified methods may result in subtherapeutic effects or adverse events. Kidney function is impaired during the first 2 years of life as a result of normal growth and development. Reduced kidney function during …

Overweight Predicts Poorer Exercise Capacity In Congenital Heart Disease Patients, Karen Kuehl, Alicia Tucker, Munziba Khan, Paula Goldberg, E. Anne Greene, Megan Smith

Pediatrics Faculty Publications

Background

Overweight (OW) and obesity (OB) are endemic in the United States and affect adolescents and adults with congenital heart disease (ACHD). Defining the burden of excess weight on the cardiovascular system in ACHD is the goal of this study. Limitation of exercise capacity due to overweight or obesity might be reversible with weight loss and improve quality of life for ACHD adults.

Methods

Exercise tests performed using a Bruce protocol and measurement of maximum oxygen consumption were retrospectively reviewed on 418 CHD patients. OW and OB were defined as the 85–95 or > 95 percentile respectively for age and gender …

Effect Of Kidney Function On Drug Kinetics And Dosing In Neonates, Infants, And Children., Frederique Rodieux, Melanie Wilbaux, Johannes N. Van Den Anker, Marc Pfister

Pediatrics Faculty Publications

Neonates, infants, and children differ from adults in many aspects, not just in age, weight, and body composition. Growth, maturation and environmental factors affect drug kinetics, response and dosing in pediatric patients. Almost 80% of drugs have not been studied in children, and dosing of these drugs is derived from adult doses by adjusting for body weight/size. As developmental and maturational changes are complex processes, such simplified methods may result in subtherapeutic effects or adverse events. Kidney function is impaired during the first 2 years of life as a result of normal growth and development. Reduced kidney function during childhood …

Developing Paediatric Emergency Medicine—An Opinion From A Developing Country Tertiary Care Center, Emaduddin Siddiqui, Shahan Waheed, Irum Qamar Khan

Department of Emergency Medicine

No abstract provided.

Overcrowding In The Emergency Departments: Challenges And Opportunities For Improvement, Muhammad Akbar Baig, Asad Mian, Fatima Najeeb, Hira Shahzad

Department of Emergency Medicine

With the advent of Emergency Medicine, one can observe an increase in the number of Emergency Departments (ED) across the country. However, most EDs struggle due to an overwhelming number of patients. Overcrowding can lead to delays in patient care. For a city like Karachi which is an active disaster zone, preemptive preparedness is required in the face of terror threats and such overcrowding needs to be decreased to a bare minimum. The most frequent causes of prolonged length of stay (LOS) in the ED include non-availability of in-hospital beds, delays in response to subspecialty consultations and escalating medical expenses. …

Systematic Review Of The Global Epidemiology, Clinical And Laboratory Profile Of Enteric Fever, Asma Azmatullah, Farah Naz Qamar, Durrane Thaver, Anita Km Zaidi, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

Background: Children suffer the highest burden of enteric fever among populations in South Asian countries. The clinical features are non-specific, vary in populations, and are often difficult to distinguish clinically from other febrile illnesses, leading to delayed or inappropriate diagnosis and treatment. We undertook a systematic review to assess the clinical profile and laboratory features of enteric fever across age groups, economic regions, level of care and antibiotic susceptibility patterns.
Methods: We searched PubMed (January 1964-December 2013) for studies describing clinical features in defined cohorts of patients over varying time periods. Studies with all culture-confirmed cases or those with at …

The Creation Of A Model Pediatric Ward For African American Children In 1920s Kansas City., Jane F. Knapp, Robert Schremmer

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Safety And Immunogenicity Of Human Serum Albumin-Free Mmr Vaccine In Us Children Aged 12-15 Months., Maurice A. Mufson, Clemente Diaz, Michael Leonardi, Christopher J. Harrison, Stanley Grogg, Antonio Carbayo, Simon Carlo-Torres, Robert Jeanfreau, Ana Quintero-Del-Rio, Gisele Bautista, Michael Povey, Christopher Da Costa, Ouzama Nicholson, Bruce L. Innis

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: M-M-R(TM)II (MMRII; Merck & Co) is currently the only measles-mumps-rubella (MMR) vaccine licensed in the United States. Another licensed vaccine would reinforce MMR supply. This study assessed the immunogenicity of a candidate vaccine (Priorix(TM), GlaxoSmithKline Vaccines [MMR-RIT]) when used as a first dose among eligible children in the United States.

METHODS: In this exploratory Phase-2, multicenter, observer-blind study, 1220 healthy subjects aged 12-15 months were randomized (3:3:3:3) and received 1 dose of 1 of 3 MMR-RIT lots with differing mumps virus titers (MMR-RIT-1 [4.8 log10]; MMR-RIT-2 [4.1 log10]; MMR-RIT-3 [3.7 log10] CCID50) or MMRII co-administered with hepatitis A vaccine …

Current Practice Of Neonatal Resuscitation Documentation In North America: A Multi-Center Retrospective Chart Review, Matthew S. Braga, Prakash Kabbur, Pradeep Alur, Michael H. Goodstein

Dartmouth Scholarship

To determine the comprehensiveness of neonatal resuscitation documentation and to determine the association of various patient, provider and institutional factors with completeness of neonatal documentation. Multi-center retrospective chart review of a sequential sample of very low birth weight infants born in 2013. The description of resuscitation in each infant’s record was evaluated for the presence of 29 Resuscitation Data Items and assigned a Number of items documented per record. Covariates associated with this Assessment were identified.

Don’T Leave Without Them: Dispensing Asthma Medications To Pediatric Patients Upon Discharge Is Associated With Decreased Hospital Readmissions, Kelly J. Hiteshew, Thaddeus T. Franz, Kristen Lamberjack, Aleda M.H. Chen

Kelly J. Wright, R.Ph., Pharm.D.

Purpose: Asthma exacerbations are a leading cause of hospital and emergency department admissions at pediatric institutions. The objective of this study was to determine if patients who obtain discharge medications from a pediatric institution’s outpatient pharmacy after an admission for asthma have a lower thirty-day readmission rate than those who do not obtain discharge medications from the outpatient pharmacy. Methods: This multi-phase retrospective study included an initial chart review, an intervention period, and a second chart review of the intervention period. The chart reviews included patients ages two years and older with a discharge diagnosis of asthma or wheezing. During …

Improving Process And Enhancing Parent And Therapist Satisfaction Through A Coordinated Intake Approach, Sharla Piecowye, Devona Gibson, Janis Carscadden, Kayla Ueland, Gregory Wells, Scott Oddie

Patient Experience Journal

Recent research indicates that, in Canada, approximately one in five children entering school are not meeting age appropriate milestones in physical, social, language, or cognitive development. Even where support services are available families often face barriers in accessing these. With the goals of improving access to programs, reducing barriers and increasing consistency and efficiency, a new Coordinated Intake Approach (CIA) was developed for families accessing Children’s Rehabilitation Services. It was expected that the CIA would result in 1) parents finding the intake process more satisfactory and easier to complete, 2) therapists feeling more supported and satisfied and 3) a decrease …

Nested Partially-Latent, Class Models For Dependent Binary Data, Estimating Disease Etiology, Zhenke Wu, Maria Deloria-Knoll, Scott L. Zeger

Johns Hopkins University, Dept. of Biostatistics Working Papers

The Pneumonia Etiology Research for Child Health (PERCH) study seeks to use modern measurement technology to infer the causes of pneumonia for which gold-standard evidence is unavailable. The paper describes a latent variable model designed to infer from case-control data the etiology distribution for the population of cases, and for an individual case given his or her measurements. We assume each observation is drawn from a mixture model for which each component represents one cause or disease class. The model addresses a major limitation of the traditional latent class approach by taking account of residual dependence among multivariate binary outcome …

Subjective Outcome Evaluation Of A University Subject On Service Leadership, Daniel T. L. Shek, Jianqiang Liang

Pediatrics Faculty Publications

University students (n=58) responded to a 45-item subjective outcome evaluation scale after taking a credit-bearing elective subject titled “Service Leadership” at The Hong Kong Polytechnic University in the first semester of the 2013–14 academic year. Results showed that the students generally displayed positive perceptions of the program content and the instructors, and most of them perceived the subject to be beneficial to different aspects of their development. As predicted, three subscales of the scale (Program Content, Program Implementer, and Program Benefits) were significantly correlated. Similar to the previous studies, perceived quality of the program but not quality of instructors and …

Character Strengths And Service Leadership, Daniel T. L. Shek, Lu Yu

Pediatrics Faculty Publications

Character strengths refer to the moral aspects of personality that have multiple dimensions. As a basic requirement of a service leader, character strengths provide the most inherent power for fulfilling different tasks and pursuing continuous development. In this paper, a lecture that aims to foster character strengths in undergraduate students is introduced. The theoretical foundation of the lecture on character strengths is first presented, including the concepts and theories related to character strengths, their relevance to service leadership and methods to promote the development of character strengths. The basic content and activities designed for this particular lecture are then outlined …

Character Strengths In Chinese Philosophies: Relevance To Service Leadership, Daniel T. L. Shek, Rachel C. F. Sun, Ting Ting Liu

Pediatrics Faculty Publications

According to the Hong Kong Institute of Service Leadership and Management, moral character or character strength is an important attribute of an effective service leader. In connection to this, “Character Strengths in Chinese Philosophies” is one of the lecture topics taught in a course titled “Service Leadership” in a university in Hong Kong. Several topics are covered in that lecture. First, the relevance of Chinese philosophies to service leadership is discussed. Second, the core virtues in Confucian thoughts are presented. Third, the relevance of Confucian virtues to service leadership is examined. Finally, conclusions and reflections on the relevance of Confucian …

The Role Of A Caring Disposition In Service Leadership, Daniel T. L. Shek, Xiang Li

Pediatrics Faculty Publications

A caring disposition is an important and fundamental attribute of a service leader. At the Hong Kong Polytechnic University, a lecture on a caring disposition in the subject “Service Leadership” was designed to help students understand the importance of caring dispositions. The curriculum design with reference to the basic concepts and theories as well as the content of the lecture are presented in this paper. In the first part of the paper, several uncaring cases are presented to serve as negative examples to inspire students’ reflection on caring leaders. Then, the three most important traits of a caring disposition, including …

The Role Of Self-Leadership In Service Leadership, Daniel T. L. Shek, Cecilia M. S. Ma, Ting Ting Liu, Andrew M. H. Siu

Pediatrics Faculty Publications

One of the core beliefs of the service leadership curriculum proposed by the Hong Kong Institute of Service Leadership and Management is that ‘Every day, every human occupies a position of leadership and possesses the potential to improve his leadership quality and effectiveness’. This core belief is in sharp contrast to some of the mainstream leadership theories that only a few people and elites can be leaders. In this paper, a lecture plan regarding the nature of self-leadership with reference to service leadership is presented. The topics include definitions and concepts of self-leadership, relationships between self-leadership and service leadership, ways …

Focus Group Evaluation Of A Service Leadership Subject In Hong Kong, Daniel T. L. Shek, Moon Y. M. Law, Ting Ting Liu

Pediatrics Faculty Publications

Two focus groups with six randomly selected students were conducted to understand the views and experiences of students taking a subject entitled “Service Leadership” at The Hong Kong Polytechnic University. Several observations were highlighted from the findings. First, students generally had positive views of the subject. Second, students felt that they had positive experience in the subject. Third, the instructors were seen in a positive light by the students. Fourth, the students perceived the subject to be beneficial to their development. Fifth, students had positive impression about the subject. Finally, recommendations regarding time allocation, teaching style, and classroom environment were …

Leadership And Mentorship: Service Leaders As Mentors Of The Followers, Daniel T. L. Shek, Li Lin

Pediatrics Faculty Publications

According to the Hong Kong Institute of Service Leadership and Management, an effective service leader serves as a mentor for his/her followers. Aside from promoting their followers’ professional and personal growth, mentoring also contributes to the development of the service leaders themselves. In this paper, a lecture addressing the concept and functions of mentoring is outlined, along with its relationship with service leadership. The professional and psychosocial functions of mentoring to service leaders and followers and various ways to promote mentoring in service leadership are highlighted. Students are also encouraged to reflect on the potential harmful effects of mentoring on …

General Education Program In A New 4-Year University Curriculum In Hong Kong: Findings Based On Multiple Evaluation Strategies, Daniel T. L. Shek, Lu Yu, Florence K. Y. Wu

Pediatrics Faculty Publications

Since the 2012−2013 academic year, undergraduate programs in Hong Kong have been changed from 3 years to 4 years, with the additional year focusing primarily on general education. A new general education framework entitled General University Requirements (GUR) implemented at The Hong Kong Polytechnic University (PolyU) was examined in a 5-year longitudinal project. Based on different evaluation strategies, including objective outcome evaluation, subjective outcome evaluation and qualitative evaluation (focus groups, case studies, and document analyses), findings consistently showed that students had positive perceptions of the subject content, teachers as well as teaching and learning methods in GUR subjects. A large …

Evaluation Of An Innovative Leadership Training Program For Chinese Students: Subjective Outcome Evaluation, Daniel T. L. Shek, Xiang Li

Pediatrics Faculty Publications

As a part of the Global Youth Leadership Program (GYLP), a 30-h “Service Leadership” subject was provided to 48 undergraduate students studying at The Hong Kong Polytechnic University (PolyU) or Peking University (PKU). This study evaluated the subjective outcomes of the “Service Leadership” subject, including students’ views on the course contents, lecturers, and perceived benefits from the course. A majority of students in the program showed very positive perceptions of the course content, lecturers, and course benefits, with more than 85% of the students indicating that they were very satisfied with this subject and would suggest their friends to take …

Rapid Fecal Calprotectin Testing To Assess For Endoscopic Disease Activity In Inflammatory Bowel Disease: A Diagnostic Cohort Study, Lukasz Kwapisz, Mahmoud Mosli, Nilesh Chande, Brian Yan, Melanie Beaton, Jessica Micsko, Pauline W. Mennill, William Barnett, Kevin Bax, Terry Ponich, John Howard, Anthony Tirolese, Robert Lannigan, James Gregor

Paediatrics Publications

Background and Aim: With increasing numbers of patients diagnosed with inflammatory bowel disease (IBD), it is important to identify noninvasive methods of detecting disease activity. The aim of this study is to examine the diagnostic accuracy of fecal rapid calprotectin (FC) testing in the detection of endoscopically active IBD. Patients and Methods: All consecutive patients presenting to outpatient clinics with lower gastrointestinal symptoms were prospectively recruited. Patients provided FC samples. Sensitivity (Sn), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) for FC were calculated. Receiver-operator characteristics (ROC) curve was used to identify the ideal FC cutoff that …

Evaluation Of A General Education Program In Hong Kong: Secondary Data Analyses Based On Student Feedback Questionnaires, Daniel T. L. Shek, Lu Yu, Joe Ngai

Pediatrics Faculty Publications

The General University Requirements (GUR) at The Polytechnic University of Hong Kong (PolyU) has been developed and implemented since the 2012–13 academic year under the reform of education system in Hong Kong. To examine the effectiveness of GUR at PolyU, the present study investigated student’s subjective perception in the academic years of 2012–13 and 2013–14 using the Student Feedback Questionnaires. Results showed that the GUR subjects were generally well-received by the students. Besides, students held different perceptions of different GUR components, and there was improvement in students’ learning experience and staff teaching over time. While there was an increased satisfaction …

Segmented Nitinol Guidewires With Stiffness-Matched Connectors For Cardiovascular Magnetic Resonance Catheterization: Preserved Mechanical Performance And Freedom From Heating., Burcu Basar, Toby Rogers, Kanishka Ratnayaka, Adrienne E Campbell-Washburn, Jonathan R Mazal, William H Schenke, +4 Additional Authors

Pediatrics Faculty Publications

BACKGROUND: Conventional guidewires are not suitable for use during cardiovascular magnetic resonance (CMR) catheterization. They employ metallic shafts for mechanical performance, but which are conductors subject to radiofrequency (RF) induced heating. To date, non-metallic CMR guidewire designs have provided inadequate mechanical support, trackability, and torquability. We propose a metallic guidewire for CMR that is by design intrinsically safe and that retains mechanical performance of commercial guidewires.

METHODS: The NHLBI passive guidewire is a 0.035" CMR-safe, segmented-core nitinol device constructed using short nitinol rod segments. The electrical length of each segment is less than one-quarter wavelength at 1.5 Tesla, which eliminates …

Use Of Modeling And Simulation In The Design And Conduct Of Pediatric Clinical Trials And The Optimization Of Individualized Dosing Regimens, Chris Stockmann, J. S. Barrett, Jessica K. Roberts, Catherine M.T. Sherwin

Pediatrics Faculty Publications

Mathematical models of drug action and disease progression can inform pediatric pharmacotherapy. In this tutorial, we explore the key issues that differentiate pediatric from adult pharmacokinetic (PK) / pharmacodynamic (PD) studies, describe methods to calculate the number of participants to be enrolled and the optimal times at which blood samples should be collected, and therapeutic drug monitoring methods for individualizing pharmacotherapy. The development of pediatric‐specific drug dosing dashboards is also highlighted, with an emphasis on clinical‐relevance and ease of use.

Postnatal Growth Standards For Preterm Infants: The Preterm Postnatal Follow-Up Study Of The Intergrowth-21st Project, José Villar, Francesca Giuliani, Zulfiqar A. Bhutta, Enrico Bertino, Eric O. Ohuma, Leila Cheikh Ismail, Fernando C. Barros, Douglas G. Altman, Cesar Victora, Julia A. Noble, Michael G. Gravett, Manorama Purwar, Ruyan Pang, Ann Lambert, Aris T. Papageorghiou, Roseline Ochieng, Yasmin A. Jaffer, Stephen H. Kennedy

Paediatrics and Child Health, East Africa

Background: Charts of size at birth are used to assess the postnatal growth of preterm babies on the assumption that extrauterine growth should mimic that in the uterus.

Methods: The INTERGROWTH-21st Project assessed fetal, newborn, and postnatal growth in eight geographically defined populations, in which maternal health care and nutritional needs were met. From these populations, the Fetal Growth Longitudinal Study selected low-risk women starting antenatal care before 14 weeks’ gestation and monitored fetal growth by ultrasonography. All preterm births from this cohort were eligible for the Preterm Postnatal Follow-up Study, which included standardised anthropometric measurements, feeding practices based on …