Medicine and Health Sciences Commons^™

The Effect Of Covid-19 On The Detection And Prevalence Of Suicidality In Adolescents, John Lantos, Hung-Wen Yeh, Fajar Raza, Mark Connelly, Shayla Sullivant

Presentations

Background: The COVID-19 pandemic saw changes to the delivery of health services and concerns about psychological morbidity not directly related to COVID infection. We analyzed the effects of the pandemic on our hospital’s program to screen adolescents for suicidality.

Objective: To determine the effect of the COVID-19 pandemic on 1) a hospital-wide screening program for suicidality in teens; and 2) the prevalence of positive screens for suicidality.

Design/Methods: Our study population was all patients > 12yo seen as inpatients or in the ED or clinics at a children’s hospital in Apr-June in 2019 (T1) and 2020 (T2). Eligible pts were screened …

Genetic Pathway Analysis Of Abnormal Facial Development In Nonsyndromic Cleft Lip And Palate, Lorena Maili

Dissertations and Theses (Open Access)

Nonsyndromic cleft lip with or without cleft palate (NSCLP) is the most common craniofacial birth defect resulting from incomplete fusion of the facial prominences during development, which leaves a gap in the lip, primary palate and/or the secondary palate. NSCLP affects 135,000 NSCLP newborns worldwide each year based on a birth prevalence of 1 per 700 live births. While surgical treatments have dramatically improved, many long-term health issues persist, imposing significant medical, psychosocial and economic burdens. Familial aggregation and segregation analyses suggest genetic contributions underlie NSCLP, but despite decades of study, only a small portion of the NSCLP genetic liability …

Using Standardized Scripting To Improve Antibiotic Stewardship In A National Pediatric Urgent Care Collaborative, Amanda Nedved, Melody Fung, Cindy Liu, Rana Hamdy, Amanda Montalbano

Posters

Background: A study using administrative data reported urgent care providers as having the highest rates of inappropriate antibiotic use for upper respiratory illnesses. In a national survey, pediatric urgent care providers reported family expectations as a primary driver for prescribing inappropriate antibiotics. Standardized scripting has been effective at reducing unnecessary antibiotics while increasing family satisfaction.


Objective: To reduce inappropriate prescribing for upper respiratory infections (acute otitis media (AOM), otitis media with effusion (OME), and pharyngitis) in pediatric urgent cares by 20% by December 1, 2020 through use of standardized scripting in Year 2 of a national pediatric urgent care quality …

Spanish-Speaking Families’ Perspectives On The Acceptability And Impact Of Culture And Language Coaching For Bilingual Residents, Ryan Northup, Francisco Martinez, Jeffrey D. Colvin

Posters

Background: Culture and language coaching in the CHiCoS (Clínica Hispana de Cuidados de Salud) Program provides bilingual (English-Spanish) residents with longitudinal, personalized training in health care Spanish and cultural aspects of care. This intensive 1:1 training by a culture and language coach (CLC) over three years has been shown to improve residents’ skills and family satisfaction with care. Families’ perspectives on acceptability of the presence and impact of the CLC during visits have not been formally described.


Objective:


Design/Methods: In this descriptive, cross-sectional pilot study, we surveyed Spanish-speaking caregivers who received care from any of 18 bilingual CHiCoS residents accompanied …

Physicians’ Burnout: A First Step To Development Of A Wellness Curriculum, Tyler Smith, Katherine E. Mason, David D. Williams, Kadriye O. Lewis

Posters

Background: Prevalence of burnout among physicians is a critical issue impacting all career levels. Identifying burnout begins in medical training with trainees and early career physicians at risk for depression and burnout1. Participation in wellness programs may mitigate burnout perhaps during the COVID-19 pandemic. Online physician wellness activities i.e., coaching and training are offered at a free-standing children’s hospital in the Midwest USA. These programs are well received, but there is no specific curriculum addressing physicians’ wellness needs within the Division of General Academic Pediatrics (GAP). In designing a meaningful program, we conducted a needs assessment survey to gauge GAP …

Pediatric Resident Reflections From A Non-Medical Home Visit Of A Child With Medical Complexity, Emily J. Goodwin, Sheryl Chadwick, Deejo Miller, Kathryn Taff, Amanda Montalbano

Posters

Background: Pediatric residents typically only interact with patients and families in healthcare settings which limits the opportunity to fully understand the patient and family experience. Encounters with children with medical complexity (CMC) that only relate to illness or health monitoring can anchor residents to false preconceptions and limit their ability to practice patient- and family-centered care (PFCC). The core principles of PFCC include acknowledging patient and family expertise and strengths, encouraging their input, and appreciating the value of their observations and perceptions.


Objective: To explore how a home visit program with patients and families serving as faculty could instill the …

Household Income, Psychosocial Stressors, And Risk Factors For Sleep-Related Infant Deaths, Jeffrey D. Colvin, Isabella Zaniletti, Carolyn Ahlers-Schmidt, Vicki Collie-Akers, Christy Schunn, Rosemary Nabaweesi, Debbie Cheney, Rachel Y. Moon

Posters

Background: Sleep-related infant deaths (e.g., SIDS, accidental suffocation, undetermined) are the leading cause of postneonatal mortality. Infants from low income families have higher rates of sleep-related deaths. Other risk factors for sleep-related death include nonsupine sleep position, bedsharing, maternal smoking, sleeping in separate room, soft bedding, and breastfeeding <8 weeks. Little is known about how these risk factors vary by income or if psychosocial stressors, social services, and education of parents from healthcare providers about risk factors influence these risks among low income families.


Objective: Aim 1: Describe differences in risk factors for sleep-related infant death by family income. Aim 2: Among low income families, describe differences in risk factors by psychosocial stressors, services, and risk-factor education.


Design/Methods: We analyzed 2016-2017 CDC Pregnancy Risk Assessment Monitoring Study (PRAMS) data in 47 states. PRAMS questions mothers of …

Simulation Based Clinical Systems Testing In The Pediatric Emergency Department To Prepare For Covid-19 Pandemic, Christopher S. Kennedy, Marc Sycip, Lisa Ell, Shautonja Woods

Posters

Background: The COVID-19 prompted pediatric emergency departments (PED) to prepare for a surge in patients. In response, guidelines developed represent “work as imagined” and may not reflect work as done. In situ simulations could identify gaps and help to mitigate errors. Simulation-based clinical systems tests (SbCSTs) can detect latent safety threats (LSTs) in systems design.


Objective: Our aim was to use SbCSTs combined with rapid cycle training to test hospital system modifications for ED preparation. This method represenst a new application of SbCSTs. The research questions were in 2 frames: 1. Can rapidly deployed SbCSTs identify LSTs and recommendations for …

A Smarter Way To Round, Charles Maloy, Adrienne G. Deporre, Erica Adams, Jessica Olson, Amber Hunley, Darcy K. Weidemann

Posters

Background: Communication is a key driver of health care outcomes. Poor communication practices contribute to sentinel safety events, poor family/patient experiences, and delays in care. Use of checklists in the healthcare setting is important to the development of high reliability and is increasingly common, however, the development and implementation of medical checklists for the standard patient floor are inadequately described.


Objective: To develop a sustainable rounding checklist for multidisciplinary discussion of patient safety measures and clinical plans.


Design/Methods: Key stakeholders in the rounding process (subspecialty and general pediatrics physicians, resident physician, bedside nurses, and nursing leadership) created a rounding checklist …

A Deleterious Ephb4 Mutation Suppresses Prox1 Expression And Disrupts Lymphatic Development In Neonatal Non-Immune Hydrops, Gangaram Akangire, Heather Menden, Sheng Xia, Atif Ahmed, Venkatesh Sampath

Posters

Background: Non-immune hydrops fetalis is often a fatal condition and in 20% of cases related to lymphatic anomalies. Maldevelopment of lymphatic valves, atretic or absence of central lymphatic vessels has been described in hydrops fetalis, but the genetic basis of these anomalies remains undefined. Recent reports suggest that Ephrin type B receptor 4 (EPHB4) gene has a significant role in embryonic development of lymphatic system. To test the hypothesis that EPHB4 mutations can cause hydrops fetalis, we combined whole exome sequencing (WES) with functional and pathological analysis of an infant who succumbed to neonatal hydrops.


Objective: To discover the possible …

A Novel Way To Describe Variation In Antibiotic Use, Adrienne G. Deporre, Troy Richardson, Jason Newland, Mark Neuman

Posters

Background: A broader understanding of antibiotic variation can inform stewardship efforts. Diversity indices are frequently calculated in ecologic studies to measure the variety of species in a given habitat, however they have not yet been used to study variation in antibiotic use in the healthcare setting.


Objective: To develop a novel assessment of antibiotic variation, based on the breadth of an antibiotic’s associated conditions as well as its use, measured by days of therapy (DOT).


Design/Methods: We assessed antibiotic use in children aged 60 days-18 years hospitalized at a US Children’s hospital included in the Pediatric Health Information System (PHIS) …

Parental Health Literacy And Acute Care Utilization In Children With Medical Complexity, Emily J. Goodwin, Joy L. Solano, Jessica L. Bettenhausen, Ryan Coller, Adrienne G. Deporre, Rupal Gupta, Kayla R. Heller, Lauren Jones, Leah Jones, Kathyrn Kyler, Ingrid Larson, Laura Plencner, Margaret Queen, Timothy Ryan Smith, Tyler Smith, Jacqueline M. Walker, Margaret Wright, Isabella Zaniletti, Jeffrey D. Colvin

Posters

Background: Inadequate health literacy, defined as inadequate ability to find, understand and use health information is associated with poor health outcomes and high health care costs. Children with medical complexity (CMC) have high rates of acute care utilization. Understanding parental health literacy in CMC and its relationship to acute care utilization may inform interventions designed to lower utilization.


Objective: To examine parental health literacy for CMC and determine its association with acute care utilization.


Design/Methods: In this single-site cross-sectional study, 250 parents of CMC completed a self-administered survey (response rate of 66.1%). CMC were included if they had a complex …

Medical Neglect: Trends In Reporting Practices And Patient Characteristics, Danielle Horton, Emily Killough, Mary Moffatt

Posters

Background: Medical neglect has significant consequences on child health and well-being. Improved processes for defining, recognizing, and reporting medical neglect are needed, however there is limited published data on the subject. Insight into patient characteristics and current reporting practices will help identify areas for intervention to improve outcomes for children at risk for medical neglect.


Objective: To describe characteristics of children identified for concern of medical neglect and trends in reporting of cases to child protective services (CPS).


Design/Methods: We performed a 1-year retrospective descriptive study of subjects < 18 years of age at a single, tertiary-care, academic pediatric institution for whom a Patient at Risk (PAR) assessment was completed exclusively for the concern of medical neglect. The PAR is a unique institutional process by which health professionals and social workers document concerns for child maltreatment. Medical records were reviewed for data regarding demographics, medical history, health care utilization and psychosocial risk factors. The role of the initiating provider and healthcare setting in which the PAR was recorded were also obtained.


Results: Of 270 children with a PAR completed for medical neglect concerns, …

Educating Providers: Timely Post-Operative Pain Management In A Level Iv Neonatal Intensive Care Unit (Nicu), Jamesia Donato, Darian Younger, Rebecca Palmer, Denise Smith, Alexandra Oschman, Meredith Kopp, Daphne Reavey, Eugenia K. Pallotto

Posters

Background: NICU patients often encounter painful procedures and can have significant short and long-term consequences from inadequately treated pain. Ensuring adequate pharmacological and non-pharmacological 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.


Objective: SMART

Aim: Increase the percentage of patients receiving acetaminophen within one hour after surgery to greater than 70% by July 2020.


Design/Methods: A multidisciplinary team developed pain treatment algorithms and postop order plans to standardize the approach to postop pain management. Providers were educated about their …

Outpatient Antimicrobial Stewardship Programs In Children’S Hospitals: Status, Needs, Barriers, Rana El Feghaly, Elizabeth Monsees, Alaina N. Burns, Brian Lee, Ann L. Wirtz, Adam L. Hersh, Jason Newland

Posters

Background: Antimicrobial stewardship programs (ASPs) are an essential tool to combat the increasing threat of antibiotic resistance. ASPs traditionally reside in acute care settings with a focus on inpatient prescribing. However, in 2016, the Centers for Disease Control and Prevention affirmed the importance of outpatient ASP through its 4 core elements. Incorporation of these elements requires time, personnel, and funding, which may not be available in many institutions.


Objective: This study aimed to evaluate the current state of outpatient ASP in a large network of children’s hospitals and inform a programming agenda.


Design/Methods: This cross-sectional study used an investigator-developed survey …

Prenatal Diagnosis Of An Uncommon Form Of A Hypoplastic Left Heart Syndrome Variant., Anmol Goyal, Kelsey Pinnick, Rita France, Maria Kiaffas

Posters

Background: Mitral valve dysplasia syndrome (MVDS) is a rare form of congenital heart disease, similar to hypoplastic left heart syndrome (HLHS). Prenatal identification is important for counseling, delivery planning and postnatal management.

Case: A 39 year-old woman underwent fetal echocardiography at ~34 weeks gestation for evaluation of fetal cardiomegaly and hydrops revealing: biatrial enlargement, mild-to-moderate mitral and tricuspid valve insufficiency, echobright mitral valve apparatus, biventricular dilation, severe LV fibroelastosis (EFE) and systolic dysfunction, mild hypoplasia of aortic valve annulus and aortic arch, and a thick restrictive atrial septum (RAS) with left to right flow (Fig 1a-c).

Decision‐making: Although critical aortic …

Mental Health Among The Latinx Population, Jocelyn Mendoza Sierra

Electronic Theses, Projects, and Dissertations

Mental health in the Latinx community has been stigmatized for several years. In the Latinx community mental health is disregarded and oftentimes not addressed and overlooked by immediate family members. The purpose of this study is to address the reason why people do not access mental health services. The methods used in this study consisted of a qualitative approach and participants were asked open ended questions. A total of eleven participants (N=11) were gathered and consisted of both female and male participants who identify as Latinxs. The key findings from this research indicate that seeking mental health services was viewed …

The Effectiveness Of Alcoholics Anonymous In Helping Adult Men Recover From Alcohol Use Disorder, Kenneth Aurthir Wiggins

Electronic Theses, Projects, and Dissertations

This research project explored the effectiveness of the Alcoholics Anonymous (AA) 12-Step recovery process among males ages 21 to 67 who have abstained from using alcohol for more than one year following residential treatment while using all the suggested AA 12-Step program concepts as their base. This study also examined males ages 21 to 67 that have been unable to maintain sobriety for a year or more following residential treatment while partially using the suggested AA 12-Step program concepts as a base. Participants in the study were enlisted from the recovery community in Southern California, and qualitative interviews were conducted …

Peripartum Antibiotics Induce Dysbiosis And Predispose The Neonatal Gut Towards Inflammation, Alain Cuna, Marianne N. Nsumu, Venkatesh Sampath

Posters

Background: Broad-spectrum antibiotics in preterm infants have been associated with necrotizing enterocolitis (NEC), but the exact mechanisms that explain this association remain poorly defined.


Objective: To examine the impact of peripartum antibiotics on gut microbiota and intestinal inflammation in the developing gut.


Design/Methods: C57BL6 dams were administered broad spectrum antibiotics mixed with sterile drinking water from E15 to postnatal day (P)14 (Fig 1). Gut microbiota were analyzed by targeted 16S PCR for total bacterial density and relative abundance of major bacterial phyla. Effects of antibiotics on inflammatory TLR-signaling and injury in the neonatal gut were evaluated with PCR and histology. …

Response To Dexamethasone Predicts Diagnosis Of Severe (Type 2) Bronchopulmonary Dysplasia Or Death, Christopher R. Nitkin, Keith Feldman, Alain Cuna, Alexandra Oschman, William E. Truog, Michael Norberg, Jane Taylor, Tamorah Lewis

Posters

Background: Bronchopulmonary dysplasia (BPD) is the most common respiratory morbidity after preterm birth but requires diagnosis at 36 weeks postmenstrual age (PMA). Dexamethasone is often used to treat infants at high-risk of BPD. The ability for earlier prediction of BPD, based on steroid response, could be useful as a surrogate marker for new therapies.


Objective: To construct a model that predicts severe BPD or death at 36 weeks PMA based on clinical response to dexamethasone.


Design/Methods: Retrospective chart review of preterm infants treated with dexamethasone between 2010-2020 at a Level IV NICU with data collected on demographics, age of steroid …

Characterization Of Comorbidities In Patients With A Dual Diagnosis Of Down Syndrome And Autism Spectrum Disorder Using Cerner Health Facts, Michael Slogic, Earl F. Glynn, Cy Nadler, Meredith Dreyer, Sarah T. Edwards

Presentations

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, outcomes for patients with a dual diagnosis (DS-ASD) are poorly understood. Large DS-ASD cohorts and comparison samples are needed to fill this gap, as well as methods for grouping and analyzing complex diagnostic phenotypes. Objective: Our objective is to utilize Cerner Health Facts, a multi-institutional healthcare database, to identify large populations with DS, ASD, and DS-ASD, allowing for characterization and comparison of their …

How Nutrition Knowledge Of Coaches, Athletic Trainers, And Strength And Conditioning Specialists Translates To Their Athletes, Alexa Carbone

Electronic Theses and Dissertations

The basis of dietary habits is linked to an individuals’ nutrition knowledge; for collegiate athletes this is the difference between optimal performance and falling short. To understand how nutrition information is disseminated to student-athletes, this research surveyed the athletes themselves and their sports staff (coaches, athletic trainers, and strength and conditioning specialists) on their current knowledge. Sport staff and student-athletes at East Tennessee State University were given the opportunity to participate in a 52-question online survey that tested both their general and sports-related nutrition knowledge. While the study sample size did not allow for statistical analyses required to address all …

Sarcopenia Screening By Registered Dietitian Nutritionists (Rdns) In The United States (U.S.), Madison Marcom

Electronic Theses and Dissertations

Sarcopenia is a disease of muscle wasting primarily seen in older adults. Although this term was first coined over three decades ago, there is a lack of consensus on a definition, screening criteria, and treatment protocol for sarcopenia. The primary purpose of this study is to determine whether registered dietitian nutritionists (RDNs) in the United States (U.S.) screen for sarcopenia. Study participants were recruited through a randomized email list and included RDNs throughout the U.S. Respondents completed a survey questioning knowledge of sarcopenia, screening tools and company protocols in place, and the need and desire for sarcopenia education. Data revealed …

Hemin Utilization In Rhizobium Leguminosarum Atcc 14479, John Lusby

Electronic Theses and Dissertations

Rhizobium leguminosarum is a Gram negative, motile, nitrogen-fixing soil bacterium. Due to the scarcity of iron in the soil bacteria have developed a wide range of iron scavenging systems. The two types of iron scavenging systems used are indirect and direct. In-silico analysis of the genome identified a unique direct iron scavenging system the Hmu operon. This system has been identified in other closely related rhizobium species and is believed to be involved in utilizing heme compounds as a sole source of iron. We have attempted to characterize the role of the Hmu operon in iron utilization by monitoring the …

Prevalence And Mortality Of Epilepsies With Convulsive And Non-Convulsive Seizures In Kilifi, Kenya, Symon M. Kariuki, Anthony Ngugi, Martha Z. Kombe, Michael Kazungu, Eddie Chengo, Rachael Odhiambo, Amek Nyaguara, Brian G. Neville, Charles Rjc Newton

Population Health, East Africa

Objectives: The prevalence of all epilepsies (both convulsive and non-convulsive seizures) in Low- and Middle- Income Countries (LMIC), particularly sub-Saharan Africa is unknown. Under estimation of non-convulsive ep- ilepsies in data from these countries may lead to inadequate and sub-optimal allocation of resources to control and prevent epilepsy. We determined the prevalence of all types of epilepsies and compared the mortality be- tween convulsive seizures and non-convulsive seizures in a resource limited rural area in Kenya.

Methods: Trained clinicians identified cases of epilepsy in a randomly selected sample of 4,441 residents in the Kilifi Health and Demographic Surveillance System site …

Effect Of Community-Based Interventions Targeting Female Sex Workers Along The Hiv Care Cascade In Sub-Saharan Africa: A Systematic Review And Meta-Analysis, Lydia Atuhaire, Olatunji Adetokunboh, Constance Shumba, Peter S. Nyasulu

School of Nursing & Midwifery, East Africa

Background: Female sex workers are extremely vulnerable and highly susceptible to being infected with human immunodeficiency virus. As a result, community-based targeted interventions have been recommended as one of the models of care to improve access to HIV services and continued engagement in care. We conducted a systematic review to (1) assess the effect of FSW-targeted community interventions on the improvement of HIV services access along the treatment cascade and (2) describe community-based interventions that positively affect continuation in HIV care across the HIV treatment cascade for FSWs in sub-Saharan Africa.

Methods: We defined the 5 steps that …

Integrating Art Therapy And Emotionally Focused Therapy With Couples: A Conceptual Framework, Pauline A. Hall

LMU Theses and Dissertations

This qualitative study examines how art interventions are aligned and integrated with emotionally focused therapy (EFT; Johnson, 2020) in the treatment of relational distress with couples. EFT is a brief humanistic evidence-based treatment, grounded in attachment theory, with experiential and systemic approaches to intervention that engage underlying emotion to create more secure bonds. Notably scant literature exists blending art-based and verbal approaches in EFT, despite the importance of verbal imagery in EFT intervention and the experiential nature of expressive therapies. In this study, NVivo qualitative data analysis software facilitated thematic analysis of semi-structured interviews with five clinicians who integrate the …

Treatment Access For Dual Diagnosis Substance Use And Mental Health Disorders, Pedro Banuelos

Electronic Theses, Projects, and Dissertations

In 2018, of 1.3 million Latinx adults in the United States facing concurrent issues with substance use disorders (SUD) and mental health disorders (MHD) 93% remained untreated for either diagnosis. This is concerning since Substance Abuse and Mental Health Services Administration (SAMHSA) data reveals that this population is at greater risk for suicidal thoughts, plans, and attempts. They also face structural barriers such as employment, housing, legal involvement, and insurability that further impede access to treatment.

This study’s purpose was to examine barriers to accessing treatment for Latinx populations confronting co-occurring SUDs and MHDs. This study used a qualitative design …

Levels Of Engagement In Mental Health Services Regarding Minorities, Karla Salazar Rendon

Electronic Theses, Projects, and Dissertations

This study focuses on analyzing if the level of engagement when receiving mental health services affects how many mental health providers an individual has. Although mental health impacts everyone, minorities encounter barriers such as language, transportation, and residential segregation. Obstacles such as these discourage individuals in regards to pursuing mental health services. Minorities make up a significant amount of the U.S. population: however, they are underrepresented in the mental health field. The challenges they encounter need to be addressed to provide efficient services. This study includes male and female participants over the age of 18 in San Bernardino County. The …

Association Between Dietary Inflammatory Index, Dietary Patterns, Plant-Based Dietary Index And The Risk Of Obesity, Yoko B. Wang, Nitin Shivappa, James R. Hébert Scd, Amanda J. Page, Yohannes Adama Melaku

Faculty Publications

Evidence on the association between various dietary constructs and obesity risk is limited. This study aims to investigate the longitudinal relationship between different diet indices and dietary patterns with the risk of obesity. Non-obese participants (n = 787) in the North West Adelaide Health Study were followed from 2010 to 2015. The dietary inflammatory index (DII®), plant-based dietary index (PDI) and factor-derived dietary pattern scores were computed based on food frequency questionnaire data. We found the incidence of obesity was 7.62% at the 5-year follow up. In the adjusted model, results from multivariable log-binomial logistic regression showed that a prudent …