Medical Specialties Commons^™

Inpatient Outcomes For Children Receiving Empiric Methicillin-Resistant Staphylococcus Aureus Coverage For Complicated Pneumonia, Sophia Hackman

Research Days

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Background: Pediatric community acquired pneumonia is responsible for an estimated 124,000 hospitalizations annually in the United States, with up to 40% of hospitalized children subsequently developing a complicated pneumonia (i.e., effusion/empyema). Children with complicated pneumonia commonly require increased numbers of procedures, have exposure to broad-spectrum antibiotics, and have prolonged hospitalizations. While the prevalence of pneumonia has overall declined with childhood vaccination, the number of children with complicated pneumonia has remained stable. Current guidelines do not adequately address antibiotic management of pediatric complicated pneumonia specifically when to utilize methicillin-resistant Staphylococcus aureus (MRSA) coverage, likely contributing to …

Improving Antibiotic Durations For Skin And Soft Tissue Infections In Pediatric Urgent Care Clinics, Megan Hamner

Research Days

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Problem Statement/Question: Although national guidelines recommend 5-7 days of oral antibiotics for most skin and soft tissue infections (SSTIs), in 2019, CMH urgent care clinics (UCCs) prescribed > 7-day courses for 42% of patients diagnosed with SSTIs. Prolonged antibiotic courses result in increased patient burden, cost and adverse events which could be prevented by prescribing shorter courses.

Background/Project Intent (Aim Statement): To increase the percentage of patients receiving 5- 7 days of oral antibiotics for SSTIs from 58% to 75% by December 31st, 2021, in CMH UCCs.

Methods (include PDSA cycles): We formed a multidisciplinary team …

A Novel Approach To Triosephosphate Isomerase Deficiency, Kyra Mccarty

Research Days

Background: Triosephosphate isomerase deficiency (TPID) is a glycolytic pathway enzymopathy causing hemolytic anemia and neurologic dysfunction. TPID is caused by mutations in the TPI1 gene. These patients experience severe hemolytic anemia in infancy followed by progressive neurodegeneration. Diagnosis of TPID is made by measuring decreased TPI enzyme activity elevated dihydroxyacetone phosphate (DHAP) levels in the blood. The diagnosis is confirmed by molecular genetic testing. Neurological involvement typically manifests between 6 and 24 months of age, causing progressive motor dysfunction. Chronic axonal neuropathy is often present on nerve biopsy, and peripheral neuropathy is evident on electrophysiologic studies. Splenectomy and blood transfusions …

Supraclavicular Neck Mass In A 14 Month Old Boy, Jana Ghulmiyyah

Research Days

Background: Lipoblastoma is a rare benign tumor arising from embryonic fat cells in children younger than 3 years of age. They rarely present in the neck and usually do not have spindle cell appearance. We therefore present a case of neck lipoblastoma with review of the literature.

Case Description: We present the case of a 14-month-old male who presented with 1 month history of a right supraclavicular neck mass that was enlarging gradually. On physical exam, it was non tender, mobile with no overlying skin changes. Patient did not have any respiratory distress. A fine needle aspirate (FNA) showed spindle …

Diagnostic Features And Clinical Outcomes Of Children With Tubulointerstitial Nephritis And Uveitis Syndrome (Tinu), Christian Oliveros

Research Days

Background: Tubulointerstitial nephritis and uveitis (TINU) syndrome is an inflammatory disease that affects the kidneys and eyes. TINU is rare, but likely under-recognized due to variable clinical presentation, nonspecific symptoms, and lack of universally accepted diagnostic criteria. The optimal treatment approach in children with TINU remains unknown.

Objectives/Goal: The purpose of this case series is to contribute further knowledge to this rare disease by describing disease features and treatment response of patients with TINU treated at a single center.

Methods/Design: A retrospective chart review was performed of children diagnosed with TINU at a single tertiary care children’s hospital since January …

Primary Venous Thromboprophylaxis In Pediatric Oncology Patients, Kyra Mccarty

Research Days

Background: The Virchow’s Triad principles of venous stasis, endothelial damage, and hypercoagulability are all features of malignancy and contribute to the increased risk venous thromboembolism (VTE) seen in oncology patients. Additionally, certain chemotherapy treatments, presence of a central venous catheter and immobility are also intrinsically associated with malignancy diagnoses and exacerbate this risk. However, much debate exists over the use of thromboprophylaxis in the pediatric population, primarily due to lack of evidence regarding safety and efficacy, primarily the risk of major bleeding. Multiple retrospective studies have attempted to identify the primary risk factors for VTE in this pediatric oncology patient …

Development Of Medical Alert Cards Using Structured Data To Assist In The Management Of Children With Anorectal Malformation, Cloaca, And Cloacal Exstrophy, Ninad Prasade

Research Days

Introduction: Anorectal malformations (ARM), including cloaca and cloacal exstrophy, are a rare collection of congenital disorders of the distal hindgut resulting in lifelong anatomic and functional impairments. Children with ARM may often have other congenital anomalies in the VACTERL association (vertebral, anorectal, cardiac, tracheoesophageal fistula, renal, limb), leading to anatomic variations and prior surgeries that require consideration in diagnosis and management. Patients with these conditions may have multiple presentations to the healthcare system. Understanding emergencies specific to these conditions can enable patients' families and providers to quickly recognize important anatomic variations and initiate care management.

Aim: Our study aimed to …

Identify Factors Associated With Excessive Corneal Haze Noted To Have Increased In Frequency Over The Last 6 Months Post Corneal Cross-Linking Procedure, Sonal Dangda

Research Days

Problem Statement/Question: Over the past 6 months, increased post-operative corneal haze and decreased vision was noted in patients following corneal crosslinking for keratoconus.

Background/Project Intent (Aim Statement): Identify factors that may contribute to increased postprocedure haze and analyze these factors for the total cohort of crosslinking patients since 2017. The goal of this study is to ensure that the increased haze is due to unique patient factors and not an external cause.

Methods (include PDSA cycles): Patients who underwent corneal cross-linking between January 2017 – December 2021 were identified. Retrospective data was collected at baseline visit, at one-month postcrosslinking and …

Outcomes Of A Quality Improvement Project: Implementing Trauma Informed Care In A Neonatal Intensive Care Unit, Jennie Godwin

Research Days

Problem Statement/Question: Will providing Trauma Informed Care (TIC) education to physicians in a large Level IV NICU increase their uptake and implementation of TIC practices?

Background/Project Intent (Aim Statement): The experience of being hospitalized in a Neonatal Intensive Care Unit (NICU) is recognized as a traumatic stressor to both the infants and their families. Physicians working in the NICU experience indirect traumatization and are at risk for burnout. Trauma Informed Care (TIC) can increase effectiveness of healthcare delivery, ensure that staff, policies and procedures do not cause unintentional harm, promote staff resilience, and improve the overall quality of the patient …

Initiating Coordination Of Care For Children In State Custody Or Shelter Care, Angela Doswell

Research Days

Problem Statement/Question: Children in the foster care system experience barriers to continuity of care, both in the primary and subspecialty outpatient settings.

Background/Project Intent (Aim Statement): To decrease average percentage of scheduled but missed specialty appointments whose initial referrals were placed in the Foundations Foster Care Clinic (FCC) from 40% to 20% over a 10- month period from March-December 2020.

Methods (include PDSA cycles): Referrals to specialty clinics were placed during an initial or follow-up visit in the Foundations Foster Care Clinic (FCC). One PDSA cycle was performed and involved notification of the patient’s case worker when a referral was …

Improving Transition To Adult Care Discussion In A Diabetes Clinic, Erica Wee, Erica Zarse, Lindsay Baldridge

Research Days

Problem Statement: Diabetes mellitus is a chronic condition requiring complex care. Adolescents with diabetes face challenges when transitioning to an adult care setting which can lead to suboptimal glycemic control and emergence of complications. It is important for a pediatric diabetes clinic to provide support and prepare adolescents for success when they transfer to adult care.

Aim Statement: In our diabetes clinic, patients are eligible for transition assessment if they are over age 17 years without a documented discussion in the past 1 year. A review of clinic data between October 2021 and November 2021 revealed that an average of …

Nasal Chondromesenchymal Hamartoma: A Case Report And Review Of The Literature, Jana Ghulmiyyah

Research Days

Background: Nasal chondromesenchymal hamartoma (NCMH) is a rare benign tumor of the sinonasal cavity. It commonly presents in infancy, however there are reported cases of adult tumors. As of August 2021, there have been 56 reported cases in the literature. This is the first description of a solely endoscopically resected NCMH in a neonate in addition to a review of the literature.

Case Presentation: A 5-day old male patient born at term presented to our institution for stridor and cyanosis since birth. The patient was reported to have desaturations while feeding at the outside hospital. On bedside examination, the patient …

Diagnosis, Management, And Treatment Of Lymphadenitis And Deep Neck Space Infections At A Children’S Hospital, Aaron Shaw

Research Days

Background: Although cervical lymphadenitis and deep neck space abscesses (DNSA) are relatively common pediatric diagnoses, no standardized approach exists for management of these infections.

Objectives/Goal: To assess variability in diagnosis and treatment of cervical lymphadenitis and DNSA in a children’s hospital.

Methods/Design: Charts were obtained using ICD9/10 codes for diagnoses of retropharyngeal and parapharyngeal abscess, and lymphadenitis between 1/1/10-12/31/20. 1,237 charts were identified. Patients with a retropharyngeal and/or parapharyngeal abscess were defined as DNSA. Charts were excluded if the diagnosis was not a bacterial infection (e.g. Kawasaki disease), if the lymphadenitis was not in the neck, or if caused by …

Automating A Well Child Visit, Daniel Merrill

Research Days

No abstract provided.

Impact Of Social Media On Safe Sleep, Robin Wolschdorf, Jennifer Hayman, Logan Murray

Costas T. Lambrew Research Retreat 2022

About 3,500 babies under one year of age die from sleep related complications annually in the United States1. Pediatricians and other health care professionals have a responsibility to counsel families on safe sleep practices to prevent these complications. The American Academy of Pediatrics recommends discussing safe sleep before discharge from the hospital and every newborn visit in the outpatient setting2. This can be done with using the message of the “ABC’s” of safe sleep: Alone on their

Back in a

Crib or bassinette

Comparison Of Clinical Outcomes Following Osteochondral Allograft Transplantation For Osteochondral Versus Chondral Defects In The Knee, John Reza Matthews, Joseph Brutico, Jeremy Heard, Kashyap Chauhan, Bradford Tucker, Kevin Freedman

Rothman Institute Papers

Purpose: Osteochondral allograft (OCA) transplantation is a restorative technique for addressing articular cartilage defects by transferring mature viable chondrocytes with subchondral bone into size-matched lesions. The purpose of this study was to compare differences in clinical and functional outcomes in patients treated with OCA for osteochondral defects compared with isolated chondral pathology.

Methods: A retrospective review identified patients who underwent OCA transplantation and grouped them into osteochondral or isolated chondral pathology. Demographic data, surgical history, lesion characteristics, complications, and rate of subsequent surgery were reviewed. The review included 86 patients (24 osteochondral, 62 chondral) with a mean follow-up of 5.4 …

Alzheimer’S Disease Drug Development Pipeline: 2022, Jeffrey Cummings, Garam Lee, Pouyan Nahed, Mina Esmail Zadeh Nojoo Kambar, Kate Zhong, Jorge Fonseca, Kazem Taghva

Brain Health Faculty Research

Introduction Alzheimer's disease (AD) represents a global health crisis. Treatments are needed to prevent, delay the onset, slow the progression, improve cognition, and reduce behavioral disturbances of AD. We review the current clinical trials and drugs in development for the treatment of AD. Methods We searched the governmental website clinicaltrials.gov where are all clinical trials conducted in the United States must be registered. We used artificial intelligence (AI) and machine learning (ML) approaches to ensure comprehensive detection and characterization of trials and drugs in development. We use the Common Alzheimer's Disease Research Ontology (CADRO) to classify drug targets and mechanisms …

Assessing The Coverage Of Us Cancer Center Primary Catchment Areas., Amy E Leader, Christopher Mcnair, Christina Yurick, Matthew Huesser, Elizabeth Schade, Emily E Stimmel, Caryn Lerman, Karen E Knudsen

Kimmel Cancer Center Faculty Papers

Background: Cancer centers are expected to engage communities and reduce the burden of cancer in their catchment areas. However, the extent to which cancer centers adequately reach the entire US population is unknown. Methods: We surveyed all members of the Association of American Cancer Institutes (N ¼ 102 cancer centers) to document and map each cancer center’s primary catchment area. Catchment area descriptions were aggregated to the county level. Catchment area coverage scores were calculated for each county and choropleths generated representing coverage across the US. Similar analyses were used to overlay US population density, cancer incidence, and cancer-related mortality …

Elucidating Human Milk Oligosaccharide Biosynthetic Genes Through Network-Based Multi-Omics Integration, Benjamin P Kellman, Anne Richelle, Jeong-Yeh Yang, Digantkumar Chapla, Austin W T Chiang, Julia A Najera, Chenguang Liang, Annalee Fürst, Bokan Bao, Natalia Koga, Mahmoud A Mohammad, Anders Bech Bruntse, Morey W Haymond, Kelley W Moremen, Lars Bode, Nathan E Lewis

Children’s Nutrition Research Center Staff Publications

Human Milk Oligosaccharides (HMOs) are abundant carbohydrates fundamental to infant health and development. Although these oligosaccharides were discovered more than half a century ago, their biosynthesis in the mammary gland remains largely uncharacterized. Here, we use a systems biology framework that integrates glycan and RNA expression data to construct an HMO biosynthetic network and predict glycosyltransferases involved. To accomplish this, we construct models describing the most likely pathways for the synthesis of the oligosaccharides accounting for >95% of the HMO content in human milk. Through our models, we propose candidate genes for elongation, branching, fucosylation, and sialylation of HMOs. Our …

Plant Based Polyphenols Decrease Cell Migration And Inhibit Proliferation Of Human Pancreatic Cancer Cells, Mary Gathoni

Electronic Theses & Dissertations

Pancreatic cancer is one of the most highly malignant tumors of the digestive tract. Both the incidence and death rate of pancreatic cancer have increased since 2000. The disease has a poor prognosis with a relative 5-year survival rate of 10%. Pancreatic cancer-related mortality can be mainly attributed to lack of early diagnosis, tumor metastasis, lack of effective treatment strategies and drug resistance. There has been a mounting interest on the use of plant-based compounds such as polyphenols in cancer treatment therapies. This is mainly due to their low toxicity and fewer side effects compared to the conventional chemotherapeutic options …

How Program Directors Understand General Surgery Resident Wellness, Darci C. Foote, Julie Evans, Tedi Engler, Alisha Lussiez

Conference Presentation Abstracts

No abstract provided.

Burnout In Pediatric Nephrology Fellows And Faculty: Lessons From The Sustainable Pediatric Nephrology Workforce Project (Superpower)., Susan M. Halbach, Kartik Pillutla, Patricia Seo-Mayer, Alan Schwartz, Darcy K. Weidemann, John D. Mahan

Manuscripts, Articles, Book Chapters and Other Papers

Physician well-being is an important contributor to both job satisfaction and patient outcomes. Rates of burnout among physicians vary by specialty, ranging from 35 to 70%. Among pediatric residents, longitudinal data demonstrates consistent rates of burnout around 50-60%, although little is known about burnout among pediatric subspecialty fellows. Specifically, the degree of burnout among pediatric nephrologists remains unknown, as does the impact faculty burnout may have on trainee burnout. We sought to evaluate prevalence and predictors of burnout among US pediatric nephrology fellows and faculty, and assess for interactions between groups. In this multi-center pilot survey of all United States …

A Bayesian Group Sequential Design For Randomized Biosimilar Clinical Trials With Adaptive Information Borrowing From Historical Data, Wen Zhang, Zhiying Pan, Ying Yuan

Faculty, Staff and Student Publications

At the time of developing a biosimilar, the reference product has been on market for years and thus ample data are available on its efficacy and characteristics. We develop a Bayesian adaptive design for randomized biosimilar clinical trials to leverage the rich historical data on the reference product. This design takes a group sequential approach. At each interim, we employ the elastic meta-analytic-predictive (EMAP) prior methodology to adaptively borrow information from the historical data of the reference product to make go/no-go decision based on Bayesian posterior probabilities. In addition, the randomization ratio between the test and reference arms is adaptively …

Large Single Center Experience In Pediatric Oncology And Bone Marrow Transplant Patients On Ecmo: How Should We Decide Candidacy?, Jordan Marquess

Research Days

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Background: ECMO is rarely utilized in pediatric oncology and bone marrow transplant (BMT) populations due to concerns surrounding poor prognoses and high rates of complications. Patients with malignancies are often not offered ECMO as an option. There is paucity of data to determine whether a pediatric oncology or bone marrow transplant patient is an appropriate candidate for ECMO.

Methods: This is a single center retrospective cohort study on pediatric patients with primary oncologic diagnosis or history of bone marrow transplant who required VA- or VV-ECMO from 2015-2020.

Results: Twelve patients were identified with a 58% …

Admission Pao2 And Mortality Among Pediatric Icu Patients And Critically Ill Subgroups, Cara Holton

Research Days

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Background and Objectives: Studies analyzing the association between hyperoxia and mortality in critically ill pediatric patients and those admitted after cardiac arrest are conflicting and limited by small sample sizes. The aim of this study is to evaluate the association between PaO2 on admission to the pediatric ICU and mortality in a heterogeneous, multicenter cohort and among subgroups of critically ill patients.

Methods/Design: A retrospective cohort study was conducted using data from Virtual Pediatric Systems (VPS) database. VPS is a clinical pediatric critical care database with over 135 participating hospitals in North America. All VPS …

Safety, Timing And Outcomes Of Early Postoperative Cardiac Catheterization Following Congenital Heart Surgery, Karoline Krzywda

Research Days

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Background: Early postoperative ( < 6weeks) cardiac catheterization (EPOCC) has been considered high risk and often delayed. Recently, the safety of EPOCC has been demonstrated. The optimal timing of catheterization and its outcomes in struggling postoperative patients remains uncertain.

Objective: To describe EPOCC in our center and its impact on length of stay (LOS), number of mechanical ventilation days, number of ECMO days, and catheter-based interventions.

Methods: This is a retrospective cohort study of patients who underwent cardiac surgery between 01/01/2010 and 12/31/2019 and EPOCC within 30 days after surgery. Cohorts were early EPOCC (≤72 hr) vs late EPOCC ( >72 hr). Data on timing, indication, and complications of EPOCC; days of mechanical ventilation and ECMO; and CICU/total hospital LOS were collected. Data was analyzed using chi-square and Student’s t-test, …

Ekg Technology: It Is Time For A Change!, Megan Carroll

Research Days

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Background: Technology for obtaining pediatric EKGs has not changed in over 70 years. Current guidelines recommend a 12-lead EKG, which takes approximately 7 minutes to complete. Newer adult technology utilizes between 1-6 leads for EKG analysis. There has not been a study in pediatrics to assess the minimum number of leads required to attain diagnostic accuracy.

Objectives/Goal: To determine the appropriate number of leads needed to read pediatric EKGs safely and accurately.

Methods/Design: This is a single center systematic review that included randomly selected EKGs from our hospital database (2017-2020) read by two independent pediatric …

Increased Prevalence Of Parenteral Nutrition-Associated Liver Disease In Neonates With Congenital Heart Disease, Yasasvhinie Santharam

Research Days

Background: A life-sustaining therapy, use of total parenteral nutrition (TPN) allows for meeting nutritional needs of low birth weight, premature, or otherwise complex infants with conditions that prevent feeding through the GI tract. However, 40-60% of infants on long-term TPN have been shown to develop parenteral nutrition-associated liver disease (PNALD)1 , a serious condition characterized by cholestatic jaundice, steatosis, and hepatic fibrosis. Given these risks, providers must account for risk of hepatic injury when prescribing TPN, including attributes of gestational age, infection, surgical and diagnosis history2-6 . Yet with a multifactorial pathogenesis, significant heterogeneity in PNALD incidence still occurs. Looking …

Pharmacometabolomics Profiling Of Preterm Infants Validates Patterns Of Metabolism Associated With Response To Dexamethasone Treatment For Bronchopulmonary Dysplasia, Bradley C. Stockard

Research Days

Background: Bronchopulmonary dysplasia (BPD) is one of the most common health complications of premature birth. Corticosteroids are commonly used for treatment of BPD, but their use is challenging due to variability in treatment response.

Objectives/Goal: Previous pharmacometabolomics study has established patterns of metabolite levels with response to dexamethasone. We obtained additional patient samples for metabolomics analysis to find associations between the metabolome and dexamethasone response in a validation cohort.

Methods/Design: 14 infants provided 15 plasma and 12 urine samples. The measure of treatment response was the calculated change in respiratory severity score (deltaRSS) from pre-to-post treatment. Each metabolite was assessed …

Patient-Facing Antihemophilic Factor Clinical Decision Support Tool, Chandni Dargan

Research Days

Background: Hemophilia represents a medical condition suited to individualization. Adherence with prophylactic antihemophilic factor regimens ranges from 6%-167%. Clinical decision support tools (CDS) have been shown to improve guideline compliance and enhance patient adherence.

Objectives/Goal: The objective of this study is to evaluate the usability, usefulness, and satisfaction of a pharmacology-driven, patient-facing antihemophilic factor CDS.

Methods/Design: A patient-facing CDS was created to allow patients and families to explore factor levels at any time during their regimen and with the administration of different dosing regimens. Development followed a user-centered design process to ensure development of a product targeted to the needs …