Medical Specialties Commons^™

Implementation Of A Virtual Interprofessional Icu Learning Collaborative: Successes, Challenges, And Initial Reactions From The Structured Team- Based Optimal Patient-Centered Care For Virus Covid-19 Collaborators, Simon Zec, Nika Zorko Garbajs, Yue Dong, Ognjen Gajic, Christina Kordik, Lori Harmon, Marija Bogojevic, Romil Singh, Yuqiang Sun, Vikas Bansal, Linh Vu, Kelly Cawcutt, John M. Litell, Sarah Redmond, Elly Fitzpatrick, Kirstin J. Kooda, Michelle Biehl, Neha S. Dangayach, Viren Kaul, June M. Chae, Aaron Leppin, Mathew Siuba, Rahul Kashyap, Allan J. Walkey, Alexander S. Niven

Jefferson Hospital Staff Papers and Presentations

IMPORTANCE: Initial Society of Critical Care Medicine Discovery Viral Infection and Respiratory illness Universal Study (VIRUS) Registry analysis suggested that improvements in critical care processes offered the greatest modifiable opportunity to improve critically ill COVID-19 patient outcomes. OBJECTIVES: The Structured Team-based Optimal Patient-Centered Care for Virus COVID-19 ICU Collaborative was created to identify and speed implementation of best evidence based COVID-19 practices. DESIGN, SETTING, AND PARTICIPANTS: This 6-month project included volunteer interprofessional teams from VIRUS Registry sites, who received online training on the Checklist for Early Recognition and Treatment of Acute Illness and iNjury approach, a structured and systematic method …

Unilateral Agenesis Of Adnexa, Srinidhi Govindarajan, Poornima M Associate Professor, Rashmi H.S., Aishwarya Bhat

Digital Journal of Clinical Medicine

No abstract provided.

Learning Through Doing: Comprehensive Programming For A Training Program In Cancer Disparities, Kayce D Solari Williams, Kamisha Hamilton Escoto, Crystal Roberson, Kathy Le, Lorraine R Reitzel, Lorna H Mcneill, Shine Chang

Faculty, Staff and Student Publications

In the United States, preparing researchers and practitioners for careers in cancer requires multiple components for success. In this reflection article, we discuss our approach to designing a comprehensive research training program in cancer disparities. We focused on elements that provide students and early career scientists a deep understanding of disparities through first-hand experiences and skills training necessary to build a research career in the area. Our Educational Program sits within the framework of an NCI P20 program, "UHAND (University of Houston/MD Anderson Cancer Center)", jointly established by an NCI-designated comprehensive cancer center and a minority-serving university as a collaborative …

Strategies For Recruiting Underrepresented In Medicine And Sexual And Gender Minority Students To Emergency Medicine, Lauren T Wilson, Benjamin Weigel, Edgardo Ordonez, Navdeep Sekhon, Adedoyin Adesina, Anisha Turner, Aleksandr M Tichter, Sarah Bezek, Ynhi T Thomas

Faculty, Staff and Students Publications

BACKGROUND: Despite having well-described benefits, diversifying the physician workforce has been an ongoing challenge. Within emergency medicine (EM), multiple professional organizations have identified expanding diversity and inclusion as top priorities. The following is a description of an interactive session held at the SAEM annual meeting addressing recruitment strategies for underrepresented in medicine (URiM) and sexual and gender minority (SGM) students into EM.

METHODS: During the session, the authors provided an overview of the current state of diversity in EM. In the small-group portion of the session, a facilitator helped characterize the challenges programs face in recruiting URiM and SGM students. …

The Development Of An Educational Workshop To Reframe And Manage Professional Conflict Via A Sex And Gender Lens, Ynhi T Thomas, Anita N Chary, Michelle I Suh, Mehrnoosh Samaei, Valerie Dobiesz, Annahieta Kalantari, Greg Buehler, Devjani Das, Jeannette Wolfe

Faculty, Staff and Students Publications

BACKGROUND: Conflict is inevitable in the emergency department, and conflict resolution is an essential skill for emergency providers to master. Effective conflict management can optimize patient care and enhance professional satisfaction. To communicate effectively in high-stress, high-impact situations, sex- and gender-based differences need to be considered.

METHODS: Nine resident, fellow, junior, and senior faculty members of the Academy for Women in Academic Emergency Medicine collaborated to design a 4-h workshop. The focus was on professional communication and conflict resolution in emergency medicine (EM), with special attention on how sex and gender can influence these processes.

RESULTS: The final educational workshop …

Association Of Diet Quality With Metabolic (Dysfunction) Associated Fatty Liver Disease In Veterans In Primary Care, Natalia I Heredia, Aaron P Thrift, David J Ramsey, Rohit Loomba, Hashem B El-Serag

Faculty, Staff and Student Publications

BACKGROUND: Diet is associated with metabolic (dysfunction)-associated fatty liver disease (MAFLD), but the dietary composition associated with MAFLD risk has not been well-examined.

AIM: The purpose of this study was to assess the association of two healthy eating indices with the presence and severity of MAFLD in a sample of Veterans in a primary care setting.

METHODS: This was a single center cross-sectional study using a random stratified sample of Veterans enrolled in primary care. Participants underwent a Fibroscan and completed an interviewer-administered Diet History Questionnaire II from which we calculated the Healthy Eating Index-2015 and Alternate Mediterranean Diet Score. …

Creating A Data Dictionary For Pediatric Autonomic Disorders, Jeffrey R Boris, Hasan Abdallah, Shelley Ahrens, Gisela Chelimsky, Thomas C Chelimsky, Philip R Fischer, John E Fortunato, Raewyn Gavin, Janice L Gilden, Renato Gonik, Blair P Grubb, Kelsey M Klaas, Erin Marriott, Lauren E Marsillio, Marvin S Medow, Lucy Norcliffe-Kaufmann, Mohammed T Numan, Erin Olufs, Laura A Pace, Paul T Pianosi, Pippa Simpson, Julian M Stewart, Sally Tarbell, Natalie R Van Waning, Debra E Weese-Mayer

Faculty, Staff and Student Publications

PURPOSE: Whether evaluating patients clinically, documenting care in the electronic health record, performing research, or communicating with administrative agencies, the use of a common set of terms and definitions is vital to ensure appropriate use of language. At a 2017 meeting of the Pediatric Section of the American Autonomic Society, it was determined that an autonomic data dictionary comprising aspects of evaluation and management of pediatric patients with autonomic disorders would be an important resource for multiple stakeholders.

METHODS: Our group created the list of terms for the dictionary. Definitions were prioritized to be obtained from established sources with which …

Incorporating Sexual And Gender Minority Patient Care Competencies: A Case Based Curriculum For Caring For Gender Diverse Youth, Eileen Cichoskikelly, Suzanne Kingery, Susan Sawning

Faculty and Staff Scholarship

There is a gap in medical education training content specifically focused on the care of Sexual and Gender Minority (SGM) people and people with Differences in Sex Development (DSD). Inadequate training contributes to suboptimal health care access, utilization, and experiences among SGM-DSD people. Improving medical education training can be challenging as many clinician educators received sparse instruction themselves in these areas and there are limited teaching resources that expand beyond didactic instruction. In 2014 the Association of American Medical Colleges (AAMC) Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development published a landmark document identifying 30 specifiers of competence …

Ensuring Adequate Power: The Importance Of Statistically Significant Results In Osteopathic Research., Amanda Disabato

Medical Education Articles

No abstract provided.

Impact Of The Covid-19 Pandemic On The Education And Procedural Volume Of Fellows In Critical Care Medicine – A Cross-Sectional Survey, Orlando Garner, Kanta Velamuri, Kristen Staggers, Andrea Barbara Braun

Faculty, Staff and Students Publications

BACKGROUND: The COVID-19 pandemic has changed the way medical education is delivered. The purpose of this study was to assess the impact of the COVID-19 pandemic on the education and procedural volume of critical care and pulmonary critical care fellows.

METHODS: We conducted a cross-sectional, internet-based, voluntary, anonymous, national survey of adult critical care fellows and academic attending physicians in critical care and pulmonary critical care fellowship programs in the United States between December 2020 and February 2021. Survey questions covered both didactic and non-didactic aspects of education and procedural volumes. Answers were ranked on a 5-point Likert scale. Survey …

Magnetic Resonance Image-Based Estimates Of Hepatic Blood Flow In Children With And Without Obesity; Implications For Physiologically-Based Pharmacokinetic Models, Yoon Cho, Sherwin S. Chan, Chance S. Friesen, Valentina Shakhnovich

Research Days

Background: Physiologically based pharmacokinetic models for simulating drug pharmacokinetics are useful to guide drug dosing for pediatric patients. Hepatic blood flow could be a useful variable to use in these models.

Objectives/Goal: In this study, we explored 2-D phase contrast non-invasive magnetic resonance imaging (MRI) to measure hepatic blood flow in children with and without obesity.

Methods/Design: In this IRB-approved study, we imaged pediatric patients with abdominal MRI with 2D phase contrast imaging of the descending aorta (AO) at the diaphragm, the inferior vena cava (IVC) at the right atrium, and inferior to hepatic drainage above the renal vein confluence …

Persistent Pediatric Breast Abscesses Following Initial Treatment At Tertiary And Community Centers, Derek Marlor, Kayla Briggs-Groves, Shai Stewart Md, Nelimar Cruz-Centeno, Charlene Dekonenko, Jason D. Fraser

Research Days

Introduction: Little data exist on the management of pediatric breast abscesses that fail initial treatment. Therefore, this study aimed to evaluate and report outcomes in these patients.

Methods: All patients <18-years-old treated for a breast abscess between January 2008 and December 2018 were included. Patients were divided into 2 groups: initial treatment at our institution (Group 1) and initial treatment at referring centers (Group 2). The primary outcome was disease persistence following treatment at our institution. Secondary outcomes included treatment modalities and patient characteristics.

Results: In total, 145 patients were identified: 111 in Group 1 and 34 in Group 2. Antibiotics alone were the initial treatment in 52.3% (n=58) of Group 1 patients and 64.7% (n=22) of Group 2 patients. Invasive treatment was more common in Group 1 (45.9% vs 5.8%; p<0.00001). Patients with persistent disease in Group 1 were treated with aspiration (n=7, 50%), I&D (n=5, 35.7%), antibiotics (n=1, 7.14%), and manual expression (n=1, 7.14%.), while Group 2 patients were treated with antibiotics (50%, n=17), aspiration (26.47%, n=9), I&D (17.65%, n=6), and manual expression (5.88%, n=2). Group 2 patients with persistent disease were more likely to be treated with antibiotics or a change in antibiotics (50% vs 7.14%; p=0.005). Following treatment at our institution, the rate of persistent disease was similar between groups (12.6% vs 11.8%).

Conclusions: Persistent breast abscesses may be treated with antibiotics in appropriate cases. Damage to the developing breast bud should be minimized. Disease …

A Case Of Dock8 Deficiency Treated With Dupilumab, Melissa Anderson, Brandon D. Newell, Hugo Escobar, Erin Stahl, Nikita Raje

Research Days

Background: Dedicator of cytokinesis 8 gene (DOCK8) deficiency is an immune disorder associated with autosomal recessive hyper-IgE syndrome, characterized by elevated IgE levels, atopic dermatitis, and predisposition to recurrent skin and lung infections.

Objectives/Goal: A 12-year-old male presented to Immunology clinic for DOCK8 deficiency. He was diagnosed in infancy due to diffuse papulopustular eruption positive for candidiasis and known family history. Past medical history included severe eczematous dermatitis, asthma, interstitial lung disease, food allergies, and poor growth, with cutaneous HSV and fungal infections, HSV keratitis, and MRSA bacteremia. Family history was notable for two siblings with DOCK8 deficiency, both deceased. …

Is It Too Complex? A Survey Of Pediatric Residency Program's Educational Approach For The Care Of Children With Medical Complexity., Kira Sieplinga, Christopher Kruger, Emily J. Goodwin

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Although Entrustable Professional Activities (EPAs) regarding pediatric training in care for children with medical complexity (CMC) exist, it is unknown what US pediatric training programs provide for education related to care of CMC and whether educators perceive that pediatric residents are prepared to care for CMC upon graduation.

METHODS: From June, 2021 through March 2022, we surveyed US pediatric residency program delegates about practice settings, current educational offerings, perception of resident preparedness regarding care of CMC, and likelihood to implement CMC education in the future.

RESULTS: Response rate was 29% (56 /195). A third of responding programs (34%, n …

Respiratory Pathogen Panel Use In Hospitalized Infants <2 Months Of Age And Impact On Patient Management., Edward Lyon

Research Days

Background: Respiratory pathogen panels (RPP) are multiplex PCR platforms able to simultaneously detect several respiratory viruses. RPP utilization is not well described in infants < 2 months of age, who frequently require hospitalization for management of acute respiratory illness (ARI) and/or fever. Detection of a viral pathogen in this age group could impact the clinician’s decision to perform additional evaluation and administer antimicrobials.

Objectives/Goal: We sought to understand predictive features and clinical management impact of RPP use in infants < 2 months of age.

Methods/Design: Between October 2017 to September 2021, participants, aged < 18 years, hospitalized with an acute respiratory infection (ARI) were enrolled in Kansas City’s New Vaccine Surveillance Network (NVSN). Eligible patients were residents of Jackson County, had symptoms consistent with ARI (e.g., cough, fever, nasal congestion) lasting < 14 days, and enrolled within 48 hours of admission. For this study, only participants < 2 months of age were included. All participants had a research RPP, but results were not available to the clinician. Per provider discretion, some infants also received a clinical RPP (cRPP). Demographic characteristics, laboratory evaluations, and antimicrobial management were compared between infants with and without a cRPP.

Results: Of the 139 participants < 2 months of age, 57 (41%) had a cRPP (table 1). A cRPP was more frequently obtained in infants < 1 month of age (n=34 [47%]) compared with infants 1-2 months of age (n=23 [35%]; p=0.17). 35 (61%) participants with a cRPP had a parental report of fever while 41 (50%) of those without a cRPP had one reported. Only 20 (35.1%) of White, non-hispanic participants had a cRPP compared to 42 (51.2%) p=0.082 who did not have a cRPP. Participants who had blood or CSF culture collected were more likely to have a cRPP obtained, 47 (82.5%) p=

Conclusions: Overall, < 50% of infants < 2 months of age hospitalized with ARI received cRPP testing. Obtaining a blood or CSF culture was associated with increased cRPP usage. The length of stay was not different between the two groups. 35 viral infections went undetected in participants without a cRPP even with accounting for positive rapid NAAT testing, further investigation is needed to understand how this may influence clinical care.

Association Between Remote Monitoring And Interstage Morbidity And Mortality In Single Ventricle Patients Across Socioeconomic Groups, Bianca Cherestal

Research Days

Background: Despite improvements in outcomes over time, morbidity and mortality for infants with single ventricle (SV) heart disease remains high. Among other risk factors for mortality, infants of low socioeconomic status (SES) are known to be particularly vulnerable following stage 1 palliation.

Objectives/Goal: We sought to determine whether use of a novel remote monitoring program, CHAMP (Cardiac High Acuity Monitoring Program), mitigates differences in outcomes by SES for infants with SV during the interstage period.

Methods/Design: Using the CHAMP database, we identified 610 infants across 11 institutions enrolled in the program between 2014–2021. All enrolled patients’ families were provided with …

Pilot Study Using Sideline Hand-Grip Dynamometry To Assess Strength Changes In A High School Baseball Season: A Feasibility Study, Thomas Munro, Jason D. Yoderq, Brian R. Lee, Brian S. Harvey

Research Days

Background: Upper extremity injuries are common in baseball players. Objective measurements could assist in determining early signs of fatigue before injury occurs. Using HGD to measure strength changes may help identify early signs in the injury process. To our knowledge, HGD has not been tested on high school baseball players in the sideline setting. It is feasible to perform hand-grip dynamometry on-site at the high school level and HGD measurements will change throughout the season in varsity baseball athletes. Secondary aim: Asses HGD measurement in the context of injury/pain/fatigue/pitching.

Objectives/Goal: It is feasible to perform hand-grip dynamometry on-site at the …

Therapeutic Plasma Exchange To Alleviate Ventricular Tachycardia After Diphenhydramine Ingestion, Kaushal Dosani, Lejla Music Aplenc, Stephen Pfeiffer

Research Days

Background: The Covid-19 pandemic has adversely affected the mental health of children causing an increased incidence of suicide attempts. Diphenhydramine is a common household medication and is frequently ingested by children. Toxic doses of diphenhydramine can affect the cardiovascular and central nervous system. In the heart, diphenhydramine blocks fast sodium channels and potassium channels which can result in conduction abnormalities including sinus tachycardia, widening of QRS duration, ventricular tachycardia and torsades de pointes. Massive ingestion can cause severe cardiovascular collapse which may require ECMO support

Objectives/Goal: To describe a novel method of clearing highly protein-bound diphenhydramine molecules from circulation after …

Genes Predictive Of Aggressive Infant Acute Lymphoblastic Leukemia, Meghana Bhumireddy

Research Days

Background: Acute Lymphoblastic Leukemia (ALL) is a rapidly progressive cancer in which the bone marrow makes too many immature leukocytes that divide uncontrollably. KMT2A, or MLL, is a methyltransferase found in many types of leukemia, whose rearrangement (KMT2A-r) is present in approximately 2/3 of infants with ALL. KMT2A-r is associated with a very poor prognosis: roughly ⅔ of patients relapse within 1 year of diagnosis, and the relapsed KMT2A-r ALL is resistant to treatment (having nearly 100% morality). We explored gene expression in patient samples from three groups at diagnosis: KMT2A-r patients who relapsed, KMT2A-r patients who did not relapse, …

Drug Metabolizing Enzymes And Transporters May Help Determineeffective Budesonide Dosing In Eoe, Laurie Mccann, Lisa Harvey, Norah Almahbub, Wendy Y. Wang, Erin C. Boone, Janelle R. Noel-Macdonnell Phd, Rachel Chevalier

Research Days

Background: Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder diagnosed in children with painful or difficult swallowing, vomiting, or poor weight gain. Current treatment models adopt a trial-and-error approach in regard EoE treatment, including restrictive elimination diets, proton pump inhibitors, and topical budesonide. This approach can delay effective treatment which increases risk of disease progression and increases medical costs to families for frequent clinic visits and endoscopy.

Objectives/Goal: The objective of this study is to determine the CYP3A5 genotype and expression of patients with eosinophilic esophagitis to discover which patients will respond to standard dosing of topical budesonide treatment (1, …

Degree Of Uncertainty In Reporting Imaging Findings For Necrotizing Enterocolitis: A Secondary Analysis From A Pilot Randomized Diagnostic Trial, Disa Rathore, Kira Bourrett, Sherwin S. Chan, Erin Opfer, Alain Cuna

Research Days

Background: Uncertainty in reporting of imaging findings for necrotizing enterocolitis (NEC) can be challenging for clinicians and result in ambiguity, miscommunication, and potential diagnostic errors. The degree to which uncertainty complicates diagnostic imaging for NEC has not been characterized.

Objective: To determine the degree of uncertainty in diagnostic imaging for NEC.

Methods: We conducted a retrospective study using data from a previously completed pilot diagnostic randomized clinical trial (RCT). The study population comprised of preterm infants with suspected NEC who were randomized to either standard imaging with abdominal radiographs (AXR) alone or experimental imaging with AXR + add-on bowel ultrasound …

Management Of Primary Spontaneous Pneumothorax In Children: A Single Institution Protocol Analysis, Shai Stewart Md, James Fraser, Nelimar Cruz-Centeno, Derek Marlor, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Tolulope A. Oyetunji, Shawn D. St.Peter

Research Days

Background: Primary spontaneous pneumothorax (PSP) affects 3.4 per 100,000 children in the United States. Regardless of the initial management, additional procedures, and prolonged hospital length of stay (LOS) may occur. There is currently no consensus in the pediatric surgical community on the optimal management of these patients, which has resulted in marked variability in management. The Midwest Pediatric Surgery Consortium (MWPSC), of which our site is a participant, suggested a management algorithm to include simple aspiration upon presentation, and if this fails, VATS should be considered.

Objectives/Goal: The purpose of this study was to evaluate the outcomes of instituting a …

Institutional Outcomes Of Blunt Liver & Splenic Injury In The Atomac Era, Shai Stewart Md, James Fraser, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Shawn D. St.Peter, Tolulope A. Oyetunji

Research Days

Background: The Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium (ATOMAC) practice management guideline (PMG) was created to standardize management of blunt liver or spleen injury (BLSI) across pediatric trauma centers. Evaluations of institutional outcomes after its adoption remain scarce. We describe our outcomes since PMG adoption at our institution.

Objectives/Goal: The purpose of this study was to assess patient outcomes and resource utilization after implementation of this protocol. We hypothesized there is no difference in length of stay (LOS) or complications regardless of grade of isolated injuries to the liver or spleen. In addition, there is limited guidance on the management of concurrent injuries to …

Laparoscopic Versus Open Inguinal Hernia Repair: A Single Institution Comparison Of 1200 Patients, Shai Stewart Md, Wendy Jo Svetanoff, James Fraser, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Shawn D. St.Peter, Tolulope A. Oyetunji

Research Days

Background: : Laparoscopy has become the standard of care for many pediatric surgical procedures; however, there is no consensus regarding the optimal approach for inguinal hernia repair (IHR). We report our experience over an 8-year period with open and laparoscopic inguinal hernia repair (LIHR).

Objectives/Goal: We aim to describe our experience within a free-standing tertiary care pediatric institution and compare outcomes between open and laparoscopic repair of pediatric inguinal hernias.

Methods/Design: A retrospective review of patients under 18 years who underwent IHR between June 2010 and June 2017 was performed. The open technique utilizes high ligation of the internal ring, …

“There’S A Difference In Practice When You Have To Make The Decision”: Autonomy In Pediatric Emergency Medicine Fellowship, Katherine Dunne, Vivek Dubey, Sarkan Toy, Camryn Martinez, Kelsey Gavin, Christopher S. Kennedy

Research Days

Background: The Accreditation Council for Graduate Medical Education allows individual training programs to define appropriate supervision and autonomy commensurate with the trainees’ knowledge, clinical competence, and patient complexity and acuity. In pediatric emergency medicine (PEM), supervision is not standardized and subject to supervisor discretion, creating variability in trainee autonomy.

Objectives/Goal: To explore the concept of autonomy from the perspectives of PEM fellows and faculty.

Methods/Design: We conducted a qualitative study consisting of semi-structured interviews of PEM fellows and faculty from a large, single-center pediatric emergency medicine fellowship program. A trained interviewer conducted the interviews over an electronic interview platform. Audio …

A Novel Approach For Laparoscopic Direct Inguinal Hernia Repair In Children, Shai Stewart Md, Charlene Dekonenko, Nelimar Cruz-Centeno, Derek Marlor, Jason D. Fraser

Research Days

Background: Inguinal hernia repair is one of the most common operations performed by pediatric surgeons, and the frequency of laparoscopy for repair is increasing. The vast majority of these are indirect hernias and therefore how to best repair a direct defect when seen during laparoscopy is still unknown. Simple high ligation of the hernia sac (as is done in an indirect hernia) does not repair the inguinal floor weakness/defect seen in a direct hernia.

Objectives/Goal: We therefore present a case of laparoscopic bilateral indirect and direct inguinal hernia repair, commonly known as pantaloon hernia, repaired without mesh and utilizing the …

Antibiotic Monotherapy Vs Dual-Drug Therapy In Perforated Appendicitis: Single Center Retrospective Review, Shai Stewart Md, Nelimar Cruz-Centeno, Derek Marlor, Dae H. Kim, Shawn D. St Peter, Tolulope A. Oyetunji Md Mph

Research Days

Background: The optimal antibiotic regimen in perforated appendicitis to reduce intraabdominal abscess (IAA) formation has not yet been agreed upon in the pediatric surgery community. We aimed to evaluate the outcomes of patients with perforated appendicitis when intravenous antibiotic monotherapy with Piperacillin-Tazobactam (PT) versus dual-drug therapy with Ceftriaxone and Metronidazole (CM) are administered. We hypothesized there is no difference in the rate of IAA formation with antibiotic monotherapy, as opposed to our once-daily dosed, institutional standard dual-drug therapy.

Objectives/Goal: The goal was to determine if our current management protocols for acute appendicitis were delivering the best possible results for our …

A Comparison Of Large Tbsa Scald Versus Flame Burns In Young Children, Ashley Daniel

Research Days

Background: It is generally accepted that of children with the same total body surface area of burns, those with flame burns seem to have longer lengths of stay and more complications than those with scald burns. Anecdotally we have seen the opposite to be true. Among a consortium of five US pediatric burn centers participating in the Pediatric Injury Quality Improvement Collaborative (PIQIC), young children with scald burns seem to experience disproportionately more frequent and severe complications compared to their older counterparts and compared to patients of a similar age with flame burns.

Objectives/Goal: In this multi-institutional study, we compared …

Relationship Between Rurality And Access To Care For Families Of Hospitalized Children, Zoetta L. Mcloughlin Md

Research Days

Background: At Children’s Mercy Hospital, greater than 1 in 5 hospitalized children are from rural areas. Rural families often travel long distances for hospitalization at free-standing children’s hospitals, a median of 70 miles according to recent work. Rural families are more likely than non-rural families to experience financial insecurity, and these baseline hardships may be intensified during hospitalization due to out-of-pocket costs, lost work, inability to meet family needs, and removal from social support. However, little is known about the differences in healthcare access and resulting burdens between rural and non-rural families.

Objectives/Goal: To describe differences in demographics, health care …

Rural And Urban Caregiver Experiences Of Financial Strain And Food Insecurity During Pediatric Hospitalizations, Rachel E. Granberg

Research Days

Background: Stress is common among caregivers of hospitalized children. In addition to stress related to their child’s illness, caregivers experience stress related to financial strain and food insecurity during their child’s hospitalization. The burden of financial strain and food insecurity related to pediatric hospitalizations may vary between rural and urban populations.

Objectives/Goal: To identify financial strain and food insecurity experienced by caregivers of hospitalized children and to describe differences between rural and urban populations.

Methods/Design: A prospective cross-sectional survey enrolled a random sample of caregivers of hospitalized children between 8/31/2021 and 12/2/2022 at a single children’s hospital. Demographic information was …