Pediatrics Commons^™

Longitudinal Assessment Of Moral Distress And Burnout During Pediatric Residency In A Canadian Site: Low Prevalence But Notable Risk Of Attrition, Kenneth S. Lee, Dianna C. Louie, Elaine O. Cheung, Peter Dodek, Dylan King, Kimee Chong

Journal of Wellness

Introduction: Although more than half of pediatric residents report burnout, the incidence of moral distress, the course of moral distress and burnout during residency, and associations between this course and personal characteristics of residents are unknown. The purpose of this work was to examine the incidence, temporal course, and associations of moral distress and burnout in pediatric residents.

Methods: In the pediatric training program of British Columbia Children’s Hospital, all residents were invited to complete the Moral Distress Scale-Revised thrice yearly, and the Maslach Burnout Inventory annually, between July 2016 and October 2018. In addition, residents reported a measure of …

Systemic Challenges In Pediatric Healthcare: Exploring Reimbursement Disparities And Their Impact On Healthcare Equity, Jessica Ford-Davis, Alexandra Gillette

Theses, Dissertations and Capstones

Introduction: Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) have provided health coverage for over 135 million Americans, with Medicaid playing a significant role in financing pediatric healthcare. Medicaid covers a wide range of services for children, particularly those from low-income families or with special healthcare needs, including preventive care, immunizations, vision and dental services, and mental health treatments. However, Medicaid reimbursement rates are lower compared to Medicare and private insurance, in some cases 30.6% lower, and have often been insufficient to cover the full cost of care, contributing to financial losses for children's hospitals. Despite these challenges, nearly …

Closing The Communication Gap: A Quality Improvement Approach To Safer Shift Changes And Transfers, Stephanie O'Kresik Jewette, Annette Santiago

East Florida Division GME Research Day 2025

No abstract provided.

Seizure Action Plan, Ian Holt, Sy Jama

East Florida Division GME Research Day 2025

No abstract provided.

Breaking The Blockade: A Retrospective Analysis Of Pediatricconstipation In Hospitalized Patients, Yenamala Reddy, Jaicy Pottokaran, Eric K. Shaw, Aimee Behnke, Jean B. Wiggins, Lauren Hebert, Norman Taylor Parks

South Atlantic Division GME Research Day 2025

No abstract provided.

Closing Racial And Ethnic Disparity Gaps In Pediatric Asthma Follow Up Care - A Quality Improvement Initiative, Ayodele Ayeko

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Closing racial and ethnic disparity gaps in pediatric asthma follow up care - A quality improvement initiative

Ayodele Ayeko

Introduction/Background: Inadequate management of asthma significantly contributes to poor asthma control, poor quality of life (QOL), and high hospitalization rates among pediatric patients. The Global Initiative for Asthma (GINA) guidelines offer recommendations designed to enhance asthma control and improve the quality of life for those affected (2015), including recommendations for close follow up care. At WVU Medicine Children’s Hospital (WVUMCH), insufficient asthma control has been associated with lower clinic follow-up rates and an increase in hospitalization. Although educational initiatives …

A Quality Improvement Initiative Using Discharge Education Videos To Improve Communication With Families In A Pediatric Urgent Care, Hannah G. Carron, Gisella Valderrama, Adam A. Vukovic

Patient Experience Journal

Introduction: Effective discharge communication, often given in verbal and written form, during pediatric acute healthcare visits positively impacts caregiver satisfaction and competency in providing at-home care. Institutions are beginning to incorporate evidence-based, and standardized multimedia education to try to further improve these outcomes.

Methods: For this QI initiative, educational videos were created and shown to families prior to discharge from a pediatric urgent care. PDSA cycles focused on development of an electronic medical record (EMR) order to provide video education, a best practice alert regarding this order, and recurrent staff education. The primary outcome measure was the percentage …

Cutaneous Adverse Effects From Diabetes Devices In Pediatric Patients With Type 1 Diabetes Mellitus: Systematic Review, Alicia Podwojniak, Joseph Flemming, Isabella J Tan, Hira Ghani, Zachary Neubauer, Anne Jones

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusions (CSIIs) are the current standard treatment devices for type 1 diabetes (T1D) management. With a high prevalence of T1D beginning in pediatrics and carrying into adulthood, insufficient glycemic control leads to poor patient outcomes. Dermatologic complications such as contact dermatitis, lipodystrophies, and inflammatory lesions are among those associated with CGM and CSII, which reduce glycemic control and patient compliance.

OBJECTIVE: This systematic review aims to explore the current literature surrounding dermatologic complications of CGM and CSII as well as the impact on patient outcomes.

METHODS: A systematic review of the …

Self-Harm In Female Youth With Undiagnosed Adhd: Implementing American Academy Of Pediatrics Screening Guidelines, Roselie M. Woodard

Dissertations

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. If undiagnosed or untreated, ADHD can lead to severe psychosocial issues such as academic failure, substance abuse, unplanned pregnancy, and incarceration. The financial burden in the U.S. from diagnostic errors creates an immense, rising fiscal impact. Early diagnosis and management are crucial to prevent these complications.

Females with ADHD, particularly those with the inattentive subtype, often face diagnostic challenges due to symptom masking and over-compensation. This results in poorer cognitive functioning and self-esteem compared to males with ADHD. ADHD is linked to autonomic nervous …

Bridging The Gap: Psychopharmacologic Education And Side Effect Screening For Non-Prescribing Mental Health Professionals, Elaine Fitzgerald

Dissertations

Abstract

Problem: The United States is experiencing a growing demand for pediatric mental health support. Surges in mental health diagnoses and psychotropic medication prescriptions have occurred, compounded by a shortage of psychiatric providers. Non-prescribing mental health professionals are well-positioned to recognize psychotropic medication side effects. However, psychologists and counselors lack formal pharmacology education.

Methods: The quality improvement (QI) initiative was guided by the Plan-Do-Study-Act (PDSA) model. The evidence-based psychopharmacologic education for non-prescribers utilized a quasi-experimental pre- and post- test design. Data collected from clinicians included knowledge, confidence, and skill concerning psychotropic medications. The Psychotropic Medication Monitoring Checklist (PMMC) screen clients …

Insurance Coverage During Transitions: Evidence From Medicaid Automatic Enrollment For Children Receiving Supplemental Security Income, Stephanie Rennane, Danielle Sobol, Bradley D Stein, Andrew Dick

Faculty, Staff and Student Publications

OBJECTIVES: To analyze relationships between Medicaid automatic enrollment for child Supplemental Security Income (SSI) recipients and health insurance coverage during transitions.

DATA SOURCES AND STUDY SETTING: Medical Expenditure Panel Study, 2000-2020 and National Survey for Children with Special Health Care Needs, 2001-2010.

STUDY DESIGN: Leveraging variation in SSI-Medicaid automatic enrollment status across regions and over time, we estimate a regression model to quantify associations between automatic enrollment and insurance coverage. We validate our findings in the NS-CSHCN.

DATA COLLECTION: Our sample includes children receiving SSI for a disability. We also analyze a subsample of children newly enrolled in SSI.

PRINCIPAL …

Approach To Pivie In Pediatrics: Standardization For Early Detection, Jamie Green, Jill Gregory, Elizabeth Murphy, Jessica Miller, Nicole Manchester, Frank Harris, Meaghan Wildes, Cecilia Inman, Jenn Paradis, Faye Weir

Operations Transformation

PIVIE (Peripheral Intravenous Infiltration & Extravasation) can have devastating effects, especially in the pediatric population. The condition may disrupt vasculature severe enough for permanent skin and tissue loss that can lead to impaired limb function due to severe scarring. Problem: No standardized process existed either to prevent or review these events at Barbara Bush Children’s Hospital at Maine Medical Center prior to the study. PIVIEs were measured through the event reporting platform and only severe PIVIEs were being documented in this report. All infiltrations (1-4 on the infiltration scale) should be measured for accurate benchmarking. Occurrences in the electronic medical …

Increasing Palliative Care Team Involvement In Pediatric Hematopoietic Stem Cell Transplant Patients, Meagan Vacek, Lisa Tarbell, Melissa List, Erin Hall, Jennifer Linebarger, Kelstan Ellis, Gina Jones, Joel Thompson

Research Days

Early implementation of palliative care in pediatric oncology is well established but its role in pediatric hematopoietic stem cell transplant (HSCT) patients is yet to be fully determined. Multiple organizations encourage palliative care involvement in HSCT patients. Our aim was to increase palliative care team consults for patients receiving HSCT for our targeted diagnosis. Though we did not achieve this aim, we were able to increase the palliative care team's involvement in the total cohort of patients undergoing HSCT.

Institutional Pilot Changes Lead To A Reduction In Emergency Department Boarding Patients, Rohan Akhouri, Jennifer Watts, Christopher S. Kennedy, Kelly A. Sinclair, Bethany Bolt, Ashley Daly

Research Days

Background: Crowding and boarding pediatric emergency departments (ED) is an ongoing problem associated with a mismatch in resources and patient care demands. ED boarding can be defined as a patient admitted to an inpatient unit who remains in the ED. ED boarding occurs when there is limited availability of inpatient bed space – either due to patient volume or decreased staffing. ED boarding is associated with adverse events, and increased mortality. Few studies address the impact of inpatient strategies on ED boarding. The objective of our study was to evaluate hospital-based strategies within a single institution and their effect on …

Evaluating The Effectiveness Of A School-Based Cognitive Behavioral Youth Depression Prevention Program In Improving Life Satisfaction, Roshani Patel, Steven M. Brunwasser, Alissa Hochman

Rowan-Virtua Research Day

Depression is the leading cause of disability worldwide, known as the global burden of disease. Incident cases from 1990 to 2017 have increased by 49.86%. Additionally, rates have been seen to dramatically rise in adolescents aged 18-25 (17%) compared to rates in individuals aged 10-14 (1.1%). This makes it beneficial to have prevention programs for middle school aged children. The Penn Resiliency Program (PRP) is a youth depression prevention program focused on cultivating healthy thinking styles and behavioral coping skills. In our study, we used archival data from a randomized control trial of PRP to evaluate whether the program led …

Interactive Distraction Techniques Versus Midazolam In Anxiolysis In Pediatric Patients: A Systematic Review And Meta-Analysis, Uzay Cagatay, Jon Elias, Alexander King

Rowan-Virtua Research Day

Background: Many pediatric patients experience high levels of anxiety prior to undergoing surgery. Midazolam is currently one of the most commonly used sedative drugs in the pediatric preoperative environment. A number of studies have evaluated the use of non-pharmacological methods of relaxing pediatric patients prior to surgery, known as ‘Interactive Distraction’. These techniques involve using various methods of distracting the child from the preoperative anesthetic procedures. Some examples of these methods involve giving the patient an iPad with which they can play video games. There have yet to be any systematic reviews comparing the usage of Midazolam alone against utilizing …

Evaluation Of Unexplained Bone Fractures In A 3-Month-Old Infant – A Case Report, Hannah Ngo, Rachel Silliman Cohen

Rowan-Virtua Research Day

Child physical abuse is a significant cause of injury in infants and young children and can present in a variety of ways. Failure to recognize abuse in infants and young children can be life-threatening and is often recurrent until safety interventions occur. Consequently, it is of paramount importance that providers strongly consider child physical abuse on the differential, along with metabolic bone disease and accidental traumatic injury, when evaluating fractures in young children and infants. This case report will focus on the evaluation of a 3-month-old male infant who was admitted to the hospital with irritability and decreased right arm …

The Impact Of Stress During Adolescence And The Prevalence Of Pediatric Obesity, Olatunbosun Olakunri, Venkat Venkataraman

Rowan-Virtua Research Day

Obesity is a chronic condition that can be attributed to myriad factors including socioeconomic status, biological risk factors, and various environmental factors. These factors can be considered stress factors, and exposure to various levels of stress can impact the development of stress within the pediatric patients. The purpose of this study is to assess the association between the environmental, mental, social, physical, and psychological stress adolescents are exposed to and how they contribute to the prevalence of pediatric obesity throughout the United States. Understanding these risk factors can help us as a community and most importantly as clinicians develop better …

Determinants Of Vaccine Hesitancy Among Parents And Caregivers, Priya Srivastava

Rowan-Virtua Research Day

•Vaccination efforts in the United States and globally are one of the largest contributors to pediatric preventative health

•Routine immunizations in the U.S for children ≤ 10 years old cover 14 vaccine-preventable diseases. As a result, an estimated 732,000 deaths, 21 million hospitalizations, and 322 diagnosed cases of diseases have been prevented between 1993 and 2013.

•Vaccines remain a point of contention with pediatricians and their patients' caregivers

•Many parents maintain hesitancy to give vaccines; to a number of reasons. Perceived risk and fear of side effects from vaccines more than the disease itself, can cause out-of-proportion concern

•Misinformation spread …

Cost-Effectiveness And Outcomes Of Utilizing Tisagenlecleucel Therapy (Car T-Cell) In Pediatric Acute Lymphoblastic Leukemia In Comparison To Standard Of Care (Soc) Therapies: A Scoping Review, Andrew Atschinow, Evangeline Attota, Warren Chan, Pooja Kasarapu, Priyal Shah, Karina Vizzoni

Rowan-Virtua Research Day

Aims

This review aims to assess the correlations between outcomes and cost of treatment methods for pediatric acute lymphoblastic leukemia patients, specifically comparing CAR T-cell therapy and Standard-of-Care (SoC) therapy. The socioeconomic background of patients will also be taken into consideration to see if there are differences in their outcomes.

Methods

Peer-reviewed publications were collected from PubMed and Web of Science. The keyword strings used were “acute lymphoblastic leukemia,” “pediatric acute lymphoblastic leukemia,” “pediatric,” “CAR T-cell therapy,” and “cost-effectiveness.” 27 citations were obtained. Titles were screened by 6 authors. Articles met the inclusion criteria including potential Quality-Adjusted Life Year (QALY) …

Ultrasound Versus Radiography For Evaluating Surgical Necrotizing Enterocolitis, Sayed H. Aftab, Santiago Martinez-Correa, Minh-Huy Huynh, Wondwossen T. Lerebo, Jorge Delgado, Rebecca Denis, Misun Hwang

Rowan-Virtua Research Day

Purpose:

Necrotizing enterocolitis (NEC) is an abdominal inflammatory condition that is common in premature neonates. Although abdominal radiograph (AR) remains the imaging standard for NEC, it may miss up to 50% of early signs of NEC and has been described to have a sensitivity as low as 15.4% for detecting pneumoperitoneum. Abdominal ultrasound (US) is portable, non-invasive, and allows real-time bowel integrity, movement, and perfusion assessment. We aim to evaluate the concordance between US and AR in detecting NEC features and the diagnostic performance of both modalities in detecting pneumoperitoneum.

Methods and materials:

We conducted an IRB-approved retrospective, cross-sectional, single-center …

Healthcare Team Members’ Views On Social Determinants Of Health Screening And Referral Practices In A Pediatric Emergency Department, Jadelynn Nagy, Natalie J. Tedford, Sahlil Ahmed, Sofia Thoms, Akiko Kamimura, Maija Holsti

Patient Experience Journal

We aimed to explore the healthcare team members’ (HTMs) views on social determinants of health (SDH) screening and referral processes in a pediatric emergency department (PED). We conducted a cross-sectional, mixed-methods study to explore PED HTMs’ views on social care practices at a quaternary-level children’s hospital. The survey was created using a goal identification framework. The survey gathered quantitative and qualitative data by assessing SDH screening practices, comfort and personal habits in screening, prioritization of SDH domains, workflows to perform screening, and perceived barriers to screening. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using thematic analysis …

The Utility Of Interventional Anesthesia, Kylie Daguio, Kiley Jackson, Samantha Boever, Andrew Chang, James Keane, Leonard B. Goldstein

SOMA Faculty Publications

no abstract

Measures Of Function In Physical Therapy Assessment Of Children With Cerebral Palsy: A Clinical Audit, Marvin D. Zotomayor

Philippine Journal of Physical Therapy

Introduction: The assessment of outcomes in children with cerebral palsy (CP) is important for monitoring their progress, evaluating interventions, and guiding health policies. This study aimed to (1) identify the most common outcome measures used in the clinics to assess function in children with CP, and (2) determine whether the outcome measures used in the clinics meet the current standards of assessment for the purpose of improving patient care decisions, research, and quality assurance.

Methodology: A retrospective record audit study design was used to determine if the current practice in the clinics on the assessment of function in children with …

Advancing Virtual At-Home Care For Community Health Center Patients Using Patient Self-Care Tools, Technology, And Education [Letter], Cheryl Modica, Joy H. Lewis, Curtis Bay

SOMA Faculty Publications

Abstract

Introduction

Health centers are community-based, patient directed primary care providers that offer accessible, high-quality primary care within medically underserved communities. Screening for cancer and managing complex chronic conditions such as diabetes, hypertension, obesity, and depression are vital services for the vulnerable populations seen by community health centers. Delivering care for complex chronic conditions and preventive services using virtual models that integrate self-care tools and technology is an important approach to increasing access for hard-to-reach patients served by health centers.

Objective

This study aimed to explore the use of a virtual care model, applied using a systems approach and patient-driven …

An Increase In Food Insecurity Correlated With An Increase In Plasma Triglycerides Among Latinx Children, Keally Haushalter, Marissa Burgermaster, Erin Hudson, Matthew J Landry, Shreela V Sharma, Jaimie N Davis

Faculty, Staff and Student Publications

BACKGROUND: Food insecurity and metabolic diseases both disproportionately affect Hispanic children. Cross-sectional studies have linked food insecurity with adverse cardiometabolic markers, including elevated plasma triglycerides and glucose concentrations. However, the association between changes in food insecurity and changes in cardiometabolic markers in children remains to be explored. Furthermore, few studies have assessed the impact of school-based nutrition interventions on household food insecurity.

OBJECTIVE: The objectives of this study are to assess the effect of the TX Sprouts intervention on household food insecurity and to examine the association between changes in household food insecurity and changes in cardiometabolic markers over 1 …

Children's Mercy Annual Report 2023, Children's Mercy Kansas City

Children's Mercy Annual Reports

Annual report for Children's Mercy Kansas City in Kansas City MO, a pediatric medical center.

Decreasing Blood Culture Contamination At A Children’S Hospital, Taylor Pearl, Brittany Bare, Ricardo Zegarra-Linares, Jessica Lee

South Atlantic Division GME Research Day 2024

No abstract provided.

Do Pediatric Patients That Receive Dexmedetomidine As Premedication Experience Less Emergence Delirium Than Pediatric Patients That Receive Midazolam As Premedication?, Shelby Mccloud

Theses, Dissertations and Capstones

Title: Do pediatric patients that receive dexmedetomidine as premedication experience less emergence delirium than pediatric patients that receive midazolam as premedication?

Problem Statement: Midazolam remains the current choice within the practice for premedication in the prevention of emergence delirium, however as research continues there could possibly be a gap between the research and current practice. Throughout the practice of pediatric anesthesia most providers choose to premedicate with midazolam while there may be a more beneficial option of dexmedetomidine.

Results: The study found a significant variance in the incidence of emergence delirium among pediatric patients, ranging from 18.1% to 89%, depending …

Quality Improvement To Optimize Pediatric Mri Efficiency In Hospitalized Patients:Improving The Ordering Process And Reducing Time To Mri Completion, Andrew Stack, John Adent, Eric Shaw

South Atlantic Division GME Research Day 2024

No abstract provided.