Pediatrics Commons^™

Adherence To Oral Iron In Adolescent Females With Iron Deficiency Secondary To Heavy Menstrual Bleeding, Kennedy Sheedy, Lauren Amos Md, Ms

Research Days

Iron deficiency is an important, but often minimized issue among adolescent females. While treat with oral iron is generally first-line treatment, IV iron has been shown to be safe and effective. Our study looks at adherence and barriers to oral iron treatment and assesses current use of IV iron for iron deficiency at Children's Mercy, in hopes of helping move towards utilizing the most beneficial treatment for each individual patient.

Decreasing Time To Narcotic Pain Medication In Patients With Sickle Cell Disease Presenting With Acute Pain Crises In A Pediatric Emergency Department: A Quality Improvement Initiative., Allison Adam, Leslie Hueschen, Lina Patel, Christopher Kaberline, Ibad Siddiqi

Research Days

Background: Guidelines published by the National Heart, Lung and Blood Institute recommend that patients with sickle cell disease who present in acute pain crisis receive narcotic medication < 60 minutes from arrival. Multi-center studies indicate approximately 50% of institutions are adherent to this level 1a recommendation. From October 2022-October 2023, our institutional median time to narcotic was 61 minutes.

Objective: Our aim was to decrease the time to narcotic administration by 10% (61 min to 55 min) in patients with Sickle Cell Disease presenting to the emergency department for acute pain crisis while simultaneously decreasing disparities in our patient population by Oct 2024. Additionally, we sought to increase the percentage of patients within this population to receive their first narcotic in 60 min from 49% to 70%, by Oct 2024.

Methods: We …

A Single Center Qualitative Study To Improve Coordination Of Follow-Up Care For Patients Diagnosed With Abusive Head Trauma, Ruairi Smith-Dewey, Elise Wright, Daniella Donofrio, Hannah Goebel, Sara Kilbride

Research Days

Background/Project Intent: Review of cases identified 16 possible follow-up needs. A single patient had a maximum of 12 potential needs. Needs not being addressed included written documentation for need of follow-up without subsequent referral placed/appointment scheduled or need not addressed at all. The goal of this project was to have all follow-up needs addressed for at least 50% of children diagnosed with AHT by January 2025.

Methods: All children admitted to CMH from January 2024-December 2024 and diagnosed with AHT by the Safety, Care & Nurturing (SCAN) team were included. Interventions were designed and implemented by a multidisciplinary team to …

Implementing Balanced Fluid Resuscitation For Sepsis Patients In A Tertiary Care Pediatric Emergency Department, Grace E. Arends Md, Christopher Kaberline, Ibad Siddiqi, Sarah Nienhaus, Viktoriya Stoycheva Mha, Rn, Cpn, Leslie Hueschen

Research Days

Background

National data supports balanced fluid during volume resuscitation in the setting of sepsis as it improves morbidity and mortality, particularly preventing acidosis and kidney injury. Despite this recommendation, the CMH ED still has not implemented balanced fluid resuscitation.

Aim

The aim of the project is to increase the percentage of patients with positive sepsis screen treated in the CMH Adele Hall Emergency Department receiving lactated ringer’s fluid resuscitation from 4.6% to 15% by June 2024.

Methods

Primary outcome measures were percentage of patients with suspected sepsis who received at least one LR fluid bolus, as well as percentage of …

Ecmo Without Compressions Versus Ecpr For Lcos Following Cardiac Surgery, Amjad Halloum, Apurva Panchal, Sarah Tabbutt, Martina Steurer, Mousumi Banerjee, John Charpie, Javi Lasa, Amy Mccammond, Katie Moynihan, Nancy Ghanayem, Tia Raymond

Research Days

A retrospective study looking into ECMO vs eCPR outcomes in the CICU. By refining the approach to postoperative ECMO initiation, this study aims to contribute valuable insights that could improve survival and reduce complications in pediatric cardiac surgery patients.

A Case Of Heterotaxy And Common Atrioventricular Canal With Bradycardia, Mohamed Aashiq Abdul Ghayum, Jenna Schermerhorn, Hayley S. Hancock, Kelsey Brattrud, Melanie Kathol, Maria Kiaffas

Research Days

Background

Heterotaxy-polysplenia syndrome (otherwise known as left atrial isomerism) should be suspected in the presence of complete atrioventricular canal defect (CAVC) with interruption of the inferior vena cava (IVC), atrioventricular block (AVB), and viscero-cardiac heterotaxy. The prognosis remains dismal for the fetus with such entity, especially in the presence of major structural heart disease and high-grade atrioventricular block. Early diagnosis, close follow up, and appropriate delivery planning, allows for effective stabilization of the baby after birth and might improve survival.

Methods

A 26-year-old mother at 26 weeks gestational age was referred for cardiac evaluation of cardiomegaly, suspected CAVC and bradycardia. …

Bisphosphonate Treatment In Pediatric Patients With Rare Ovarian Malignancy And Hypercalcemia: A Case Series, Samhita Bhattarai, Seth Lamb, Jennifer W. Boyd

Research Days

Objectives

To describe the presentation, management, and outcomes of severe hypercalcemia in two adolescent females secondary to ovarian malignancy.

Methods

The case series includes two adolescent female patients, aged 11 and 16, diagnosed with rare ovarian malignancies and associated hypercalcemia. Both patients presented with abdominal pain, nausea and constipation. The 11-year-old received zoledronic acid while the 16-year-old received pamidronate. Serum calcium levels, symptoms and medication side effects were monitored before and after bisphosphonate therapy.

Results

Both girls presented with severe hypercalcemia. Patient 1 was an 11-year old girl who presented with serum calcium of 15.0 mg/dL. She began hyperhydration with …

Temperature Monitoring In The Cardiac Operating Room, Abby Pint, Clint Humpherys, Dave Stubler, Nathaniel Lata

Research Days

Background: The goal of this project is to improve the accuracy of temperature readings in the cardiac operating room and, in turn, improve patient safety.

Methods: The project obtained nasopharyngeal, tympanic, and bladder/rectal temperature measurements from twenty CPB cases. Measurements were obtained at six critical points: time of incision, initiation of CPB, aortic cross clamping, removal of aortic cross clamping, CPB termination, sternal closure. Data was analyzed to determine discrepancies among methods of measuring temperature for each type of probe utilized. Plan: Tympanic probes are unreliable and provide lower temperature measurements when compared to other probes Do: Temperatures recorded from …

Academic Half Days Dedicated To Phone Triage Improves Resident Confidence To Independently Triage Calls, Sarah Gwazdacz, Kelsey Gavin, Cati Kral

Research Days

We aim to improve Children’s Mercy residents’ confidence and competence to independently triage admission phone calls, and to help residents develop a system to obtain information during a transport phone call through dedicated academic half days.

A needs assessment at the beginning of the 2024-25 academic year was completed to assess the need for triage education. Then, curriculum design, goals & objectives, educational strategies, and implementation of the half day were discussed with leaders in medical education, admission hub physicians, and hospital medicine. Pediatric residents of all training levels were divided into 5 cohorts of 10-15 participants, which rotated through …

Favorability Of Progesterone With Estrogen Among Physicians In Transgender Adolescents: A Survey, Samhita Bhattarai, Michelle Knoll

Research Days

To evaluate the current perspective and clinical practices of physicians regarding the use of synthetic progestins as an adjunct to estrogen therapy in transfeminine adolescents. The survey focuses on perceived benefits, risks and overall efficacy in gender affirming hormone therapy.

Low-Dose Bevacizumab Treatment For Retinopathy Of Prematurity, Makayla Ayres, Katherine Brown Md

Research Days

Background: Retinopathy of prematurity (ROP) is an eye disease that affects very premature infants and causes blindness. Treatment for ROP consists of anti-VEGF intravitreal injections (e.g., bevacizumab), laser therapy, and cryotherapy. The concern of anti-VEGF intravitreal injections is systemic toxicity and potential detrimental effects on these developing infants. In research trials, doses as low as 0.031 mg of bevacizumab have been shown to be effective in treating ROP. However, in clinical practice, the most common doses used are 0.125-0.25 mg.

Objectives/Goal: At CMKC, 0.075 mg doses of bevacizumab have been used to treat Type 1 ROP since 2022. We aim …

Navigating The Fallout: How Pediatric Spine Surgeons Cope, Recover, And Persevere After Major Surgical Complications, Sandeep Yanamala, Richard M. Schwend, Hannah Geoffroy, Gary Sutkin

Research Days

Hypothesis: We hypothesized that surgeons who continue practicing after a major complication are more likely to have strong institutional and peer support, a growth mindset, and access to coping mechanisms that mitigate distress and legal pressures. Study Design:
Qualitative study using Constructivist Grounded Theory (CGT) based on semi-structured interviews with pediatric spine surgeons who have experienced major surgical complications.
Introduction:
Complications in pediatric spine surgery have significant emotional, ethical, and legal
consequences. However, little is known about the factors that differentiate surgeons who continue performing spine surgery from those who transition away.
Methods:
33 pediatric spine surgeons were interviewed (28 …

Implementation And Evaluation Of A Resident Pediatric Complex Care Education Series, Calivin Schaffer, Danielle Doctor, Amy Buczkowski, Bonnie Lynne Boomsma, Logan Murray

Costas T. Lambrew Research Retreat 2025

Children with medical complexity have significant chronic health problems that affect multiple organ systems and result in functional limitations, high health care need or utilization, and often dependence on medical technology. Addressing their needs requires optimizing care within the medical home and medical neighborhood.

In-Person And Virtual Adaptation Of An Interprofessional Palliative Care Communications Skills Training Course For Pediatric Oncology Clinicians, Karen Moody, Clark R. Andersen, Robert M. Arnold, Julie Bradley, Allie Carter, Lauren Draper, Timothy Garrington, Jonathan B. Gill, Douglas J. Harrison, Masanori Hayashi, Amy Heaton, Cynthia Holladay, Alex Lion, Alakh Rajan, Beatriz N. Rozo, Daniel V. Runco, Shermini Saini, Laura K. Salvador, Kathryn Sutton, Verna Ferguson

Advances in Cancer Education and Quality Improvement

Introduction

Empathic communication is crucial for clinicians when discussing palliative and end-of-life (PC/EOL) care with parents of children with cancer. Unfortunately, many parents report inadequate communication at these distressing times. This study evaluates the communication skills training (CST) clinicians received to deliver a PC/EOL communication intervention as part of a multi-site randomized-controlled trial (RCT). Training was provided using an in-person format and then adapted to a virtual platform to accommodate remote learners.

Methods

Clinicians were trained in dyads (one physician and one nurse [RN] or advanced practice provider [APP]) over 3 days (in-person or virtually). Four pediatric oncology cases were …

Child Sex Trafficking In Pediatrics: From Screening To Comprehensive Care, Victoria Shwe, Tracy Lin, Nicole M. Leopardi

Rowan-Virtua Research Day

Child sex trafficking is a significant issue in New Jersey, with minors making up 22% of trafficking victims in 2023. While screening tools exist to identify at-risk youth, there is a major gap in understanding the steps healthcare providers should take after identification to ensure appropriate care, support, and referrals. Current research highlights the lack of data on the use of trafficking screening tools and the absence of standardized post-screening protocols. Most pediatricians rely on referrals to social services or law enforcement, yet limited coordination between healthcare providers and these agencies complicates effective care. The shortage of child abuse pediatric …

Effectiveness Of The Use Of An Opt-Out Script To Increase Hiv Screening In Adolescent Clients In Pediatric Primary Care Clinics In West Tennessee: A Scoping Review, Julie Cupples Msn, Rn, Allison Johnson Ms, Bsn, Rn, Sally Humphrey Dnp, Aprn, Cpnp-Pc

Doctor of Nursing Practice Projects

Purpose/Background

The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) recommend one-time human immunodeficiency virus (HIV) screening for all adolescents. Pediatric primary care providers are on the front lines of adolescent healthcare and can provide testing that is adolescent-friendly, confidential, and easily accessible. This scoping review aims to synthesize the evidence and assess the literature on the efficacy of using an opt-out script to increase HIV testing in adolescent well-child checks.

Methods

A literature review was conducted between October 2022 and August 2024 to collect studies assessing adolescents aged 12-18, provider-led sex education, and …

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 …

A Multipronged Effort To Incorporate Professionalism Into Campuswide Programming Through A Center For Professionalism, Kyler M Godwin, Asma Ali, Larry Laufman, Ellen M Friedman

Faculty, Staff and Students Publications

Background Professionalism, a core competency for graduate medical education accreditation, has a clear educational mandate. However, the pathway to successful incorporation of professionalism within organizational culture has not been established. Integration of professionalism within the learning environment requires intentional design and formal education. Objective To describe the integration of professionalism in the learning environment through formal education and programming and report feasibility and acceptability data.

Methods The Center for Professionalism (Center) was developed in 2013 to align with the learning and clinical environments of our academic medical center. Primary drivers of a culture of professionalism were identified through input from …

Stop The Bleed! Acute Epistaxis Management, Christopher R. Cannell

Lynchburg Journal of Medical Science

Epistaxis, the most common Otolaryngology-related emergency, is responsible for one in 200 emergency department (ED) visits in the United States (US) and one-third of otolaryngology visits.^1,11 Up to 60% of the population will experience epistaxis during their lifetime, and 6% -10 % will require medical intervention.^2,3 Epistaxis occurs in children and adults and has a seasonal variation. Although 85% of nosebleeds are idiopathic, they are more frequent in those on supplemental oxygen, anticoagulation, antiplatelet therapy, and in those with other conditions that may predispose them to bleeding. Most clinicians will encounter patients with acute epistaxis; therefore, it is …

Developing And Implementing Pediatric Nephrology Milestones 2.0 As An Efficient Tool For Trainee Evaluation And Just-In-Time Feedback., Caroline V. Jackson, Rebecca Hjorten, Laura Edgar, Beatrice Goilav, Roshan P. George, Darcy K. Weidemann

Manuscripts, Articles, Book Chapters and Other Papers

In 2013, the Accreditation Council for Graduate Medical Education (ACGME) implemented Milestones 1.0 as a tool to assess trainee progress towards readiness for independent practice. Critiques of Milestones 1.0 suggested its complexity made the tool difficult to quickly understand and implement in a standardized fashion. This was particularly challenging among subspecialties due to inherent differences in clinical practice settings and make-up of procedural and patient care needs. In response, ACGME launched Milestones 2.0 in 2016 to harmonize competencies applicable to all subspecialties and develop new subspecialty specific competencies to facilitate precise feedback on subspecialty specific content domains. We describe how …

The Usefulness Of 3d Heart Models As A Tool Of Congenital Heart Disease Education: A Narrative Review, Raghad Abdulaziz Alhojailan, Reghd Husain M Alkhalifah, Bana Albani, Majed Wadi

Journal of the Saudi Heart Association

Objectives: The objective of this review is to evaluate the effectiveness of three-dimensional (3D) heart models as teaching tools for congenital heart disease (CHD), addressing the limitations of traditional medical education methods. Methods: A thorough literature review was conducted using PubMed, Google Scholar, Scientific Direct and Scopus databases. Relevant articles were screened and selected based on their discussion of the application of 3D models in CHD education. Results: The comprehensive review of 19 studies revealed that 3D heart models provide students, healthcare professionals, and patients with meaningful experiences that significantly enhance understanding and learning outcomes. These models improve …

A Case Report Of Moderate Factor X Deficiency, Harpreet Kaur, Tanmoy Das, Poonam Wade, Murtuja Shaikh

Digital Journal of Clinical Medicine

Factor X deficiency is a rare coagulation disorder with a varied clinical spectrum. It can present at any age, but most severe cases present in childhood. There are no evidence-based management guidelines for the management of factor X deficiency due to limited literature. Detailed history, clinical examination and specialized tests (coagulation profile, mixing studies, factor assay) are required for the diagnosis of factor X deficiency. In this case report, we are discussing the case of a 1-month-old, 12-day-old female child who presented with the complaint of spontaneous bleeding from the nose since 1 day with no other bleeding manifestations from …

Practice Patterns In Pediatric And Adult Dysphagia: Implications For Clinical Training, Jane Grothaus, Kaitlyn Hill, Marlee Nebesniak, Anastasia Raymer

Speech-Language Pathology Faculty Publications

Objective: Most speech language pathologists (SLPs) receive training to work with patients with swallowing disorders in graduate school, focusing primarily on adult dysphagia. Although SLPs share common foundational knowledge and skills for adult and pediatric dysphagia populations, there are considerable differences in these two specialized areas of practice. We aimed to query SLPs’ practice patterns for dysphagia assessment and management for adults and pediatric populations to consider differences and guide training efforts.

Methods: We distributed two comprehensive anonymous surveys to explore practice patterns of SLPs who provide assessment and management of dysphagia for adult or pediatric populations. The 118 respondents, …

Educational Interventions To Improve Pediatric Emergency Care: A Qualitative Assessment Of The Perspectives Of African Healthcare Workers, Emily A. Hartford, Chris A. Rees, Isaac Kihurani, Raana Hussain, Elena Seifert, Alexis Schmid, Tigist Bacha, Carol C. Chen, Megan L. Schultz

Paediatrics and Child Health, East Africa

Pediatric emergency care (PEC) training for health care workers (HCWs) is commonly offered in the form of short courses. This study gathers the perspectives of HCWs from eight African countries on how to best deliver and implement short training courses in PEC. This is a qualitative study using semi-structured key informant (KI) interviews. Utilizing the African Federation for Emergency Medicine (AFEM) member list serve, we identified African HCWs who had previous experience participating in and/or delivering short training courses in PEC. From this cohort, four interviewers were selected. These interviewers all received training in qualitative interviewing and then each recruited …

Diagnosis And Management Of Cardiometabolic Disease After Spinal Cord Injury: Identifying Gaps In Physician Training And Practices, Chinenye Christa Nnoromele, Du Pham, Felicia Skelton, Ryan Solinsky

Faculty, Staff and Students Publications

CONTEXT: Cardiometabolic disease (CMD) frequently occurs in individuals with spinal cord injury (SCI), with growing awareness surrounding the expansive scope of this problem. As CMD has significant morbidity and mortality, early guidelines-based screening and management have been established. However, the extent to which these guidelines have been adopted are unclear.

OBJECTIVE: Describe physicians' screening and management pattern for CMD in patients with SCI, as compared to SCI-specific CMD screening guidelines, and elucidate variables linked to screening and management patterns.

METHODS: SCI medicine-boarded physicians were surveyed on screening timing for CMD following acute SCI, along with their practice pattern and comfort …

Breastfeeding Education Knowledge, Danielle Sees

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Enhancing Prenatal Breastfeeding Education To Improve Breastfeeding Rates, Angela Maietta

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Social Determinants Of Health Curriculum For The Pediatric Clerkship, Caroline Roth, Amy Prudhomme, Kayla Griese, Robbie Beyl, Jessica Patrick-Esteve

School of Medicine Faculty Publications

Introduction: Education on social determinants of health (SDH) aligns with national standards for medical education. However, there are minimal existing resources targeted to medical students specific to the care of the pediatric population. We designed a case-based curriculum on SDH for third-year medical students on their pediatric clerkship to address this deficit. Methods: Third-year medical students on their pediatric clerkship received a case-based flipped classroom educational series on SDH in four 10-minute segments. Students completed voluntary and anonymous surveys delivered via an electronic survey tool before and after completion of the curriculum. Surveys were a self-assessment of knowledge and skills …

Gender And Sexuality Awareness In Medical Education And Practice: Mixed Methods Study, Rola Khamisy-Farah, Eden Biras, Rabie Shehadeh, Ruba Tuma, Hisham Atwan, Anna Siri, Manlio Converti, Francesco Chirico, Łukasz Szarpak, Carlo Biz, Raymond Farah, Nicola Bragazzi

Faculty, Staff and Students Publications

BACKGROUND: The integration of gender and sexuality awareness in health care is increasingly recognized as vital for patient outcomes. Despite this, there is a notable lack of comprehensive data on the current state of physicians' training and perceptions in these areas, leading to a gap in targeted educational interventions and optimal health care delivery.

OBJECTIVE: The study's aim was to explore the experiences and perceptions of attending and resident physicians regarding the inclusion of gender and sexuality content in medical school curricula and professional practice in Israel.

METHODS: This cross-sectional survey targeted a diverse group of physicians across various specializations …

Low-Acuity Pediatric Emergency Department Utilization, Lisa Ziemnik, Noah Parker, Kyra Bufi, Kristen Waters, Jacob Almeda, Adrienne Stolfi

Medical Education Faculty Publications

Objectives: Proper emergency department (ED) utilization is a hallmark of population health. Emergency department overcrowding due to nonurgent visits causes increased stress to healthcare staff, higher costs, and longer wait times for more urgent cases. This study sought to better understand post pandemic reasons caregivers have when bringing in their children for nonurgent visits and devise effective interventions to improve caregiver choice for non-ED care for nonurgent conditions.

Methods: Surveys were conducted at an urban pediatric hospital for Emergency Severity Index (ESI) level 3 to 5 visits. A total of 602 surveys were completed with 8 being excluded from analysis. …