Medicine and Health Sciences Commons^™

Margaret Mitchell's Lost Letter To A Kansas Horse Buggy Doctor., Jane F. Knapp, Robert Schremmer

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Cancer Risk From Pediatric Diagnostic Radiology; Should We Be Concerned ?, P Trinavarat, S Manaphol, N Yimpraphan, S. Assawakulkamnurd

Chulalongkorn Medical Journal

Diagnostic radiology has an important role in pediatrics. Some imaging modalities give high radiation doses and there is a rising concern on the safety of radiation. This article aims to provide information on the increased risk of cancer from radiation used in diagnostic radiology. The information may help in the process of decision making in referring pediatric patients to CT and in communicating with their parents. Radiation doses in diagnostic radiology in pediatrics are mostly low, but some may reach the moderate level. From the recent knowledge, many believe that even a low-dose radiation has a certain risk of cancer …

Parent-Led Activity And Nutrition (Plan) For Healthy Living: Design And Methods, William T. Dalton, Karen E. Schetzina, Nicole Holt, Hazel Fulton-Robinson, Ai-Leng Ho, Fred Tudiver, Mathew T. Mcbee, Tiejian Wu

ETSU Faculty Works

Child obesity has become an important public health concern, especially in rural areas. Primary care providers are well positioned to intervene with children and their parents, but encounter many barriers to addressing child overweight and obesity. This paper describes the design and methods of a cluster-randomized controlled trial to evaluate a parent-mediated approach utilizing physician's brief motivational interviewing and parent group sessions to treat child (ages 5–11 years) overweight and obesity in the primary care setting in Southern Appalachia. Specific aims of this pilot project will be 1) to establish a primary care based and parent-mediated childhood overweight intervention program …

A Qualitative Study Examining Tensions In Interdoctor Telephone Consultations, Anupma Wadhwa, Lorelei Lingard

Lorelei Lingard

OBJECTIVE: Communication skills have gained increasing attention in medical education. Much of the existing literature and medical curricula addresses issues of doctor-patient communication. The critical importance of communication between health professionals, however, is now coming under the spotlight. The interdoctor telephone consultation is a common health care setting in which health professional communication skills are exercised. Breakdowns in this communication commonly occur and, surprisingly, this skill is not formally addressed in medical training. This study sought to clarify the communication issues that can occur during interdoctor telephone consultations in order to inform future educational initiatives in this domain. METHODS: Data …

Junior Faculty Experiences With Informal Mentoring, Karen Leslie, Lorelei Lingard, Sarah Whyte

Lorelei Lingard

Mentoring is one way in which new faculty can acquire the skills needed for a successful academic career. Little is known about how informal mentoring is operationalized in an academic setting. This study had two main objectives: (1) to determine if junior faculty identify as having an informal mentor(s) and to describe their informal mentoring relationships; and (2) to identify the areas in which these faculty seek career assistance and advice. The study employed a grounded theory approach. Subjects were recruited from the clinical teaching faculty and were 3-7 years into their first faculty position. Theoretical sampling was employed in …

A Certain Art Of Uncertainty: Case Presentation And The Development Of Professional Identity, Lorelei Lingard, K. Garwood, C. Schryer, M. Spafford

Lorelei Lingard

Healthcare professionals use the genre of case presentation to communicate among themselves the salient patient information during treatment and management. In case presentation, many uncertainties surface, regarding, e.g., the reliability of patient reports, the sensitivity of laboratory tests, and the boundaries of scientific knowledge. The management and portrayal of uncertainty is a critical aspect of professional discourse. This paper documents the rhetorical features of certainty and uncertainty in novice case presentations, considering their pragmatic and problematic implications for students' professional socialization. This study was conducted during the third-year inpatient clerkship at a tertiary care, pediatric hospital in hospital in Canada. …

Technical Skills In Paediatrics: A Qualitative Study Of Acquisition, Attitudes And Assumptions In The Neonatal Intensive Care Unit, Susan Bannister, Robert Hilliard, Glenn Regehr, Lorelei Lingard

Lorelei Lingard

PURPOSE: While the effective acquisition of technical skills is essential for excellent paediatric care, little is known about how technical skills are learned in the paediatric setting. This study sought to describe and theorise the variables influencing technical skills acquisition in a tertiary care neonatal intensive care unit (NICU) inpatient setting. METHODOLOGY: Using non-participant field methodology, paediatric residents and their teachers (nurses, respiratory therapists, neonatal staff and fellows) were observed at various times in the NICU for 8 weeks. Thirteen semistructured interviews with these teachers and learners and 1 focus group of additional learners were conducted and used to triangulate …

The Effects Of Computer-Based Education On Children's Knowledge About Asthma, Matyt L. Adler

Evidence-Based Practice Project Reports

Asthma is a global health problem affecting people of all ages that can cause severe limitations when uncontrolled. In the United States, asthma was the most prevalent chronic disease among children and youth in 2008 (U.S. Department of Health and Human Services, 2009). Because day-to-day management of asthma is the responsibility of the child or the parent, education of patients is one of four crucial components to effectively provide quality asthma care. Changes in workload complexities with primary care visits has increased and visit duration decreased, resulting in less available time to address individual patient needs including the education aspect …

Application Of Pharmacometric Methods To Improve Pediatric Drug Development, Mallika Lala

Theses and Dissertations

Pharmacometrics is a quantitative science that is rapidly changing the landscape of drug development, and particularly so for the pediatric population. The motivation behind the research underlying this dissertation is to contribute towards the improvement of pediatric drug development by the astute application of pharmacometric methods. Two distinct research areas have been focused upon: 1- improving pediatric pharmacokinetic (PK) trial design and 2- improving pediatric dosing of warfarin by using a genetics-based dosing regimen. The first project examined in detail the feasibility of and simulation-based methodology for implementing a recent regulatory PK quality standard. The focus was on designing pediatric …

Pediatric Traumatic Putamenal Strokes: Mechanisms And Prognosis, Zain A. Sobani, Arshad Ali

Section of Neurosurgery

Background: Studies have shown that nearly 3% of closed head injuries result in basal ganglia hemorrhages and that this may be a more frequent occurrence in pediatric patients. Various mechanisms based on shearing forces have been implicated in the injury; however, the underlying mechanism leading to the increased incidence in pediatric patients has not been well described. Angiographic data suggest that putamenal perforators in children are more severely stretched at acute angles compared to those in adults, which may be a contributing factor to the increased incidence.
Case description: We discuss a series of five relatively benign cases of traumatic …

Pediatric Ethics Guidelines For Hereditary Medullary Thyroid Cancer, M. Sara Rosenthal, Douglas S. Diekema

Internal Medicine Faculty Publications

Hereditary medullary thyroid cancer is an aggressive cancer for which there is no standard effective systemic therapy, but which can be prevented through genetic screening and prophylactic thyroidectomy. Although this cancer accounts for roughly 17% of all pediatric thyroid cancers, a significant percentage of affected families do not "accept" screening, while many gene carriers delay or refuse prophylactic thyroid surgery for their children. Current genetic screening practices in medullary thyroid cancer are inadequate; more than 50% of index patients with hereditary medullary thyroid cancer present with a thyroid mass; up to 75% have distant metastasis. These proposed pediatric ethics guidelines …

Cefepime Neurotoxicity In An Adolescent Cystic Fibrosis Patient With Aminoglycoside-Induced Acute Kidney Injury, Kristen R. Nichols, Danielle M. Brown, Chad A. Knoderer, Sharon P. Andreoli

Scholarship and Professional Work – COPHS

Objective: To describe a case of cefepime neurotoxicity in an adolescent with cystic fibrosis and aminoglycoside-associated acute kidney injury (AKI).

Case Summary: A 15-year-old, 46-kg male with cystic fibrosis (CF) and chronic sinusitis was admitted to the hospital for CF exacerbation. The patient was subsequently discharged to complete home antibiotic therapy with intravenous gentamicin and cefepime. Thirteen days after discharge, while still receiving intravenous antibiotics, the patient presented to an outside hospital complaining of vomiting, fatigue, decreased appetite, and decreased urine output. The patient was diagnosed with AKI and was transferred to our institution, where he displayed signs and symptoms …

Assessment Of The Validity Of Reported Antibiotic Allergic Reactions In Pediatric Patients, Lauren E. Miller, Chad A. Knoderer, Elaine G. Cox, Martin B. Kleinman

Scholarship and Professional Work – COPHS

Study Objective. To determine whether a reported antibiotic allergy was likely to have been immunologically mediated.

Design. Questionnaire-based study.

Setting. Tertiary care, freestanding children's hospital.

Patients. One hundred patients aged 1 month-18 years for whom guardians reported an allergy to an antibiotic at the time of hospital admission between October 2009 and March 2010.

Intervention. Guardians of the patients were interviewed by using a standardized allergy assessment questionnaire.

Measurements and Main Results. Based on answers to the questionnaire, the reported allergic reactions were categorized to determine if they were true allergies or adverse reactions. Among the 100 patients, reported allergies …

Efficacy Of Limited Cefuroxime Prophylaxis In Pediatric Patients After Cardiovascular Surgery, Chad A. Knoderer, Elaine G. Cox, Michelle D. Berg, Andrea H. Webster, Mark W. Turrentine

Scholarship and Professional Work – COPHS

Purpose The efficacy of limited cefuroxime prophylaxis in pediatric patients after cardiovascular surgery was evaluated.

Methods All patients age 18 years or younger who underwent cardiovascular surgery and received postoperative care from the cardiovascular surgery team between February and July 2006 (preintervention group) and between August 2006 and January 2007 (postintervention group) were eligible for study inclusion. Patients were excluded if they did not receive cefuroxime as postoperative prophylaxis, had a preexisting infection, underwent cardiac transplantation or extracorporeal membrane oxygenation, or underwent delayed sternal closure. The preintervention group received prolonged cefuroxime prophylaxis, and the postintervention group received 24 hours of …

Assessment Of Web-Based Training (Wbt) Modules On Learning Facilitation For Advanced Pharmacy Practice Experiences (Appe) In Pediatrics, Jennifer L. Morris, Chad A. Knoderer

Scholarship and Professional Work – COPHS

OBJECTIVES: To assess the effectiveness of web-based training (WBT) modules to enhance and facilitate student pharmacists’ learning and their ability to provide pharmaceutical care to children during a pediatric advanced pharmacy practice experience (APPE).

METHODS: Pediatric-specific WBT modules were developed for completion by APPE students during a 4- week rotation. Pediatric modules covered developmental pharmacology; antimicrobial use and monitoring; fluids, electrolytes, and dehydration; and drug information. Students were responsible for completing all modules within the first week of the APPE. Preassessments and postassessments consisted of 8 to 10 multiple-choice questions, with scores ranging from 0 to 100 points. Data were …

Pertussis In Ohio: A Descriptive Analysis Of The 2010 Columbus Outbreak And Patterns Of A Reemerging Childhood Disease, Christopher Rohde

Master of Public Health Program Student Publications

Objective: In 2010, Columbus, Ohio experienced the largest outbreak of pertussis that it has had in the past 25 years. Similar outbreaks are occurring across the nation on an increasing basis. This descriptive study examines the 2010 outbreak and describes the demographics of the affected population. Comparison is made to previous and current pertussis incidence in Ohio and outbreaks elsewhere in the United States. Contributing factors to the increasing occurrence of pertussis outbreaks are discussed.

Methods: Raw data was obtained from the Columbus Public Health epidemiology department and is gathered through the Ohio Disease Reporting System (ODRS). Pertussis cases are …

The Influence Of School Eating Environment On Children's Eating Behaviors: An Examination Of The Snda-Iii, Sabrina M. Neeley

Master of Public Health Program Student Publications

The prevalence of childhood overweight and obesity in the United States has prompted researchers to examine the factors that contribute to children’s food choices and consumption. Schools provide ample opportunities to teach children healthy eating habits, as well as create eating environments that are conducive to healthy eating behaviors. The National School Lunch Program (NSLP) provides federally assisted meals to millions of children every day and the assessment of the NSLP provides an opportunity to examine the school-eating environment. Hierarchical and logistic modeling of the SNDA-III, the USDA assessment of the NSLP, was conducted to determine relationships between environmental factors …

Gaps And Strengths In Us Policies On Infant And Young Child Feeding: An Analysis Based On The Global Strategy On Infant And Young Child Feeding, Linda J. Smith

Master of Public Health Program Student Publications

This research project reviews the evidence on the significance of infant and young child feeding to public health goals, analyzes US policy documents in relationship to the Global Strategy using the World Breastfeeding Trends Initiative (WBTi) to quantify the findings into a national score, and then summarizes the gaps and strengths in US policies and makes recommendations. Using the WBTi scoring system, strengths for the US exist in national policy, Baby-Friendly Hospital Initiative, monitoring and evaluation, and complementary feeding. Mother support and community outreach, information and support were moderate. Gaps exist in policies on infant feeding in emergencies and for …

Prevalence Of Metabolic Abnormalities In Children With Varying Degrees Of Obesity, Leah Sabato

Master of Public Health Program Student Publications

As the prevalence of obesity among children has risen, metabolic syndrome, a cluster of abnormalities which includes obesity, altered glucose metabolism, hypertension, and dyslipidemia, has increasingly become recognized in the pediatric population. Metabolic syndrome has been studied extensively in adults, and there is increasing interest to understand the condition in adolescents; however, studies of metabolic syndrome in younger children are limited. The purpose of this study is to examine the prevalence of metabolic syndrome and its individual components among children aged 6-10 years. Demographic, anthropometric, and biochemical data were gathered retrospectively from the medical records of 222 obese children aged …

Prevalence Of Obesity Among Head Start Preschoolers In Western Ohio, Angela Sims

Master of Public Health Program Student Publications

Objective: The intent of this study was to examine low income Head Start overweight and obese preschoolers, ages 3-5, in 8 western Ohio counties. Variables of interest included: obesity status, rural versus metropolitan location, home versus center-based Head Start, and access to physicians.

Methods: Data was collected retrospectively from the host Head Start site located in Piqua, Ohio. All Head Start enrolled preschoolers (N=1,181) ages 3 to 5 within the 8 western Ohio counties and 43 programs were studied. All children were considered of low income based on their acceptance into the Head Start program.

The data was retrieved from …

The Effect Of Prenatal Care And Other Factors On Preterm Births In Montgomery County 2007-2009, Leslie A. Schmieder

Master of Public Health Program Student Publications

Introduction Preterm birth is defined as a baby who is born before 37 weeks of pregnancy. Problems with preterm birth include an increased risk for health complications throughout life as well as having significantly more medical expenses compared to a full term infant. Prenatal care has shown to decrease the risk for preterm birth nationally. The objective of this project was to analyze prenatal care and other risk and demographic factors to determine their association with preterm birth in Montgomery County.

Method Data used included the 2007-2009 Montgomery County Birth Certificate Data for mothers who had singleton births. The Kessner …

Graduate Medical Education 2010 Annual Report, Children's Mercy Hospital

GME Annual Reports

Annual report of the Children's Mercy Hospital Graduate Medical Education department, including pediatric residency, internal medicine/pediatrics residency, fellowship programs, medical students, continuing medical education, and library services.

2011 Cancer Care Annual Report, Children's Mercy Hospital

Cancer Center Annual Reports

Annual report of cancer care and oncology services at the Children's Mercy Hospital, Kansas City MO, a pediatric medical center.

Graduate Medical Education 2010-2011 Annual Report, Children's Mercy Hospital

GME Annual Reports

Annual report of the Children's Mercy Hospital Graduate Medical Education department, including pediatric residency, internal medicine/pediatrics residency, fellowship programs, medical students, continuing medical education, and library services.

Primary Care Practice Addressing Child Overweight And Obesity: A Survey Of Primary Care Physicians At Four Clinics In Southern Appalachia, Nicole Holt, Karen E. Schetzina, William T. Dalton, Fred Tudiver, Hazel Fulton-Robinson, Tiejian Wu

ETSU Faculty Works

Objective: The prevalence of childhood overweight and obesity in southern Appalachia is among the highest in the United States (US). Primary care providers are in a unique position to address the problem; however, little is known about attitudes and practices in these settings.

Methods: A 61-item healthcare provider questionnaire assessing current practices, attitudes, perceived barriers, and skill levels in managing childhood overweight and obesity was distributed to physicians in four primary care clinics. Questionnaires were obtained from 36 physicians.

Results: Physicians' practices to address childhood overweight and obesity were limited, despite the fact that most physicians shared the attitude that …

Nitrous Oxide Anesthesia In Children For Mri: A Comparison With Isoflurane And Halothane, Mehmet Emi̇n Orhan, Ferruh Bi̇lgi̇n, Oğuz Kiliçkaya, Abdulkadi̇r Atim, Ercan Kurt

Turkish Journal of Medical Sciences

To compare the anesthetic effects of nitrous oxide, isoflurane, and halothane on hemodynamic stability and recovery characteristics in pediatric patients during magnetic resonance imaging (MRI). Materials and methods: The present study includes 60 ASA I-II children aged 1-12 years undergoing MRI. After endotracheal intubation, patients were randomly assigned into 1 of 3 anesthetic groups. Group N (n = 20) received nitrous oxide and oxygen (N_2O:O_2 60:40), Group I (n = 20) received 0.5% isoflurane and oxygen, Group H (n = 20) received 0.5% halothane and oxygen to maintain anesthesia. At the completion of the procedure, inhalation anesthetic was discontinued. Extubation, …