Pediatrics Commons^™

Central Lines In Children, Rishi Agrawal, Neha H. Shah

E-Learning Modules

Children with special health care needs are increasingly prevalent in US hospitals. The pediatric hospitalist is often the primary provider of inpatient care for these patients. However, exposure to this patient population during training varies from provider to provider. No published educational curricula are specific to the inpatient care of this population.

This publication is a self-directed education module on central lines in children, including indications for placement, types of lines available, and prevention and treatment of complications. The module includes a PowerPoint slide show, instructor guide, and questions for assessment.

The purpose of this project is to build a …

Determining The Natural Distribution Of 24 Hour Bilirubin Levels In Term, Exclusively Breastfed Newborns, Lauren Greenawald Do, Alexis M. Newton Md, Michael D. Schwartz Md, Gwendolyn Chung Md, Greg Floyd Mba

Department of Pediatrics

No abstract provided.

Hdl In Sepsis - Risk Factor And Therapeutic Approach, Emily E. Morin, Ling Guo, Anna Schwendeman, Xiang-An Li

Pediatrics Faculty Publications

High-density lipoprotein (HDL) is a key component of circulating blood and plays essential roles in regulation of vascular endothelial function and immunity. Clinical data demonstrate that HDL levels drop by 40-70% in septic patients, which is associated with a poor prognosis. Experimental studies using Apolipoprotein A-I (ApoAI) null mice showed that HDL deficient mice are susceptible to septic death, and overexpressing ApoAI in mice to increase HDL levels protects against septic death. These clinical and animal studies support our hypothesis that a decrease in HDL level is a risk factor for sepsis, and raising circulating HDL levels may provide an …

Mortality-Related Resource Utilization In The Inpatient Care Of Hypoplastic Left Heart Syndrome., David A. Danford, Quentin Karels, Aparna Kulkarni, Aysha Hussain, Yunbin Xiao, Shelby Kutty

Journal Articles: Pediatrics

BACKGROUND: Quantifying resource utilization in the inpatient care of congenital heart diease is clinically relevant. Our purpose is to measure the investment of inpatient care resources to achieve survival in hypoplastic left heart syndrome (HLHS), and to determine how much of that investment occurs in hospitalizations that have a fatal outcome, the mortality-related resource utilization fraction (MRRUF).

METHODS: A collaborative administrative database, the Pediatric Health Information System (PHIS) containing data for 43 children's hospitals, was queried by primary diagnosis for HLHS admissions of patients ≤21 years old during 2004-2013. Institution, patient age, inpatient deaths, billed charges (BC) and length of …

Investigation Of Potential Early Histologic Markers Of Pediatric Inflammatory Bowel Disease, Julie A. Bass, Craig A. Friesen, Amanda D. Deacy, Nancy Neilan, Julia M. Bracken, Valentina Shakhnovich, Vivekanand Singh

Manuscripts, Articles, Book Chapters and Other Papers

© 2015 Bass et al. Background: Early manifestations of pediatric inflammatory bowel disease (IBD) can be relatively nonspecific. Initial mucosal biopsies may not be conclusive, delaying the diagnosis until subsequent biopsies demonstrate typical histologic features of IBD. We hypothesized that certain inflammatory cell types may be utilized as early histologic indicators of IBD in children. Methods: A retrospective analysis compared histologic findings from initially inconclusive or negative endoscopic studies in 22 patients who were subsequently diagnosed with IBD (after diagnostic endoscopy) to those of 20 comparison patients with functional abdominal pain matched for age, gender, and study type. A pediatric …

When Mumps Is Not The Diagnosis: Acute Sialadenitis During Influenza Season, Tasha Desai Do, Tibisay Villalobos Md

Department of Pediatrics

No abstract provided.

Vascular Ring In An Adolescent Patient With Nausea And Mild Dysphagia, Kristen Kametz Crnp

Department of Pediatrics

No abstract provided.

Quality Of Life In Children With Adverse Drug Reactions: A Narrative And Systematic Review, Blanca R. Del Pozzo-Magaña, Michael J. Rieder, Alejandro Lazo-Langner

Paediatrics Publications

Aims Adverse drug reactions are a common problem affecting adults and children. The economic impact of the adverse drug reactions has been widely evaluated; however, studies of the impact on the quality of life of children with adverse drug reactions are scarce. The aim was to evaluate studies assessing the health-related quality of life of children with adverse drug reactions. Methods We conducted a systematic review that included the following electronic databases: MEDLINE, EMBASE and the Cochrane Library (including the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, the Cochrane Controlled Trials Register and the …

The P53 Tumor Suppressor Protein Protects Against Chemotherapeutic Stress And Apoptosis In Human Medulloblastoma Cells., Sarah Waye, Aisha Naeem, Muhammad Umer Choudhry, Erika Parasido, Lucas Tricoli, Brian R. Rood, +6 Additional Authors

Pediatrics Faculty Publications

Medulloblastoma (MB), a primitive neuroectodermal tumor, is the most common malignant childhood brain tumor and remains incurable in about a third of patients. Currently, survivors carry a significant burden of late treatment effects. The p53 tumor suppressor protein plays a crucial role in influencing cell survival in response to cellular stress and while the p53 pathway is considered a key determinant of anti-tumor responses in many tumors, its role in cell survival in MB is much less well defined. Herein, we report that the experimental drug VMY-1-103 acts through induction of a partial DNA damage-like response as well induction of …

Women With Disabilities: Reproductive Care And Women’S Health, Stephanie Stockburger, Hatim A. Omar

Pediatrics Faculty Publications

Children, adolescents, and women with disabilities experience the same sexual development, pubertal changes, concerns, and desire to reproduce as their typically developing counterparts. However, society has tended to stigmatize women with disabilities as “asexual” and ignore this aspect of their health care. These women are less likely to receive gynecological exams, contraception, and evaluation of sexual dysfunction. Unfortunately, having a disability places women at risk for sexual exploitation and abuse as well as sexually transmitted infections. Therefore, reproductive health care for these women is imperative. A number of barriers to receiving reproductive care exist. However, with proper education and knowledge …

Impact Of Environmental Health On Teen Outcomes In Rural Kentucky, Lesley Davidson, Alissa Briggs, Hatim A. Omar

Pediatrics Faculty Publications

Understanding the impact of family dynamics on health has become an environmental health priority in the field of adolescent medicine. Family dynamics are much more complex than they were 60 years ago and so are behavioral outcomes. This transformation in the American family has led towards a large array of adolescent living situations. Rural Kentucky is a prime example of an area with a high rate of non-traditional family composition. Poor family dynamics may be associated with increased rates of high risk behaviors among teenagers. Among these behaviors are drug use, sexual activity, and depression. In this study, we evaluated …

Prognostic Role Of Bnp In Children Undergoing Surgery For Congenital Heart Disease: Analysis Of Prediction Models Incorporating Standard Risk Factors., Massimiliano Cantinotti, Raffaele Giordano, Marco Scalese, Sabrina Molinaro, Francesca Della Pina, Simona Storti, Luigi Arcieri, Bruno Murzi, Marco Marotta, Vitali Pak, Vincenzo Poli, Giorgio Iervasi, Shelby Kutty, Aldo Clerico

Journal Articles: Pediatrics

BACKGROUND: The routine use of brain natriuretic peptide (BNP) in pediatric cardiac surgery remains controversial. Our aim was to test whether BNP adds information to predict risk in pediatric cardiac surgery.

METHODS: In all, 587 children undergoing cardiac surgery (median age 6.3 months; 1.2-35.9 months) were prospectively enrolled at a single institution. BNP was measured pre-operatively, on every post-operative day in the intensive care unit, and before discharge. The primary outcome was major complications and length ventilator stay >15 days. A first risk prediction model was fitted using Cox proportional hazards model with age, body surface area and Aristotle score …

Neonatal Presentation Of An Air-Filled Neck Mass That Enlarges With Valsalva: A Case Report., Jasminkumar Bharatbhai Patel, Howard Kilbride, Lorien Paulson

Manuscripts, Articles, Book Chapters and Other Papers

Branchial cleft cysts are common causes of congenital neck masses in the pediatric population. However, neonatal presentation of branchial cleft cysts is uncommon, but recognizable secondary to acute respiratory distress from airway compression or complications secondary to infection. We report a 1-day-old infant presenting with an air-filled neck mass that enlarged with Valsalva and was not associated with respiratory distress. The infant was found to have a third branchial cleft cyst with an internal opening into the pyriform sinus. The cyst was conservatively managed with endoscopic surgical decompression and cauterization of the tract and opening. We review the embryology of …

Hereditary Sensory Autonomic Neuropathy Ii, A Rare Disease In A Large Pakistani Family, Fazal M. Arain, Prem Chand

Department of Paediatrics and Child Health

Hereditary Sensory Autonomic Neuropathy II (HSAN II) is a rare genetic disorder, characterized by severe loss of pain, temperature and touch sensation. Injuries in these patients can progress to necrosis and shedding of digits and limbs. Here we report two cases of HSAN II belonging to a Pakistani family. Individual 1, a forty five year old man, had complete loss of pain sensation since birth. Self-mutilation and complication of injuries resulted in the shedding of all the digits and right foot and surgical amputation of left leg. Individual 2, a five year old girl,had delay in healing of wounds and …

Congenital Factor Vii Deficiency In Children At Tertiary Health Care Facility In Pakistan, Muhammad Matloob Alam, Bushra Moiz, Karim Abdur Rehman, Priyanka Jethwani, Zehra Fadoo

Department of Paediatrics and Child Health

This study presents the demographics, clinical spectrum, and outcome of patients with congenital factor VII (FVII) deficiency at a tertiary care center over a period of 12 years. Of the 49 patients, 27 (55%) patients were males. Consanguinity was found in 92% of the patients. The median age of symptom onset was 2.4 (interquartile range [IQR]: 1.1-6.5) years with a median age of 5.8 (IQR: 3.1-10) years at diagnosis. Life-threatening complications like intracranial bleeding (ICB) and intra-abdominal bleeding (IAB) were observed in 8 (16.4%) patients. We found that 11 (55%) of the 20 patients with FVII coagulant activity (FVIIc) 5% …

Acquired Right Atrial Appendage To Right Ventricle Accessory Pathway In A Lateral Tunnel Fontan Patient: Successful Ablation Via Transconduit Approach., John Papagiannis, Anand Pillai, Stephen Kaine, Svjetlana Tisma-Dupanovic

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Discordant Identification Of Pediatric Severe Sepsis By Research And Clinical Definitions In The Sprout International Point Prevalence Study, S. L. Weiss, J. C. Fitzgerald, F. A. Maffei, J. M. Kane, A. Rodriguez-Nunez, Michael C. Spaeder, +260 Additional Authors

Pediatrics Faculty Publications

Introduction

Consensus criteria for pediatric severe sepsis have standardized enrollment for research studies. However, the extent to which critically ill children identified by consensus criteria reflect physician diagnosis of severe sepsis, which underlies external validity for pediatric sepsis research, is not known. We sought to determine the agreement between physician diagnosis and consensus criteria to identify pediatric patients with severe sepsis across a network of international pediatric intensive care units (PICUs).

Methods

We conducted a point prevalence study involving 128 PICUs in 26 countries across 6 continents. Over the course of 5 study days, 6925 PICU patients <18 years of age were screened, and 706 with severe sepsis defined either by physician diagnosis or on the basis of 2005 International Pediatric Sepsis Consensus Conference consensus criteria were enrolled. The primary endpoint was agreement of pediatric severe sepsis between physician diagnosis and consensus criteria as measured using Cohen’s κ. Secondary endpoints included characteristics and clinical outcomes for patients identified using physician diagnosis versus consensus criteria.

Results

Of the …

Nurturing University Students To Be Social Entrepreneurs: Relevance Of Service Leadership Education, Daniel T. L. Shek, Li Lin

Pediatrics Faculty Publications

When the concept of social entrepreneurship becomes more popular, many universities explicitly claim that they wish to nurture social entrepreneurs. In this paper, the concept of social entrepreneurship and the successful attributes of social entrepreneurs are outlined. With reference to the question of how university students can be nurtured to be social entrepreneurs, it is suggested that the service leadership model proposed by the Hong Kong Institute of Service Leadership and Management is a good framework to be considered. In the framework, it is asserted that there are three attributes of a successful service leader – leadership competence, moral character, …

Intrapersonal Competencies And Service Leadership, Daniel T. L. Shek, Li Lin

Pediatrics Faculty Publications

Intrapersonal competencies form the foundation of one’s development, and they are fundamental qualities of leadership competences. Four types of intelligence are highlighted in the literature of positive psychology: intelligence quotient (IQ), emotional intelligence quotient (EQ), adversity quotient (AQ) and spiritual intelligence quotient (SQ). It is argued that these competences are important in a service leader. Through this lecture, it is expected that students will understand the basic concepts and the importance of different intrapersonal competencies (IQ, EQ, AQ and SQ). We also discuss the relationship between these intrapersonal competencies and effective service leadership. Finally, ways to promote different intrapersonal competencies …

Factors Leading To The Creation, Development, And Maintenance Of Positive Social Relationship, Daniel T. L. Shek, Jocelyn L. Lin

Pediatrics Faculty Publications

In contrast to the manufacturing economy where the focus is primarily placed on the man-machine interface, social relationships are important building blocks in the service economy. Hence, identifyig the factors leading to creation, development, and maintenance of positive social relationships within the context of leadership is an important consideration. In this paper, a lecture covers the nature of social relationships and the related determinants (including trust, care, and respect) are outlined. Through this lecture, students can develop the ability to identify the characteristics and determinants of positive social relationships, appreciate the importance of positive relationships to service leaders, and evaluate …

Adolescent Developmental Assets And Service Leadership, Daniel T. L. Shek, Cecilia M. S. Ma, Ting Ting Liu

Pediatrics Faculty Publications

In the field of positive youth development, it is generally asserted that developmental assets or positive youth development qualities contribute to positive adolescent developmental outcomes. In the context of training for service leadership, it is argued that the promotion of developmental assets would help university students develop the foundational competence of service leaders. In this paper, the lesson plan of Lecture Eleven in a course entitled “Service Leadership” run in The Hong Kong Polytechnic University is discussed. In the lecture, four developmental assets related to positive identity (self-esteem, self-efficacy, purpose in life and optimism about the future) proposed by Peter …

Evolution And Realms Of Service Leadership And Leadership Models, Daniel T. L. Shek, Rachel C. F. Sun, Ting Ting Liu

Pediatrics Faculty Publications

This paper presents a lesson plan in a course entitled “Service Leadership” at The Hong Kong Polytechnic University. In that lecture, three basic aspects of the service leadership model are presented. First, the origin of service leadership from an evolutionary anthropology perspective is outlined. Second, three realms of service leadership with reference to self, others and systems are presented. Third, two leadership models (i.e. top-down and bottom-up models) are introduced, and their strengths and weaknesses are examined. Students are also invited to reflect on their assumptions of men with reference to leadership. Several class activities including role-play, self-reflection exercises and …

Core Beliefs In The Service Leadership Model Proposed By The Hong Kong Institute Of Service Leadership And Management, Daniel T. L. Shek, Li Lin

Pediatrics Faculty Publications

The service leadership model and related curriculum were developed by the Hong Kong Institute of Service Leadership and Management. To nurture service leadership qualities in university students, a 2-credit service leadership subject was developed at The Hong Kong Polytechnic University. This paper presents the core beliefs and key components of the service leadership model and outlines the content of one of the lectures in the subject. The lecture attempts to help students recognize the importance of leadership competencies, moral character and caring disposition in successful leadership, and to explore ways to develop service leadership qualities. In addition to the lecture, …

Interpersonal Competence And Service Leadership, Daniel T. L. Shek, Lu Yu, Andrew M. H. Siu

Pediatrics Faculty Publications

According to the Hong Kong Institute of Service Leadership and Management, interpersonal competence is an important component of an effective service leader. The present paper introduces a lecture embedded in a service leadership subject that focuses on promoting students’ interpersonal competence. Several topics are covered in this lecture. First, concepts and theories about interpersonal competence are introduced. Second, the relevance of interpersonal competence to service leadership is outlined. Third, methods of developing interpersonal competence are presented, particularly different conflict management strategies and assertiveness skills. Finally, conclusions and reflections on students’ own interpersonal competence and its relevance to the service leadership …

Manufacturing Economy Vs. Service Economy: Implications For Service Leadership, Daniel T. L. Shek, Po P.Y. Chung, Hildie Leung

Pediatrics Faculty Publications

In the past few decades, there has been a shift from manufacturing to service economy in many places throughout the world. In Hong Kong, 95% of its GDP is made up by the service industries. Conceptually, these two economies are associated with different production characteristics, organizational structures, and desired attributes of workers and leaders. The differences between these two economies in terms of the production modes are discussed in this paper. In particular, the implications of the economy on effective leadership requirements are outlined. With specific reference to the Service Leadership model proposed by the Hong Kong Institute of Service …

How Unique Is The Service Leadership Model? A Comparison With Contemporary Leadership Approaches, Daniel T. L. Shek, Po P.Y. Chung, Hildie Leung

Pediatrics Faculty Publications

The growth of the service economy in the contemporary world has resulted in a different set of requirements for effective leadership as compared with the industrial era, which focused primarily on manufacturing industries. To nurture “service leaders” in the service economy, the Hong Kong Institute of Service Leadership and Management proposed the service leadership model. The key characteristics of the service leadership model are outlined in this paper. A systematic comparison was also conducted to identify the common and unique features of the service leadership model with reference to the existing leadership theories, including the trait, servant, spiritual, authentic, ethical, …

Speckle-Tracking Echocardiographic Measures Of Right Ventricular Function Correlate With Improvement In Exercise Function After Percutaneous Pulmonary Valve Implantation., Shahryar M. Chowdhury, Ziyad M. Hijazi, John T. Fahey, John F. Rhodes, Saibal Kar, Raj Makkar, Michael Mullen, Qi-Ling Cao, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Speckle-tracking echocardiographic (STE) measures of right ventricular (RV) function appear to improve after transcatheter pulmonary valve implantation (TPVI). Measures of exercise function, such as ventilatory efficiency (the minute ventilation [VE]/carbon dioxide production [VCO2] slope), have been shown to be prognostic of mortality in patients who may require TPVI. The aim of this study was to evaluate the correlation between STE measures of RV function and changes in VE/VCO2 after TPVI.

METHODS: Speckle-tracking echocardiography and cardiopulmonary exercise testing were performed at baseline and 6 months after TPVI in 24 patients from four centers. Conventional echocardiographic measures of RV function were …

Pathogen-Specific Burdens Of Community Diarrhoea In Developing Countries: A Multisite Birth Cohort Study (Mal-Ed), Sadia Shakoor, Shahida Qureshi, Furqan Kabir, Anita K. M. Zaidi, Zulfiqar Ahmed Bhutta, Imran Ahmed, Didar Alam, Syed Asad Ali, Muneera Rasheed, Sajid Bashir Soofi, Ali Turab, Aisha Khizar Yousafzai

Department of Pathology and Laboratory Medicine

Background: Most studies of the causes of diarrhoea in low-income and middle-income countries have looked at severe disease in people presenting for care, and there are few estimates of pathogen-specific diarrhoea burdens in the community.
Methods: We undertook a birth cohort study with not only intensive community surveillance for diarrhoea but also routine collection of non-diarrhoeal stools from eight sites in South America, Africa, and Asia. We enrolled children within 17 days of birth, and diarrhoeal episodes (defined as maternal report of three or more loose stools in 24 h, or one loose stool with visible blood) were identified through …

Fifteen Years Of Irinotecan Therapy For Pediatric Sarcoma: Where To Next?, Lars M. Wagner

Pediatrics Faculty Publications

Over the past 15 years, irinotecan has emerged as an important agent for treating pediatric sarcoma patients. This review summarizes the activity noted in previous studies, and outlines current issues regarding scheduling, route of administration, and amelioration of side effects. Also discussed are new pegylated and nanoliposomal formulations of irinotecan and its active metabolite, SN-38, as well as future plans for how irinotecan may be used in combination with other conventional cytotoxic as well as targeted agents.

Diagnostic Utility Of Who Defined Sepsis Syndromic Criteria With Procalcitonin In Identification Of Sepsis In Children With Suspected Infections, Samuel Owuor Akech

Master of Medicine in Paediatrics and Child Health

Title: Diagnostic Utility of WHO Defined Sepsis syndromic Criteria with Procalcitonin in Identification of Sepsis in Children with Suspected Infections Background: Bacterial infections are a major cause of morbidity and mortality in children but accurate and timely diagnosis remains a challenge to the frontline clinicians. Cultures of sterile bodily specimens are considered the gold standard but are insensitive and results are delayed. Procalcitonin (PCT) has recently emerged as a biomarker with high sensitivity and specificity making it superior to culture based techniques performed in non-ideal circumstances which prevail in resource poor settings. This study investigated the diagnostic utility World Health …